CMS stands for Centers for Medicare and Medicaid Services, a federal government agency responsible for overseeing several key healthcare programs. CMS gathers and analyses data, produces research reports and works to combat insurance industry fraud.
CMS oversees programs including Medicare, Medicaid, the Children’s Health Insurance Program and Health Insurance Marketplace; in addition it oversees Medicare Advantage plan programs where private companies handle medical care for Medicare enrollees. CMS ensures all the agencies under its regulatory jurisdiction comply with laws set forth by Congress.
CMS plays an essential role in overseeing all healthcare providers and facilities’ compliance with government contracts, and those who fail to abide by them face fines or lower reimbursement rates from CMS. CMS has also instituted meaningful use rules, intended to encourage hospitals and physicians alike to adopt electronic health record (EHR) systems.
CMS not only regulates healthcare providers and facilities, but is also charged with creating and administering healthcare technology. CMS has been widely credited with driving EHR adoption across the nation; thus creating the Office of the National Coordinator for Health Information Technology (ONC), which reviews health IT systems while updating HIPAA standards to protect patient privacy.
CMS strives to help healthcare industries move away from fee-for-service models toward ones based on outcomes and patient satisfaction, by creating innovation centers to test new models; those agencies who do well under such models will receive higher reimbursement rates from CMS.
As part of its efforts to enhance patient healthcare quality, the agency has instituted standard protocols and definitions of what constitutes a critical incident. This may include verbal, physical or sexual abuse; neglect; financial exploitation; misappropriation or misuse of medication or supplies; falls with injuries; fire in facilities; unexplained deaths and any other incidents which pose significant threats to both patients and staff alike.
As well as setting standards, CMS also conducts validation surveys and investigations of organizations with deemed status that fail to meet them, or those that receive complaints filed against them. If an organization doesn’t comply with standards set by CMS they risk losing their deemed status; to qualify an organization must pass validation surveys as well as submit annual documentation showing compliance with all rules, policies and procedures set by CMS as well as maintaining records of any incidents reported and making reports accessible on demand. Their website offers more details of this requirement as well as contact details for local offices as well as specific program matters.