Rural Health
Resources by Topic: Medicare
Medicare Claims Processing Manual: Chapter 9 - Rural Health Clinics/Federally Qualified Health Centers
Describes the differences between Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). Identifies the rules and regulations for processing Medicare claims.
Date: 06/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Describes the differences between Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). Identifies the rules and regulations for processing Medicare claims.
Date: 06/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Medicare Care Management Billing Strategies
Webinar recording featuring speakers from Eide Bailly and the NORC Walsh Center for Rural Health Analysis discussing new 2025 Medicare care management billing codes and how they can be used to support care coordination to improve care quality for Medicare beneficiaries
Additional links: Audio Recording, Webinar Slides
Date: 05/2025
Sponsoring organization: Rural Health Information Hub
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Webinar recording featuring speakers from Eide Bailly and the NORC Walsh Center for Rural Health Analysis discussing new 2025 Medicare care management billing codes and how they can be used to support care coordination to improve care quality for Medicare beneficiaries
Additional links: Audio Recording, Webinar Slides
Date: 05/2025
Sponsoring organization: Rural Health Information Hub
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Annual Insurance Update 2025: Health Insurance in Kansas
Reports on health insurance coverage across Kansas and nationwide, including 2009-2023 trends in coverage. Presents 2022 county-level data on uninsured rates by age group and urban/rural classification, as well as Medicaid and Children's Health Insurance Program (CHIP) enrollment by county.
Author(s): Angela S. Wu, Kaci Cink, Viktoria Sterkhova, et al.
Date: 05/2025
Sponsoring organization: Kansas Health Institute
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Reports on health insurance coverage across Kansas and nationwide, including 2009-2023 trends in coverage. Presents 2022 county-level data on uninsured rates by age group and urban/rural classification, as well as Medicaid and Children's Health Insurance Program (CHIP) enrollment by county.
Author(s): Angela S. Wu, Kaci Cink, Viktoria Sterkhova, et al.
Date: 05/2025
Sponsoring organization: Kansas Health Institute
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Delaying Screening Until Covered? Changes in Lung Cancer Screening at the Age of Nearly-Universal Medicare Insurance
Examines the impact of first-time screening of lung cancer at age 65, the age of nearly universal Medicare insurance coverage. Utilizes 2015-2020 American College of Radiology's Lung Cancer Screening Registry data to analyze differences in screening rates between ages 60-64 and 65-69. Includes additional data breakdowns such as patient demographics, smoking behaviors, eligibility for screening, and rural versus non-rural patient location.
Author(s): Marcelo C. Perraillon, Adam Warren, Lenka Goldman, Jamie L. Studts, Rebecca M. Myerson
Citation: Health Services Research, 61(2), e14638
Date: 05/2025
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Examines the impact of first-time screening of lung cancer at age 65, the age of nearly universal Medicare insurance coverage. Utilizes 2015-2020 American College of Radiology's Lung Cancer Screening Registry data to analyze differences in screening rates between ages 60-64 and 65-69. Includes additional data breakdowns such as patient demographics, smoking behaviors, eligibility for screening, and rural versus non-rural patient location.
Author(s): Marcelo C. Perraillon, Adam Warren, Lenka Goldman, Jamie L. Studts, Rebecca M. Myerson
Citation: Health Services Research, 61(2), e14638
Date: 05/2025
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Community Health Centers Are Increasingly Important to Medicare Beneficiaries
Presents data on health center Medicare patient characteristics, service utilization, and revenue between 2019-2023. Compares sociodemographic and health characteristics of health center patients with those of the general Medicare population. Discusses the impact of managed care plans on health center finances.
Author(s): Elizabeth Dutta, Marsha Regenstein, Feygele Jacobs
Date: 05/2025
Sponsoring organization: Geiger Gibson Program in Community Health
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Presents data on health center Medicare patient characteristics, service utilization, and revenue between 2019-2023. Compares sociodemographic and health characteristics of health center patients with those of the general Medicare population. Discusses the impact of managed care plans on health center finances.
Author(s): Elizabeth Dutta, Marsha Regenstein, Feygele Jacobs
Date: 05/2025
Sponsoring organization: Geiger Gibson Program in Community Health
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Environmental Scan on Reducing Barriers to Participation in Population-Based Total Cost of Care (PB-TCOC) Models and Supporting Primary and Specialty Care Transformation
Presents results of an environmental scan on reducing barriers to participation in population-based total cost of care (PB-TCOC) models and supporting primary and specialty care transformation. Discusses identifying pathways for maximizing participation of different kinds of organizations in PB-TCOC models; an assessment of and approaches to reducing organization-level barriers; approaches to support primary and specialty care transformation; an assessment of factors that influence the ability of PB-TCOC models to be competitive; and a summary of relevant features in previously submitted Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references throughout.
Date: 05/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Presents results of an environmental scan on reducing barriers to participation in population-based total cost of care (PB-TCOC) models and supporting primary and specialty care transformation. Discusses identifying pathways for maximizing participation of different kinds of organizations in PB-TCOC models; an assessment of and approaches to reducing organization-level barriers; approaches to support primary and specialty care transformation; an assessment of factors that influence the ability of PB-TCOC models to be competitive; and a summary of relevant features in previously submitted Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references throughout.
Date: 05/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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CMS Innovation Center Strategic Direction
Describes the vision and strategic objectives for the Center for Medicare and Medicaid Innovation (CMS Innovation Center). Strategic objectives include promoting evidence-based prevention, empowering people to achieve their health goals, and driving choice and competition.
Additional links: Frequently Asked Questions, White Paper: The CMS Innovation Center's Strategy to Make America Healthy Again
Date: 05/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Describes the vision and strategic objectives for the Center for Medicare and Medicaid Innovation (CMS Innovation Center). Strategic objectives include promoting evidence-based prevention, empowering people to achieve their health goals, and driving choice and competition.
Additional links: Frequently Asked Questions, White Paper: The CMS Innovation Center's Strategy to Make America Healthy Again
Date: 05/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Evaluation of the Primary Care First Model: Third Annual Report
Provides an overview of the Primary Care First (PCF) model, which aims to enhance primary care and move primary care practitioners toward value-based payment. Describes the PCF model implementation experiences for Cohort 1 and Cohort 2 practices through 2023. Explores the characteristics of practices and payers that continued to participate in the PCF model compared to those who left. Examines the role that the PCF Model's incentives and supports played in the strategies and practices adopted to improve care delivery and how the trajectory of these strategies and activities practices have transformed over time. Estimates the impact of the PCF Model on Medicare fee-for-service (FFS) expenditures and service use, including acute hospitalizations. Estimates the impacts of the model on a set of seven leading indicators to provide an early assessment of whether care delivery changes are resulting in meaningful early outcome changes.
Additional links: Executive Summary, Findings at a Glance
Date: 05/2025
Sponsoring organizations: Centers for Medicare & Medicaid Services, Mathematica
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Provides an overview of the Primary Care First (PCF) model, which aims to enhance primary care and move primary care practitioners toward value-based payment. Describes the PCF model implementation experiences for Cohort 1 and Cohort 2 practices through 2023. Explores the characteristics of practices and payers that continued to participate in the PCF model compared to those who left. Examines the role that the PCF Model's incentives and supports played in the strategies and practices adopted to improve care delivery and how the trajectory of these strategies and activities practices have transformed over time. Estimates the impact of the PCF Model on Medicare fee-for-service (FFS) expenditures and service use, including acute hospitalizations. Estimates the impacts of the model on a set of seven leading indicators to provide an early assessment of whether care delivery changes are resulting in meaningful early outcome changes.
Additional links: Executive Summary, Findings at a Glance
Date: 05/2025
Sponsoring organizations: Centers for Medicare & Medicaid Services, Mathematica
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Medicare Shared Savings Program: Rule Changes and Implications for Rural Health Care Organizations
Summarizes changes to the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program (SSP) that take effect in January 2023 for current participants, and in January 2024 for organizations applying for a January 1, 2024 start. Discusses the potential impact of these changes on rural health and participation considerations.
Date: 05/2025
Sponsoring organization: Rural Health Value
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Summarizes changes to the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program (SSP) that take effect in January 2023 for current participants, and in January 2024 for organizations applying for a January 1, 2024 start. Discusses the potential impact of these changes on rural health and participation considerations.
Date: 05/2025
Sponsoring organization: Rural Health Value
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Stand-Alone Drug Plans Cover a Larger Share of Medicare Part D Enrollees Living in the Most Rural Areas Than Medicare Advantage Plans
Examines Medicare Part D enrollment in stand-alone Medicare prescription drug plans and Medicare Advantage drug plans in 2025. Presents data by urban, rural adjacent, and rural non-adjacent status nationally and by state.
Author(s): Juliette Cubanski, Tricia Neuman, Anthony Damico
Date: 04/2025
Sponsoring organization: KFF
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Examines Medicare Part D enrollment in stand-alone Medicare prescription drug plans and Medicare Advantage drug plans in 2025. Presents data by urban, rural adjacent, and rural non-adjacent status nationally and by state.
Author(s): Juliette Cubanski, Tricia Neuman, Anthony Damico
Date: 04/2025
Sponsoring organization: KFF
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