Review of Medicaid Hospice Payments Made by Massachusetts for State Fiscal Years 2007 and 2008

摘要

Title XVIII of the Social Security Act (the Act) established the Medicare program, which provides health insurance coverage to people aged 65 and over, people with disabilities, and people with end-stage renal disease. The Centers for Medicare & Medicaid Services (CMS) administers the Medicare program. Section 1886(d) of the Act established the prospective payment system (PPS) for inpatient hospital services. Under the PPS, CMS pays hospital costs at predetermined rates for patient discharges. The rates vary according to the diagnosis-related group (DRG) to which a beneficiary's stay is assigned. The DRG payment is, with certain exceptions, payment in full to the hospital for all inpatient costs associated with the beneficiary's stay. Our objective was to determine whether the Hospital complied with Medicare requirements for billing inpatient and outpatient services on selected claims. Our objective was to determine whether the State agency made Medicaid payments to Massachusetts hospices in accordance with Federal and State requirements.