Centers for Medicare & Medicaid Services (CMS)
The federal agency that administers Medicare, Medicaid, and the ACA marketplace — setting hospital payment rates, quality standards, and the data that HospitalCostData uses.
How It Works
CMS is the single most influential entity in U.S. hospital economics. It sets Medicare payment rates (which influence commercial insurance rates), defines quality measures and star ratings, enforces hospital conditions of participation, and publishes the data that enables hospital cost comparison. CMS's Hospital Compare website (now Care Compare) provides public quality data on nearly every U.S. hospital. CMS also administers the Hospital Value-Based Purchasing program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program — all of which adjust payments based on quality performance.
Related Terms
- Medicare — Federal health insurance for Americans aged 65+ and certain younger people with disabilities — covering hospital stays (Part A), outpatient care (Part B), and prescription drugs (Part D).
- Inpatient Prospective Payment System (IPPS) — Medicare's payment system for hospital inpatient stays — paying a fixed amount per DRG rather than reimbursing each individual service.
- CMS Star Rating (Hospital Overall Rating) — A 1-to-5 star rating assigned by CMS to hospitals based on quality measures — covering mortality, safety, readmissions, patient experience, and timely care.
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About This Definition
This definition is part of the HospitalCostData Hospital Pricing Glossary — 25 terms explaining hospital costs, quality ratings, and healthcare billing. Written for patients, journalists, researchers, and healthcare professionals.