Rural Health
Resources by Topic: Reimbursement and payment models
CMS Bundled Payments for Care Improvement Advanced Model: Sixth Annual Evaluation Report
Sixth annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which tests whether linking payments for a clinical episode of care can reduce Medicare expenditures while maintaining or improving the quality of care. Examines the impact of BPCI Advanced on episode payments, utilization, and quality of care, as well as estimates of Medicare program savings in Model Year 5. Also explores the impact of the model on accountable care relationships, strengthening primary care, and care for patients eligible for both Medicare and Medicaid. Includes data on the percentage of BPCI Advanced episodes with and without ACO attribution by patient characteristics, including rural residents.
Additional links: Appendices, Executive Summary, Findings at a Glance, Transformation Spotlight
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 04/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Sixth annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which tests whether linking payments for a clinical episode of care can reduce Medicare expenditures while maintaining or improving the quality of care. Examines the impact of BPCI Advanced on episode payments, utilization, and quality of care, as well as estimates of Medicare program savings in Model Year 5. Also explores the impact of the model on accountable care relationships, strengthening primary care, and care for patients eligible for both Medicare and Medicaid. Includes data on the percentage of BPCI Advanced episodes with and without ACO attribution by patient characteristics, including rural residents.
Additional links: Appendices, Executive Summary, Findings at a Glance, Transformation Spotlight
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 04/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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April 2025 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2025 meeting. Covers physician fee schedule updates and improving the accuracy of relative payment rates; structural differences between the stand-alone prescription drug plan (PDP) and Medicare Advantage–Prescription Drug plan (MA–PD) markets; the utilization and delivery of Medicare Advantage supplemental benefits; the effect of Medicare Advantage on rural hospitals; paying for software technologies in Medicare; access to hospice and certain services under the hospice benefit for beneficiaries with end-stage renal disease and beneficiaries with cancer; and regulations, star ratings, and fee-for-service Medicare policies aimed at improving nursing home quality.
Additional links: Exploring the Effect of Medicare Advantage on Rural Hospitals
Date: 04/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2025 meeting. Covers physician fee schedule updates and improving the accuracy of relative payment rates; structural differences between the stand-alone prescription drug plan (PDP) and Medicare Advantage–Prescription Drug plan (MA–PD) markets; the utilization and delivery of Medicare Advantage supplemental benefits; the effect of Medicare Advantage on rural hospitals; paying for software technologies in Medicare; access to hospice and certain services under the hospice benefit for beneficiaries with end-stage renal disease and beneficiaries with cancer; and regulations, star ratings, and fee-for-service Medicare policies aimed at improving nursing home quality.
Additional links: Exploring the Effect of Medicare Advantage on Rural Hospitals
Date: 04/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Small Practice After-Action Review: 2023 Performance Year Final Score
Tool for small practices interested in examining their 2023 Merit-based Incentive Payment System (MIPS) final score to identify opportunities to improve performance in 2025.
Additional links: Video: Small Practice Action Planning Tool for MIPS
Date: 04/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Tool for small practices interested in examining their 2023 Merit-based Incentive Payment System (MIPS) final score to identify opportunities to improve performance in 2025.
Additional links: Video: Small Practice Action Planning Tool for MIPS
Date: 04/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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The Impacts of New York's Balance Billing Regulation on Ground Ambulance Pricing
Examines the impact of surprise out-of-network (OON) billing regulations on New York emergency ground ambulances. Analyzes 2012-2019 commercial claims data and discusses the impacts of billing regulations on costs of care, with considerations related to transports from rural, super-rural, and urban locations.
Author(s): Wendy Y. Xu, Christopher Garmon, Sheldon M. Retchin, Yiting Li
Citation: Health Services Research, 60(2)
Date: 04/2025
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Examines the impact of surprise out-of-network (OON) billing regulations on New York emergency ground ambulances. Analyzes 2012-2019 commercial claims data and discusses the impacts of billing regulations on costs of care, with considerations related to transports from rural, super-rural, and urban locations.
Author(s): Wendy Y. Xu, Christopher Garmon, Sheldon M. Retchin, Yiting Li
Citation: Health Services Research, 60(2)
Date: 04/2025
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Advancing Value-Based Payment Policies Relevant to Rural Areas – Continued Challenges and New Opportunities
Discusses lessons from the recent public health emergency, rising health care costs, improved quality measurement, and innovative technologies on the transition from volume-based payment to value-based payment. Outlines potential policy opportunities for the Centers for Medicare & Medicaid Services (CMS) Innovation Center model design and CMS program inclusion to expand rural-appropriate opportunities to participate in the transition to value-based care. Builds on the 2020 publication How to Design Value‐based Care Models for Rural Participant Success: A Summit Findings Report.
Date: 04/2025
Sponsoring organization: Rural Health Value
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Discusses lessons from the recent public health emergency, rising health care costs, improved quality measurement, and innovative technologies on the transition from volume-based payment to value-based payment. Outlines potential policy opportunities for the Centers for Medicare & Medicaid Services (CMS) Innovation Center model design and CMS program inclusion to expand rural-appropriate opportunities to participate in the transition to value-based care. Builds on the 2020 publication How to Design Value‐based Care Models for Rural Participant Success: A Summit Findings Report.
Date: 04/2025
Sponsoring organization: Rural Health Value
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Medicare Advantage Reimbursement Remains Top Challenge for RHCs
Summarizes results of a 2025 national survey of over 1,200 Rural Health Clinics. Presents data on the average payer mix, Medicare Advantage (MA) reimbursement relative to traditional Medicare reimbursement, MA contract structures, use and attitude toward telehealth services, and more.
Additional links: NARHC 2025 Policy Survey Results
Date: 03/2025
Sponsoring organization: National Association of Rural Health Clinics
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Summarizes results of a 2025 national survey of over 1,200 Rural Health Clinics. Presents data on the average payer mix, Medicare Advantage (MA) reimbursement relative to traditional Medicare reimbursement, MA contract structures, use and attitude toward telehealth services, and more.
Additional links: NARHC 2025 Policy Survey Results
Date: 03/2025
Sponsoring organization: National Association of Rural Health Clinics
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2025 MIPS Eligibility Decision Tree
Presents information to determine if providers are eligible to participate in the Merit-Based Incentive Payment System (MIPS) in the 2025 Performance Year. Includes information on the low-volume threshold criteria.
Date: 03/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Presents information to determine if providers are eligible to participate in the Merit-Based Incentive Payment System (MIPS) in the 2025 Performance Year. Includes information on the low-volume threshold criteria.
Date: 03/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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MedPAC Report to the Congress: Medicare Payment Policy, 2025
Annual review of Medicare payment policies, with recommendations to Congress. Includes discussion on Medicare payment policies directly affecting rural providers and beneficiaries. Addresses payment adequacy for Medicare fee-for-service payment systems, Medicare Advantage (MA), and Medicare Part D.
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Annual review of Medicare payment policies, with recommendations to Congress. Includes discussion on Medicare payment policies directly affecting rural providers and beneficiaries. Addresses payment adequacy for Medicare fee-for-service payment systems, Medicare Advantage (MA), and Medicare Part D.
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Report to the Congress: Medicare Payment Policy: Skilled Nursing Facility Services: Chapter 6
Discusses payment adequacy for skilled nursing facility (SNF) services. Features statistics on SNF care provided by rural hospitals and Critical Access Hospitals (CAHs) via swing beds and Medicare margins for urban, rural, and frontier freestanding SNFs in 2023.
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Discusses payment adequacy for skilled nursing facility (SNF) services. Features statistics on SNF care provided by rural hospitals and Critical Access Hospitals (CAHs) via swing beds and Medicare margins for urban, rural, and frontier freestanding SNFs in 2023.
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Report to the Congress: Medicare Payment Policy: Home Health Care Services: Chapter 7
Discusses payment adequacy for home health care services. Features statistics on Medicare margins for home health agencies between 2019-2023 with breakdowns by urban and rural areas, a comparison of patient-experience quality measures by urban and rural status, and the number of home health periods provided to rural beneficiaries.
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Discusses payment adequacy for home health care services. Features statistics on Medicare margins for home health agencies between 2019-2023 with breakdowns by urban and rural areas, a comparison of patient-experience quality measures by urban and rural status, and the number of home health periods provided to rural beneficiaries.
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
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