Rural Health
Resources by Topic: Medicare
Health Care Transparency: CMS Needs More Information on Hospital Pricing Data Completeness and Accuracy
Provides an overview of the Centers for Medicare & Medicaid Services (CMS) hospital price transparency requirements before and after 2024 updates to the requirements. Describes users' experiences with hospital pricing data before the 2024 updates. Examines CMS's enforcement of hospital price transparency requirements and offers recommendations to CMS regarding the sufficiency and accuracy of the data reported. Table 3 compares CMS enforcement actions by hospitals' rural or urban designation between 2021 and 2023.
Additional links: Full Report
Date: 10/2024
Sponsoring organization: Government Accountability Office
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Provides an overview of the Centers for Medicare & Medicaid Services (CMS) hospital price transparency requirements before and after 2024 updates to the requirements. Describes users' experiences with hospital pricing data before the 2024 updates. Examines CMS's enforcement of hospital price transparency requirements and offers recommendations to CMS regarding the sufficiency and accuracy of the data reported. Table 3 compares CMS enforcement actions by hospitals' rural or urban designation between 2021 and 2023.
Additional links: Full Report
Date: 10/2024
Sponsoring organization: Government Accountability Office
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Merit-Based Incentive Payment System (MIPS): 2025 MIPS Payment Year (2023 Performance Year) - Payment Adjustment User Guide
Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2025. Describes how 2023 MIPS scores relate to 2025 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2025. Describes how 2023 MIPS scores relate to 2025 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-Based Incentive Payment System (MIPS): 2024 Reporting Options Comparison Resource
Provides an overview of the similarities and differences among the three Merit-Based Incentive Payment System (MIPS) reporting options: Traditional MIPS, MIPS Value Pathways (MVP), and Alternative Payment Model (APM) Performance Pathway (APP). Designed to help providers understand which reporting options may be best for their practice. Includes information on reporting flexibilities and scoring for small and rural practices.
Additional links: 2024 Merit-Based Incentive Payment System (MIPS) At-A-Glance Reporting Options for Small Practices
Date: 10/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of the similarities and differences among the three Merit-Based Incentive Payment System (MIPS) reporting options: Traditional MIPS, MIPS Value Pathways (MVP), and Alternative Payment Model (APM) Performance Pathway (APP). Designed to help providers understand which reporting options may be best for their practice. Includes information on reporting flexibilities and scoring for small and rural practices.
Additional links: 2024 Merit-Based Incentive Payment System (MIPS) At-A-Glance Reporting Options for Small Practices
Date: 10/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Payment Basics: Federally Qualified Health Center and Rural Health Clinic Payment Systems
Presents an overview of Medicare payments for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Details how the all-inclusive rate (AIR) is calculated for RHCs and how the national statutory payment limit applies to provider-based RHCs enrolled in Medicare before December 31, 2020, and whether they part of a hospital with fewer than 50 beds. Includes information on special payment rules for certain services provided by FQHCs and RHCs.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Presents an overview of Medicare payments for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Details how the all-inclusive rate (AIR) is calculated for RHCs and how the national statutory payment limit applies to provider-based RHCs enrolled in Medicare before December 31, 2020, and whether they part of a hospital with fewer than 50 beds. Includes information on special payment rules for certain services provided by FQHCs and RHCs.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Skilled Nursing Facility Services Payment System
Overview of Medicare payments for skilled nursing and rehabilitation services. Describes what constitutes a skilled nursing facility and how small, rural hospitals and Critical Access Hospitals (CAHs) may be used to provide these services with CMS approval. Compares Medicare daily base rates for urban and rural skilled nursing facilities.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Overview of Medicare payments for skilled nursing and rehabilitation services. Describes what constitutes a skilled nursing facility and how small, rural hospitals and Critical Access Hospitals (CAHs) may be used to provide these services with CMS approval. Compares Medicare daily base rates for urban and rural skilled nursing facilities.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Physician and Other Health Professional Payment System
Overview of Medicare payments for physician services conducted in a variety of settings including physicians' offices, hospitals, ambulatory surgical centers, skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries' homes.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Overview of Medicare payments for physician services conducted in a variety of settings including physicians' offices, hospitals, ambulatory surgical centers, skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries' homes.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Part D Payment System
Overview of the Medicare Part D prescription drug benefit, including subsidy amounts, payments to plans, how enrollee premiums are calculated, and benefit and payment updates.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Overview of the Medicare Part D prescription drug benefit, including subsidy amounts, payments to plans, how enrollee premiums are calculated, and benefit and payment updates.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Outpatient Hospital Services Payment System
Outlines Medicare's payments for outpatient hospital services, including considerations for rural sole community hospitals.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Outlines Medicare's payments for outpatient hospital services, including considerations for rural sole community hospitals.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Outpatient Dialysis Services Payment System
Overview of Medicare payment methods for outpatient dialysis services of beneficiaries with end-stage renal disease (ESRD). Describes the base payment rate for freestanding and hospital-based facilities and identifies facility-level adjustments, including facilities located in rural areas.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Overview of Medicare payment methods for outpatient dialysis services of beneficiaries with end-stage renal disease (ESRD). Describes the base payment rate for freestanding and hospital-based facilities and identifies facility-level adjustments, including facilities located in rural areas.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Medicare Advantage Program Payment System
Overview of Medicare payments to Medicare Advantage (MA) local and regional plans discussing the methods for determining Medicare payments to both plans.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Overview of Medicare payments to Medicare Advantage (MA) local and regional plans discussing the methods for determining Medicare payments to both plans.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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