Medicare Review Programs

CMS reviews acute IPPS and long-term care hospital (LTCH) records for payment purposes. Documentation and coding assignment must be accurate and specific. CMS contracts with Medicare Administrative Contractors (MAC) to conduct medical and coding reviews to prevent improper payment of inpatient hospital claims. Quality Improvement Organizations (QIO), Medicare Administrative Contractors (MACs), Comprehensive Error Rate Testing Program (CERT), and Recovery Audit Program Contractors (RAC) are four Medicare Review Programs that are used in hospital settings.

Create a table with three columns. There should be a heading for the table and a heading for each column. Quality Improvement Organization (QIO), Medicare Administrative Contractors (MACs), Comprehensive Error Rate Testing Program (CERT), and Recovery Audit Program Contractors (RAC).

Also,Answer the following questions:

1. Should every acute hospital and LTCH have a policy and procedure in place for CMS reviews? Why and why not? (Provide answers in a short essay format, 50-word minimum).
2. What types of services are included in a RAC review? (Provide answers in a short essay format, 50-word minimum).
3. CMS contracts QIO to review the patient's quality of healthcare. Do you agree that QIO promotes better care, better population health, and lowers healthcare costs? Why and why not? (Provide answers in a short essay format, 50-word minimum).

Example:

CMS Review Programs

Medicare Review Programs	Definition	Example

*Reference(s) required (APA Format), Correct spelling, and grammar.

References should be from a .org, .gov, or .edu domain. Proofreading for grammar and punctuation is required. The document is to contain original wording.