Medicare is the federal health insurance program for Tennesseans who are 65 or older, certain younger individuals with disabilities and individuals with end-stage renal disease.
Elements of Medicare
Covers inpatient care in hospitals, nursing homes, skilled nursing facilities, and critical access hospitals. Most individuals who qualify for Medicare are automatically enrolled in the program and do not have to pay a premium. It is financed by a payroll tax on both employers and employees.
Covers outpatient services, laboratory tests, physician services, and durable medical equipment. Part B is optional coverage and individuals pay a monthly premium.
Optional coverage and is paid through premiums. Part C includes private plans that offer Parts A, B, and D benefits, often in conjunction with additional benefits.
Optional program that provides coverage to help seniors pay for prescription drugs.
Payment Prospective Systems
Inpatient Prospective Payment System (IPPS)
- FY 2024 IPPS Proposed Rule – THA Formal Comments
- FY 2024 IPPS Proposed Rule – AHA Regulatory Advisory
Outpatient Prospective Payment System (OPPS)
Other Prospective Payment Systems
- FY 2024 Inpatient Rehabilitation Facility PPS Proposed Rule – THA Formal Comments
- FY 2024 Inpatient Rehabilitation Facility PPS Proposed Rule – AHA Regulatory Advisory
- FY 2024 Inpatient Psychiatric Facility PPS Proposed Rule – THA Formal Comments
- FY 2024 Inpatient Psychiatric Facility PPS Proposed Rule – AHA Regulatory Advisory
- FY 2024 Skilled Nursing Facility PPS Proposed Rule – AHA Regulatory Advisory
- FY 2024 Long-term Care Hospital PPS Proposed Rule – AHA Regulatory Advisory
Inpatient Prospective Payment System (IPPS)
Other Prospective Payment System
- FY 2024 Inpatient Rehabilitation Facility PPS Final Rule – AHA Regulatory Advisory
- FY 2024 Inpatient Psychiatric Facility PPS Final Rule – AHA Regulatory Advisory
- FY 2024 Skilled Nursing Facility PPS Final Rule – AHA Regulatory Advisory
- FY 2024 Long-term Care Hospital PPS Final Rule – AHA Regulatory Advisory
Inpatient Prospective Payment System (IPPS)
- FY 2022 Inpatient PPS Final Rule – AHA Regulatory Advisory
- FY 2022 Inpatient PPS Final Rule – Alston and Bird Summary
- FY 2023 IPPS Proposed Rule – THA Formal Comments
- FY 2023 IPPS Proposed Rule – AHA Regulatory Advisory
- FY 2023 IPPS Proposed Rule – Alston and Bird Summary
- FY 2023 IPPS Proposed Rule Medicare DSH 1115 Days Issue – THA Formal Comments
- FY 2023 Inpatient PPS Final Rule – AHA Regulatory Advisory
- FY 2023 Inpatient PPS Final Rule – Alston and Bird Summary
Outpatient Prospective Payment System (OPPS)
- CY 2022 OPPS/ASC Final Rule
- CY 2022 OPPS/ASC Finale Rule – Alston and Bird Summary
- CY 2023 OPPS/ASC Proposed Rule – THA Formal Comments
- CY 2023 OPPS/ASC Proposed Rule – AHA Regulatory Advisory
- CY 2023 OPPS/ASC Proposed Rule – Alston and Bird Summary
- CY 2023 Outpatient PPS/Ambulatory Surgical Center Final Rule – AHA Regulatory Advisory
Other Prospective Payment Systems
- FY 2022 Inpatient Rehabilitation Facility PPS Final Rule – AHA Regulatory Advisory
- FY 2022 Inpatient Psychiatric Facility PPS Final Rule – AHA Regulatory Advisory
- FY 2022 Skilled Nursing Facility PPS Final Rule – AHA Regulatory Advisory
- FY 2022 Long-term Care Hospital PPS Final Rule – AHA Regulatory Advisory
- CY 2022 Medicare Physician Fee Schedule Final Rule – AHA Regulatory Advisory
- CY 2022 Physician Fee Schedule Final Rule – Alston and Bird Summary
- CY 2022 Home Health PPS Final Rule – AHA Regulatory Advisory
- CY 2023 Physician Fee Schedule Proposed Rule – AHA Regulatory Advisory
- CY 2023 Home Health PPS Proposed Rule – THA Formal Comments
- CY 2023 Home Health PPS Proposed Rule – AHA Regulatory Advisory
- FY 2023 Inpatient Rehabilitation Facility PPS Proposed Rule – THA Formal Comments
- FY 2023 Inpatient Rehabilitation Facility PPS Proposed Rule – AHA Regulatory Advisory
- FY 2023 Inpatient Psychiatric Facility PPS Proposed Rule – AHA Regulatory Advisory
- FY 2023 Skilled Nursing Facility PPS Proposed Rule – AHA Regulatory Advisory
- CY 2023 Physician Fee Schedule Final Rule – AHA Regulatory Advisory
- CY 2023 Home Health PPS Final Rule – AHA Regulatory Advisory
- FY 2023 Inpatient Rehabilitation Facilty PPS Final Rule – AHA Regulatory Advisory
- FY 2023 Skilled Nursing Facility PPS Final Rule – AHA Regulatory Advisory
- FY 2023 Long-term Care Hospital PPS Final Rule – AHA Regulatory Advisory
- FY 2023 Long-term Care Hospital PPS Proposed Rule – AHA Regulatory Advisory
Webinars on Medicare Value-Based Purchasing Programs
THA is pleased to partner with DataGen to offer two webinars that can help enhance your understanding of Medicare’s value-based purchasing programs and other reports that you receive on related topics. DataGen, a subsidiary of the Healthcare Association of New York State (HANYS), contracts with 48 state hospital associations and ten multi-state health systems to research and analyze the financial impact of regulatory and legislative changes on Medicare reimbursement to hospitals and health systems. Below is an overview of the training and objectives.
Overview
These webinars cover all of the Medicare quality-based payment programs for hospital inpatient acute care: value-based purchasing (VBP), readmissions reduction program (RRP) and hospital-acquired conditions (HAC) reduction program. Staff from DataGen review the regulatory updates, provide details on the metric calculation methodologies, examine patterns and trends and look ahead to changes in each of the programs.
Commercial and Other Payers 