Recovery Audit Contractor (RAC) Program
This page guides user to HFMA's resources on the Recovery Audit Contractor (RAC) program, which was developed as a demonstration project to identify improper Medicare payments.
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FY08 Inpatient PPS Final Rule
CMS’ plan to adopt severity-adjusted DRGs is the most significant change that has been made to the Medicare hospital inpatient prospective payment system since it was created in 1984. HFMA has compiled a comprehensive collection of resources designed to help you and your organization address issues related to Medicare DRGs.
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FY08 Inpatient PPS Final Rule Fact Sheet
The hospital inpatient PPS final rule for FY08 builds on changes begun last year to improve the accuracy of Medicare's inpatient hospital payments by using hospital costs, rather than charges, to set rates.
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Cost Report Changes to Improve the Accuracy of "Cost-Based" Weights
Recognizing that improvements are needed to the current methodology CMS uses for gathering data and developing the DRG weights to make the new “cost-based” weights more accurate, an industry workgroup came together to identify potential changes to the Medicare cost report to improve the accuracy of DRG weights under the new CMS “cost-based” method.
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HFMA Fact Sheet: Medicare's CY08 Home Health PPS Proposed Rule
This fact sheet contains details on the rule published by CMS that proposes the first major changes to the home health prospective payment system since it's implementation on 2000. The rule also contains the proposed annuual update to the Medicare national standardized 60-day episode payment amount, case-mix rmodel refinements, and home health quality improvements.
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HFMA Executive Roundtable: Quality- and Severity-Based Payment -- Will You Receive What You Earn?
How severity-based payment adjustments impact a healthcare facilities pay-for-performance program are covered in this report.
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Medicare Part D Payment System Explained
This report provides a thorough overview of the Medicare Part D payment system for outpatient prescription drug benefits.
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Fact Sheet: Medicare and Medicaid Changes in the President's 2007 Budget Proposal
This fact sheet presents a list of the changes to Medicare and Medicaid in the 2007 federal budget.
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HFMA Fact Sheet: Medicare Physician Fee Schedule Final Rule for CY07
This fact sheet summarizes the major points of the Medicare Physician Fee Schedule Final Year for CY07 published in the Federal Register, December 1, 2006. A graph comparing physician payments from 2003 -2007 is include.
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HFMA Fact Sheet: Hospital Outpatient PPS Final Rule for CY07
The rule provides for a full market basket (MB) update estimated at 3.4 percent for the final rule. After taking into account other factors that affect the level of payments, CMS estimates hospitals will receive an overall average increase of 3.0 percent in Medicare payments for outpatient services in CY07.
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HFMA Fact Sheet: Medicare Home Health PPS Update for CY07 Final Rule
This fact sheet covers the important points of the Medicare home health pps final rule for calendar year 2007, published in the November 9, 2007, Federal Register. The payment update for 2007 is 3.3 percent. A graph showing historical payment updates from 2003 - 2007 is also provided.
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