Course | Basic | Medicare Payment and Reimbursement
In this course we will address scheduling processes, including<div><ul><li>Patient identification</li><li>Requested service</li><li>Medical necessity screening</li><li>Medicare Advance Beneficiary Notice of Noncoverage processing</li><li>Pa...
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Course | Overview | Medicare Payment and Reimbursement
This course provides a brief history and overview of Medicare and Medicaid. It describes government organizations that regulate and administer this program. This course also discusses Medicare reimbursement. In addition, it highlights recen...
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Course | Intermediate | Medicare Payment and Reimbursement
This course provides an overview of the prospective payment systems used in the Medicare program and as well as Medicare fee schedules. This course provides a general discussion and overview of Medicare reimbursement under the Inpatient Pro...
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Course | Intermediate | Medicare Payment and Reimbursement
This course provides a general discussion and overview of reimbursement provided by Medicare under the outpatient prospective payment system. It also discusses the use of ambulatory payment classifications in the outpatient prospective paym...
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On Demand Webinar | Intermediate | Medicare Payment and Reimbursement
As the senior population continues to outpace the relative growth of the general population, and Medicare Advantage is accounting for about one-third (and growing every year) of all new Medicare eligible enrollees, providers are increasingl...
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Fact Sheet | Medicare Payment and Reimbursement

Hospital Readmissions Reduction Program Overview

Fact Sheet | Medicare Payment and Reimbursement

Hospital Readmissions Reduction Program Overview

This fact sheet discusses aspects of the Hospital Readmissions Reduction Program, as mandated by the Affordable Care Act (ACA).

The Affordable Care Act (ACA) establishes the Hospital Readmissions Reduction Program, effective for discharges from an applicable hospital beginning on or after Oct. 1, 2012. This program requires that payments to those hospitals under section 1886(d) of the Social Security Act (The Act) be reduced to account for certain excess readmissions. This fact sheet discusses various aspects of the Hospital Readmissions Reduction Program.

To promote quality of care, the Centers for Medicare &amp; Medicaid Services (CMS) developed hospital quality-of-care measures that compare patient outcomes across different hospitals. These measures include hospital risk-standardized readmission measures for:

  • Acute myocardial infarction (AMI) 30-day Risk Standardized Readmission Measure (NQF #0505)
  • Heart failure (HF) 30-Day Risk Standardized Readmission Measure (NQF #0330)
  • Pneumonia (PN) 30-day Risk Standardized Readmission Measure (NQF #0506)

The measures, originally developed for public reporting as a part of the Hospital Inpatient Quality Reporting (IQR) Program, are endorsed by the National Quality Forum (NQF), and have been publicly reported on the Hospital Compare website since 2009 to encourage quality improvement and lower readmission rates. 

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