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)

Outpatient Prospective Payment System (OPPS)

Other Prospective Payment Systems

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.


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.

Understand Medicare’s value-based purchasing program and the impact on a hospital’s revenue.

Slides | Recording

Understand Medicare’s readmissions reduction program (RRP) and hospital-acquired condition (HAC) program and their impact on a hospital’s revenue.

Slides | Recording