Linking quality to payment

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Hospital-Acquired Condition (HAC) Reduction Program – The Affordable Care Act authorized Medicare to reduce payments to subsection (d) hospitals that rank in the worst performing quartile (25 percent) of subsection (d) hospitals with respect to HAC quality measures. The worst performing quartile is identified by calculating Total HAC Scores based on hospitals’ performance on risk adjusted quality measures. Hospitals with a Total HAC Score above the 75th percentile of the Total HAC Score distribution will have their payments reduced to 99 percent of what would otherwise have been paid for such discharges. The HAC Reduction Program is designed to encourage hospitals to improve patient safety by reducing the incidence of hospital-acquired conditions and adverse patient safety events. Get more information about the Hospital-Acquired Condition Reduction Program.

100 things to know about Medicare reimbursement

99. Participants can select as many as 48 different clinically related condition episodes for each BPCI model. Model 1 involves an episode of care focused on acute-care inpatient hospitalization, and participants agree to provide a standard discount to Medicare from the typical Part A payments for inpatient hospital services. In Model 2, the episode of care includes the inpatient stay in an acute-care hospital and all related services during the episode, which will be considered to end either a minimum of 30 and up to 90 days after discharge. Model 3 involves episodes of care that are triggered by an acute-care hospital stay but begin at the initiation of post-acute care services with a participating skilled nursing facility, inpatient rehabilitation facility, long-term care hospital or home health agency. By contrast, under Model 4, CMS will make a single, prospectively determined bundled payment to the participating hospital for all services administered during the inpatient stay. Related readmissions for 30 days after discharge are included in the bundled payment amount.

Medicare Information, Help, and Plan Enrollment

Humana is a Medicare Advantage [HMO, PPO and PFFS] organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. [Benefits, premiums and/or member cost-share] may change on January 1 of each year. The [Formulary, pharmacy network, and/or provider network] may change at any time. You will receive notice when necessary.

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