This report provides a general overview of the Medicare program including descriptions of the program's history, eligibility criteria, covered services, provider payment systems, and program administration and financing.

This guide is designed to assist hospitals that are thinking of becoming new teaching hospitals and medical schools seeking to develop education partnerships with non-teaching hospitals to understand the basic principles of the Medicare payments available to support the added costs associated with being a teaching hospital.--Publisher's note.

Learn how the Anti-Kickback Statute protects the healthcare system and beneficiaries from the influence of money on referral decisions.

The Code of Federal Regulations is a codification of the general and permanent rules published in the Federal Register by the Executive departments and agencies of the United States Federal Government. This print ISBN is the official U.S. Federal Government edition. 2 CFR Parts 414-429 covers federal regulations, rules, and processes for the Centers for Medicare and Medicaid Services within the United States Department of Health and Human Services. This print volume part of the annual2017 print subscription covers topics such as payment for Part B Medical and other health services, ambulatory surgical services, hospice care, Medicare Advantage Program, conditions for Medicare payment, Medicare contracting and more. ​Medicare beneficiaries and participants, internal medicine and geriatric physicians, health practitioners, hospice care facilities and home services personnel and volunteers may be interested in this volume. Additionally, students pursuing coursework in personal and community health, health science terminology, patient care, primary care, speech pathology, and occupational therapy or rehabilitation for elder populations. Related products: Aging resources collection is available here: http://ttps://bookstore.gpo.gov/catalog/aging Other products produced by the Center for Medicare and Medicaid Services (CMS) are available here: https://bookstore.gpo.gov/agency/centers-medicare-and-medicaid-services-cms Your Guide to Choosing a Nursing Home or Other Long-Term Services & Supports is available here: https://bookstore.gpo.gov/products/your-guide-choosing-nursing-home-or-other-long-term-services-supports Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, Public Law 111-192 available here: https://bookstore.gpo.gov/products/preservation-access-care-medicare-beneficiaries-and-pension-relief-act-2010-public-law-111 Health, United States, 2016, With Chartbook on Long-Term Trends in Health and Health United States 2016 in Brief can be found here: https://bookstore.gpo.gov/products/health-united-states-2016-chartbook-long-term-trends-health-and-health-united-states-2016

" Due to its size, complexity, and susceptibility to mismanagement and improper payments, GAO has designated Medicare as a high-risk program. In 2013, Medicare financed health care services for approximately 51 million individuals at a cost of about $604 billion, and reported an estimated $50 billion in improper payments-payments that either were made in an incorrect amount or should not have been made at all. Most of these improper payments were made through the Medicare FFS program, which pays providers based on claims and uses contractors to pay the claims and ensure program integrity. This statement focuses on the progress made and steps still to be taken by CMS to improve improper payment prevention and recoupment efforts in the Medicare FFS program. This statement is based on relevant GAO products and recommendations issued from 2007 through 2014 using a variety of methodologies. GAO also updated information by examining public documents and, in April 2014, GAO received updated information from CMS on its actions related to laws and regulations discussed in this statement. What GAO Found The Centers for Medicare & Medicaid Services (CMS), the agency within the Department of Health and Human Services (HHS) that oversees Medicare, has made progress improving improper payment prevention and recoupment efforts in the Medicare fee-for-service (FFS) program, but further actions are needed. Provider enrollment. CMS has implemented certain provider enrollment screening procedures authorized by the Patient Protection and Affordable Care Act (PPACA) that address past weaknesses identified by GAO and others. The agency has also put in place other measures intended to strengthen existing procedures, but could do more to improve provider enrollment screening and ultimately reduce improper payments. For example, CMS has hired contractors to determine whether providers and suppliers have valid licenses, meet certain Medicare standards, and are at legitimate locations. CMS also recently contracted for fingerprint-based criminal history checks of providers and suppliers it has identified as high-risk. However, CMS has not implemented other screening actions authorized by PPACA that could further strengthen provider enrollment. Prepayment controls. In response to GAO's prior recommendations, CMS has taken steps to improve the development of certain prepayment edits-prepayment controls used to deny Medicare claims that should not be paid; however, important actions that could further prevent improper payments have not yet been implemented. For example, CMS has implemented an automated edit to identify services billed in medically unlikely amounts, but has not implemented a GAO recommendation to examine certain edits to determine whether they should be revised to reflect more restrictive payment limits. GAO has found that wider use of prepayment edits could help prevent improper payments and generate savings for Medicare. Postpayment claims reviews. Postpayment claims reviews help CMS identify and recoup improper payments. Medicare uses a variety of contractors to conduct such reviews, which generally involve reviewing a provider's documentation to ensure that the service was billed properly and was covered, reasonable, and necessary. GAO has found that differing requirements for the various contractors may reduce the efficiency and effectiveness of such reviews. To improve these reviews, GAO has previously recommended CMS examine ways to make the contractor requirements more consistent.

Medicaid Program - Disproportionate Share Hospital Payments (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) The Law Library presents the complete text of the Medicaid Program - Disproportionate Share Hospital Payments (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition). Updated as of May 29, 2018 This final rule sets forth the data elements necessary to comply with the requirements of Section 1923(j) of the Social Security Act (Act) related to auditing and reporting of disproportionate share hospital payments under State Medicaid programs. These requirements were added by Section 1001(d) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). This book contains: - The complete text of the Medicaid Program - Disproportionate Share Hospital Payments (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) - A table of contents with the page number of each section