CMS is the Centers for Medicare & Medicaid Services, which is the U.S. federal agency that assists in providing health insurance through Medicare, Medicare Advantage, Medicaid, the Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace. With more than 100 million beneficiaries currently enrolled in CMS health insurance programs, it is imperative to understand how to work with the federal agency for your medical billing practice.
The Centers for Medicare & Medicaid Services administers major healthcare insurance programs in the US, along with a focus on collecting and analyzing data. They produce research reports that are aligned with their dedication to supporting better healthcare systems with improved health care and wellness programs and accessibility.
History of CMS – Centers for Medicare
President Lyndon B. Johnson signed Medicare into law in 1965, as a medical care program. Initially, the Social Security Administration (SSA) administered the program under the Department of Health, Education, and Welfare. In 1977, the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS).
The agency has expanded quite a bit in its scope and coverage since President Johnson first established those initial medical care programs. With all the rate changes, exceptions, reporting, and other requirements over the last year, it’s more important than ever to consult with TempDev to determine appropriate provider solutions, to ensure that you’re current on your regulatory requirements, and to get strategic advice on how to plan future initiatives.
Centers for Medicare – Reimbursement and Regulatory Functions
The Centers for Medicare (CMS) administers the following:
- Medicare: A health insurance program, for elderly
- Medicare Advantage (Part C): A commercial partnership to also administer Medicare
- Medicaid: A needs-based program, assisting with medical costs.
- Children’s Health Insurance Program (CHIP)
- Health Insurance Portability and Accountability Act (HIPAA)
- 2015 Medicare Access and CHIP Reauthorization Act (MACRA) law
- Health Information Technology for Economic and Clinical Health (HITECH) Act
CMS not only administers healthcare programs but is also tasked with determining whether healthcare providers and facilities have successfully implemented healthcare IT programs and are compliant with the rules. They can set reimbursement rates for healthcare providers based on their use of healthcare IT programs as set forth in MACRA & HITECH.
TempDev offers the support and tools you need to ensure you’re operating your medical organization to peak efficiency. Many of the most recent CMS policy changes were put in place to reduce the cost and complexity of the healthcare system. The goal is to make it easier for providers to stay in compliance with the various regulations that Congress has implemented.
If you are an organization that participates in Medicare Advantage, your star rating makes a significant difference when it comes to reimbursement and patient enrollments. It also means that you’re required to submit quality reporting on relevant data. TempDev can help you optimize your NextGen EHR to improve your quality scores.
- You can regularly review how your doctors are progressing toward quality measures.
- You can use TempDev’s Quality Measure Dashboard to highlight the gaps in care with HEDIS and other quality programs.
- You can also implement business intelligence with NextGen EHR to better understand how to improve the health of your patient population.
Office of the National Coordinator – ONC-Affiliated Agency
The Office of the National Coordinator for Health Information Technology (ONC) works with CMS. The ONC approves certified healthcare IT systems, which are essential for regulatory, security, and privacy regulations under the Cures Act, MACRA, HITECH, & HIPAA. Healthcare IT has increased in importance over the last few years, as more hospitals and healthcare organizations are transitioning to electronic healthcare records (EHRs) and electronic medical records (EMRs).
ONC has been instrumental in spearheading the successful adoption and implementation of EHRs by doctors and medical staff at hospitals and medical facilities across the US. ONC now estimates that 96% of hospitals have established certified and federally tested EHR systems, which has already supported payouts to the tune of more than $35 billion to hospitals and doctors. Of course, there’s still more work to be done, since complete interoperability is the goal, which would ensure high-quality care, patient safety, and lower costs for healthcare.
How TempDev Can Help with CMS Regulatory Trends
TempDev’s team of NextGen & CMS experts support you in meeting regulatory requirements to be successful in both revenue cycle management and quality initiatives. TempDev supports your need for custom automation, configuration, dashboards, remote patient monitoring, telehealth, and workflow redesign for CMS. You’ll find the tools and resources you need, with top tips and tricks that will ensure your success even as your needs change under the pressures.
It’s often challenging to keep up with the transformations in the healthcare industry, which is why TempDev’s team of experts is standing by to consult with you and help you to better understand the policy changes, how it has affected revenue and compliance, and how you can satisfy CMS regulations and requirements. Your goal continues to be to protect your staff, doctors, and patients while providing quality care, affordable healthcare pricing, and flexible care options.
Contact us here or by calling us at 888.TEMP.DEV to get the help you need with the Centers for Medicare & Medicaid Services requirements.