Rural Health
Resources by Topic: Reimbursement and payment models
2018 Rural Hospital and Clinic Financial Summit Report: Key Financial Success Indicators and Strategies
Identifies the indicators of financial success for hospitals and clinics, provides strategies to transition into value-based payment models, and includes success stories from Summit participants and resources necessary for hospitals and clinics. Includes a table showing Critical Access Hospital financial indicators medians for 2016.
Date: 07/2018
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Identifies the indicators of financial success for hospitals and clinics, provides strategies to transition into value-based payment models, and includes success stories from Summit participants and resources necessary for hospitals and clinics. Includes a table showing Critical Access Hospital financial indicators medians for 2016.
Date: 07/2018
Type: Document
Sponsoring organization: National Rural Health Resource Center
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The Medicaid Fee-for-Service Provider Payment Process
Outlines Medicaid's fee-for-services (FFS) provider payment process. Details the claims-based submission payment process, as well as additional non-claims-based payment processes. Includes information targeted to Rural Health Clinics and Federally Qualified Health Centers throughout.
Date: 07/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Outlines Medicaid's fee-for-services (FFS) provider payment process. Details the claims-based submission payment process, as well as additional non-claims-based payment processes. Includes information targeted to Rural Health Clinics and Federally Qualified Health Centers throughout.
Date: 07/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Rural Health Clinic Participation in the Merit-Based Incentive System and Other Quality Reporting Initiatives: Challenges and Opportunities
Reports on past and current RHC quality reporting initiatives in relation to the Merit-Based Incentive Payment System (MIPS). Explores options for RHCs to voluntarily participate in MIPS and covers challenges for RHCs participating in quality reporting.
Author(s): John A. Gale, Zachariah Croll, Andrew F. Coburn
Date: 07/2018
Type: Document
Sponsoring organization: Maine Rural Health Research Center
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Reports on past and current RHC quality reporting initiatives in relation to the Merit-Based Incentive Payment System (MIPS). Explores options for RHCs to voluntarily participate in MIPS and covers challenges for RHCs participating in quality reporting.
Author(s): John A. Gale, Zachariah Croll, Andrew F. Coburn
Date: 07/2018
Type: Document
Sponsoring organization: Maine Rural Health Research Center
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Average Beneficiary CMS Hierarchical Condition Category (HCC) Risk Scores for Rural and Urban Providers
Findings brief investigating potential differences in urban and rural CMS-HCC risk scores at the provider's patient panel level. Features statistics from the 2015 Medicare Physician and Other Supplier Public Use File to compare patient panel CMS-HCC risk scores with breakdowns by urban and rural providers across provider specialties, census divisions, and Merit-Based Incentive Payment System (MIPS) participation requirements.
Author(s): Abby F. Hoffman, Kristin L. Reiter, Randy K. Randolph
Date: 07/2018
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Findings brief investigating potential differences in urban and rural CMS-HCC risk scores at the provider's patient panel level. Features statistics from the 2015 Medicare Physician and Other Supplier Public Use File to compare patient panel CMS-HCC risk scores with breakdowns by urban and rural providers across provider specialties, census divisions, and Merit-Based Incentive Payment System (MIPS) participation requirements.
Author(s): Abby F. Hoffman, Kristin L. Reiter, Randy K. Randolph
Date: 07/2018
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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MedPAC Comment on CMS's Interim Final Rule on Durable Medical Equipment Fee Schedule Adjustments
Describes Medicare's method of setting payment rates for durable medical equipment, prosthetics, orthotics, and supplies, and explains the reinstitution of 50/50 blended payment rates for rural and non-contiguous areas from June 1, 2018 to December 31, 2018.
Author(s): Francis J. Crosson
Date: 07/2018
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Describes Medicare's method of setting payment rates for durable medical equipment, prosthetics, orthotics, and supplies, and explains the reinstitution of 50/50 blended payment rates for rural and non-contiguous areas from June 1, 2018 to December 31, 2018.
Author(s): Francis J. Crosson
Date: 07/2018
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Small and Rural Practices' Experiences in Previous Programs and Expected Performance in the Merit-Based Incentive Payment System
Examines how small and rural physician practices fared in legacy Medicare programs and reviews the projected effect of Merit-Based Incentive Payment System (MIPS). Discusses Medicare legacy program challenges small and rural physician practices experience including technology, financial and staff resources, and legacy program requirements. Covers efforts to assist small and rural physician practices participate in MIPS. Includes 2014 and 2015 data on Medicare legacy payment incentive programs by rural and urban status.
Additional links: Full Report
Date: 07/2018
Type: Document
Sponsoring organization: Government Accountability Office
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Examines how small and rural physician practices fared in legacy Medicare programs and reviews the projected effect of Merit-Based Incentive Payment System (MIPS). Discusses Medicare legacy program challenges small and rural physician practices experience including technology, financial and staff resources, and legacy program requirements. Covers efforts to assist small and rural physician practices participate in MIPS. Includes 2014 and 2015 data on Medicare legacy payment incentive programs by rural and urban status.
Additional links: Full Report
Date: 07/2018
Type: Document
Sponsoring organization: Government Accountability Office
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Estimate of Federal Payment Reductions to Hospitals Following the ACA 2010-2028: Estimates and Methodology
Examines cumulative federal payment reductions to hospitals for 2010-2028. Addresses the impact of sequestration, changes in Medicare payments for bad debt including to Critical Access Hospitals, federal Medicaid Disproportionate Share Hospital (DSH) allotments, and other legislation affecting hospital reimbursement.
Author(s): Allen Dobson, Joan DaVanzo, Randy Haught, Phap-Hoa Luu
Date: 06/2018
Type: Document
Sponsoring organizations: American Hospital Association, Dobson DaVanzo & Associates, Federation of American Hospitals
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Examines cumulative federal payment reductions to hospitals for 2010-2028. Addresses the impact of sequestration, changes in Medicare payments for bad debt including to Critical Access Hospitals, federal Medicaid Disproportionate Share Hospital (DSH) allotments, and other legislation affecting hospital reimbursement.
Author(s): Allen Dobson, Joan DaVanzo, Randy Haught, Phap-Hoa Luu
Date: 06/2018
Type: Document
Sponsoring organizations: American Hospital Association, Dobson DaVanzo & Associates, Federation of American Hospitals
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Evaluation of the Round Two Health Care Innovation Awards (HCIA R2): Third Annual Report
Summarizes the third year evaluation results of 38 Health Care Innovation Awards Round Two projects, one awardee of the original 39 having left the program in September 2016. Focuses on implementation effectiveness, developing payment models, planning for sustainability, and some preliminary work related to evaluating program impacts. Provides findings for the individual awardees, which include projects that serve rural areas.
Date: 06/2018
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica Policy Research
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Summarizes the third year evaluation results of 38 Health Care Innovation Awards Round Two projects, one awardee of the original 39 having left the program in September 2016. Focuses on implementation effectiveness, developing payment models, planning for sustainability, and some preliminary work related to evaluating program impacts. Provides findings for the individual awardees, which include projects that serve rural areas.
Date: 06/2018
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica Policy Research
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MedPAC Report to the Congress: Medicare and the Health Care Delivery System, June 2018
Evaluates Medicare payment issues and offers recommendations to the U.S. Congress. Includes a chapter on ensuring appropriate access to and use of hospital emergency department (ED) services that provides extensive information on rural access to ED services and identifies examples of rural off-campus emergency departments. Other sections of the report addressing rural concerns focus on post-acute care, quality and value payment programs, and medical device payment policies. Also includes a report on the effects of the Hospital Readmissions Reduction Program.
Additional links: Fact Sheet
Date: 06/2018
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Evaluates Medicare payment issues and offers recommendations to the U.S. Congress. Includes a chapter on ensuring appropriate access to and use of hospital emergency department (ED) services that provides extensive information on rural access to ED services and identifies examples of rural off-campus emergency departments. Other sections of the report addressing rural concerns focus on post-acute care, quality and value payment programs, and medical device payment policies. Also includes a report on the effects of the Hospital Readmissions Reduction Program.
Additional links: Fact Sheet
Date: 06/2018
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Geographic Variation in Uncompensated Care Between Rural and Urban Hospitals
Findings brief describing how uncompensated hospital care varies across regions of the country, using data from the 2014-2016 Medicare Cost Report Worksheet S-10. Features statistics including breakdowns by Critical Access Hospitals (CAHs), other rural hospitals, and urban hospitals.
Author(s): Krystal G. Garcia, Kristie Thompson, Hilda A. Howard, George H. Pink
Date: 06/2018
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Findings brief describing how uncompensated hospital care varies across regions of the country, using data from the 2014-2016 Medicare Cost Report Worksheet S-10. Features statistics including breakdowns by Critical Access Hospitals (CAHs), other rural hospitals, and urban hospitals.
Author(s): Krystal G. Garcia, Kristie Thompson, Hilda A. Howard, George H. Pink
Date: 06/2018
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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