All Things CMS
What is a federal agency within the Department of Health and Human Services (HHS) administers the Medicare program, a federal health insurance program for people 65 and older, and some younger people with disabilities or end-stage renal disease. works in partnership with state governments to administer Medicaid, a joint federal and state program that provides healthcare coverage to low-income individuals and families and oversees other programs, including the Children's Health Insurance Program (CHIP) and health insurance portability standards.
What is CMS - Centers for Medicare and Medicare?
What is the Medicare value-based purchasing program that incentivizes hospitals to reduce hospital-acquired conditions by reducing Medicare payments for hospitals in the lowest-performing quartile on HAC quality measures.
What is the Hospital-Acquired Conditions Reduction Program
This act made affordable health insurance available to more people. The law provides consumers with subsidies that lower costs for households with incomes between 100% and 400% of the federal poverty level (FPL).
It also expanded the Medicaid program to cover all adults with income below 138% of the FPL. Not all states have expanded their Medicaid programs.
What is The Affordable Care Act? or also ACA or also Obamacare
This is a federal law that imposes liability on individuals and companies who defraud the government, particularly by submitting false claims for payment. It allows the government and private citizens (whistleblowers) to sue those who commit fraud, with whistleblowers potentially receiving a portion of the recovered funds
What is 1040 hours?
1.0 - 2080
2080*.50 = 1040
What is the program that providies low-cost health coverage to children in families that earn too much money to qualify for Medicaid.
CHIP
What is the a Medicare value-based purchasing program that penalizes hospitals with higher-than-expected 30-day readmission rates, aiming to improve discharge planning, care transitions, and care coordination to reduce avoidable readmissions.
What is the Hospital Readmission Reduction Program?
What is Medical Necessity?
A federal law that prohibits offering, paying, soliciting, or receiving remuneration in exchange for referrals or business related to services or items paid for by federal healthcare programs like Medicare and Medicaid. It aims to prevent financial incentives from influencing medical decisions.
What is the Anti-Kick Back Statue?
2080 hours
What is 1.0 FTE?
This program is a federal health insurance program for people age 65 or older. People younger than age 65 with certain disabilities, permanent kidney failure, or amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease), may also be eligible for Medicare.
What is Medicare?
What are entities contracted by the Centers for Medicare & Medicaid Services to identify and recover improper Medicare payments.
What are RACs? (Recovery Audit Contractors?)
They must meet the Internal Revenue Service (IRS) Community Benefit Standard and publicly and extensively report the range of benefits and services they provide to their communities.
What is Tax Exempt Status?
This law prohibits physicians from referring Medicare patients for certain designated health services (DHS) to entities where the physician has a financial relationship, unless an exception applies.
What is Stark Law?
What is a joint federal and state program that helps cover medical costs for some people with limited income and resources. This program allows each state runs its own program. This means eligibility requirements and benefits can vary from state to state.
What is Medicaid?
This law established the Quality Payment Program (QPP) within Medicare. Under the QPP, clinicians will receive payments through either the new Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APM) as of 2019.
What is MACRA?
This rule was implemented in January 2021, mandates that hospitals publicly disclose their standard charges for services and procedures, including gross charges, discounted cash prices, and payer-specific negotiated rates.
What is the Hospital Price Transparency Rule?
This act was designed to increase transparency around the financial relationships between physicians, teaching hospitals and manufacturers of drugs, medical devices and biologics.
What is the Physician Payments Sunshine Act?
What is the program that provides an opportunity to revise, rework and improve the existing Medicare programs focused on quality, costs and use of electronic health records to improve their relevance to real-world medical practice and reduce administrative burdens for physicians.
Under this payment system, physicians no longer face the threat of double-digit cuts each year, as they did under the now-repealed sustainable growth rate. There is greater certainty in annual payment updates.
What is MIPS?
This Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers.
What is the No Surprises Act or the Surprise Billing Act?