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Any negative action or finding by a State licensing or certification authority; Private accreditation organization negative actions or findings against a health care practitioner or entity; Any negative action or finding by a Federal or State licensing and certification agency that is publicly available information
External parties who may request an NCD are Medicare beneficiaries, manufacturers, providers, suppliers, medical professional associations, or health plans. NCDs can also be internally generated by the Centers for Medicare and Medicaid Services (CMS) under multiple circumstances. For existing items or services
Healthgrades evaluates hospitals solely on risk-adjusted mortality and in-hospital complications. [17] Its website evaluates roughly 500 million claims from federal and private reviews and data to rate and rank doctors based on complication rates at the hospitals where they practice, experience, and patient satisfaction. [8]
HCFA was renamed the Centers for Medicare and Medicaid Services on July 1, 2001. [9] [11] In 2013, a report by the inspector general found that CMS had paid $23 million in benefits to deceased beneficiaries in 2011. [12] In April 2014, CMS released raw claims data from 2012 that gave a look into what types of doctors billed Medicare the most. [13]
Recent claim experience—whether better or worse than average—is a strong predictor of future costs in the near term. But the average health status of a particular small employer group tends to regress over time towards that of an average group. [91] The process used to price small group coverage changes when a state enacts small group ...
The Medicare Extra Help program helps Medicare beneficiaries pay for Part D drug coverage premiums, deductibles, coinsurance, and other costs. To qualify, individuals must have an income capped at ...
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI has replaced the Unique Physician Identification Number (UPIN) as the required identifier for Medicare services, and is used by other payers ...
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