Medicare Law: Payment Rules

The inpatient hospital prospective payment system (IPPS) applies to all short-term hospital stays unless they are specifically excluded from the IPPS.

Payment of benefits for Medicare Part B.

CMS.gov

CMS.gov

The Hospital Readmissions Reduction Program (HRRP) reimbursements from Medicare for to hospitals that have excess readmissions for certain medical conditions, such as pneumonia and heart failure. It is meant to improve quality of health care.

Definitions for the Hospital Readmissions Reduction Program.

The Hospital-Acquired Condition (HAC) Reduction Program reduces reimbursements by 1% to hospitals that rank in the worst performing quartile of hospitals with respect to risk-adjusted HAC quality measures.

Hospital-Acquired Conditions Present on Admission Indicator Program - If select conditions, such as air embolism and catheter-associated urinary tract infections, manifest during the hospital stay, the case is paid as though the secondary diagnosis was not present.

Outpatient services are covered under Medicare Part B and paid under the outpatient prospective payment system (OPPS).

CMS pays for outpatient surgeries using a payment system based on OPPS.