Cheat sheets: Medicare payment programs

Feeling overwhelmed by all of the new proposed rules CMS has released? Get back to basics by viewing our cheat sheets which provide an overview of different payment programs, who they affect, when they're updated and what goes into payment calculations.

IPPS | HOPPS | MPFS | MACRA

Inpatient Prospective Payment System (IPPS)

The Inpatient Prospective Payment System (IPPS) is the payment system through which CMS reimburses short-term acute care hospitals (STACHs) for inpatient services delivered under Medicare Part A to Medicare Fee-for-Service patients

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Hospital Outpatient Prospective Payment System (HOPPS)

The Outpatient Prospective Payment System (HOPPS) is the payment system through which CMS reimburses hospitals for outpatient services delivered to Medicare Fee-for-Service patients. HOPPS also covers certain Medicare Part B services for inpatients when Part A payments cannot be made, some partial hospitalization services, and some other varied services

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Medicare Physician Fee Schedule (MPFS)

The Medicare Physician Fee Schedule (MPFS) is the payment system through which CMS reimburses physicians, other health care professionals or providers/suppliers for services on a Fee-For-Service (FFS) basis. It is the main payment system for CMS to reimburse physicians (and other health care professionals) for services such as office visits, surgical procedures, anesthesia services, diagnostic tests and radiology services.

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Medicare Access and CHIP Reauthorization Act (MACRA)

The Medicare Access and CHIP Re-Authorization Act (MACRA) repealed the Sustainable Growth Rate (SGR) formula and stipulated the development of two new payment tracks under the Quality Payment Program (QPP), which incentivize moving away from fee-for-service payment models to a value-based payment structure. These two tracks include: The Merit-Based Incentive Payment System (MIPS), and Advanced Alternative Payment Models (APM).

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