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Medicare Data Requirements in Massachusetts

The law requires that a provider maintain full and complete documentation in the patient’s medical record in order to receive payment for services from Medicare.1  Hospitals are also required to include a discharge plan for all Medicare beneficiaries.2  Massachusetts has taken a number of steps to protect Medicare beneficiaries.  Primarily, the law allows disclosure of information from Medicare applicants or recipients only when it is directly connected to the administration of medical assistance programs.  In this case, the names of recipients cannot not be published.3  Also, the law prohibits discriminatory behavior, related to admission or services, against Medicare beneficiaries.  The Department of Community Health has established an advocacy office to deal with complaints or allegations regarding discriminatory conduct against Medicare beneficiaries specifically.4

Footnotes

  • 1. 130 MA ADC 433.409
  • 2. M.G.L.A. 111 §51D
  • 3. M.G.L.A. 118E §49
  • 4. M.G.L.A. 111 §51D

 

Medicare Data Requirements in Massachusetts

Subtopic Statute/Regulation Description
Reporting by Medicare providers: Cost 114.1. Mass. Code Regs. 42.03. - General Reporting Requirements “General Reporting Requirements”   Provides that acute and non-acute hospitals must file the following documents with the Division...
Medicare medical recordkeeping requirements: Elements to be recorded 130. Mass. Code Regs. 433.409. - Recordkeeping (Medical Records) Requirements Payment for any service under Medicare or Medicaid or other medical assistance program is conditioned upon full and complete documentation in the...
Medicare Data Requirements Mass. Gen. Laws. Ann. ch. 111, § 51D - Discrimination by acute hospitals against Medicare beneficiaries; Discharge planning An acute hospital cannot establish discriminatory practices in relation to admission, availability of services or treatment or transfer for any...
Mass. Gen. Laws. Ann. ch. 26, § 8H - Authorization of Assessment Against Domestic Insurers and Nonprofit Hospital, Medical and Dental Service Corporations All health plans are required to report to the Division of Insurance all consumers who are also recipients of medical assistance.  A health plan...
Confidentiality of Medicare data Mass. Gen. Laws. Ann. ch. 118A, §6 - Disclosure or use of information restricted “Disclosure or use of information restricted”   The department cannot disclose or use any information concerning applicants or...
Mass. Gen. Laws. Ann. ch. 118E, § 49 - Use and disclosure of information Use or disclosure of information from applicants and recipients of medical benefits under Medicare/Medicaid must be directly connected to the...