Medicare Reimbursement Policy and Teaching Physiciansʼ Behavior in Hospital Clinics

Changes in Medicare reimbursement for hospital-acquired conditions including infections.

As part of the Deficit Reduction Act of 2005, Congress required the Secretary of Health and Human Services (HHS) to identify conditions that (1) are high cost or high volume or both, (2) result in the assignment of a case to a diagnosis-related group that has a higher payment when present as a secondary diagnosis, and (3) could reasonably have been prevented through the application of evidence-...

Medicare physician reimbursement: past, present, and future.

Medicare reimbursement and regression to the mean

There is evidence that Medicare's payment formula for health maintenance organizations (HMO's) overpays or underpays HMO's in cases of biased selection. There is also evidence that costs of biased groups regress toward the population mean cost, so the incorrect payment is temporary. We found that reimbursement regressed toward the mean for cohorts biased on medical use but not for groups biased...

Medicare skilled nursing facility reimbursement and upcoding.

Post-acute care provided by skilled nursing facilities (SNFs) is reimbursed by Medicare under a prospective payment system using resource utilization groups (RUGs) that adjust payment intensity on the basis of predefined ranges of weekly therapy minutes provided and the functionality of the patient. Individual RUGs account for differences in the intensity of care provided, but there exists sign...

Transparency in Medicare Reimbursement: Help or Hindrance?

Welcome to the latest edition of JADPRO! It is my pleasure and honor to serve as an associate editor for this elite and unique journal. As one of the co-chairs of the meeting, I would like to invite you to attend the second JADPRO Live symposium to be held in sunny Orlando, Florida, this October 30 through November 2. The faculty lineup is superb, the content offerings are first rate, and you c...