Rural Health
Resources by Topic: Reimbursement and payment models
Exploring the State of Value-Based Care
Slides presented to the South Dakota Rural Health Equity Summit on September 5, 2024. Provides an overview of value-based care and payment models and progress toward value-based care models. Describes potential strategies state agencies and organizations may use to assist rural healthcare organizations to deliver value-based care and receive value-based payments. Highlights state-level engagements to advance rural value-based care and payment in North Dakota and Pennsylvania.
Author(s): Karla Weng
Date: 09/2024
Type: Presentation Slides
Sponsoring organization: Rural Health Value
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Slides presented to the South Dakota Rural Health Equity Summit on September 5, 2024. Provides an overview of value-based care and payment models and progress toward value-based care models. Describes potential strategies state agencies and organizations may use to assist rural healthcare organizations to deliver value-based care and receive value-based payments. Highlights state-level engagements to advance rural value-based care and payment in North Dakota and Pennsylvania.
Author(s): Karla Weng
Date: 09/2024
Type: Presentation Slides
Sponsoring organization: Rural Health Value
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Environmental Scan on Identifying a Pathway Toward Maximizing Participation in Population-Based Total Cost of Care (PB-TCOC) Models
Presents results of an environmental scan on the identification of a pathway toward maximizing participation in population-based total cost of care (PB-TCOC) models. Describes the Center for Medicare & Medicaid Services's (CMS's) goal of having all Medicare beneficiaries with Parts A and B in accountable care relationships by 2030. Discusses challenges and technical issues related to maximizing participation in PB-TCOC models, including organizational structure, payment, and risk adjustment. Summarizes relevant features of CMS Innovation Center (CMMI) models identified in previous Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references and considerations throughout.
Date: 09/2024
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Presents results of an environmental scan on the identification of a pathway toward maximizing participation in population-based total cost of care (PB-TCOC) models. Describes the Center for Medicare & Medicaid Services's (CMS's) goal of having all Medicare beneficiaries with Parts A and B in accountable care relationships by 2030. Discusses challenges and technical issues related to maximizing participation in PB-TCOC models, including organizational structure, payment, and risk adjustment. Summarizes relevant features of CMS Innovation Center (CMMI) models identified in previous Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references and considerations throughout.
Date: 09/2024
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Rural Emergency Hospitals Fact Sheet
Provides a brief overview of the Rural Emergency Hospital (REH) provider designation. Outlines REH payment, services, eligibility requirements, and how to apply for REH designation.
Date: 09/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides a brief overview of the Rural Emergency Hospital (REH) provider designation. Outlines REH payment, services, eligibility requirements, and how to apply for REH designation.
Date: 09/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Financial Performance of Rural and Urban Hospitals in the Medicare Shared Savings Program
Presents financial performance trends of hospitals that participated in Medicare's Shared Savings Program (SSP) from 2011-2018. Compares trends in 6 financial outcomes between SSP and non-SSP hospitals, and differences in these trends among rural and urban hospitals.
Author(s): Huang Huang, Xi Zhu, Fred Ullrich, A. Clinton MacKinney, Keith Mueller
Date: 09/2024
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Presents financial performance trends of hospitals that participated in Medicare's Shared Savings Program (SSP) from 2011-2018. Compares trends in 6 financial outcomes between SSP and non-SSP hospitals, and differences in these trends among rural and urban hospitals.
Author(s): Huang Huang, Xi Zhu, Fred Ullrich, A. Clinton MacKinney, Keith Mueller
Date: 09/2024
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Evaluating the Effectiveness of a Patient-Centered, Nonphysician Led Self-Monitoring Blood Pressure Program in a Rural Federally Qualified Health Center
Evaluated the effectiveness of a self-monitoring blood pressure program (SMBP) involving a nonphysician team for 205 patients with recent hypertension diagnoses in a rural Washington Federally Qualified Health Center (FQHC). Discusses facilitators and barriers to implementation including COVID-19, telehealth, community health workers, working with limited English proficiency populations, reimbursement, and collaborations.
Author(s): Magali Sanchez, KeliAnne Hara-Hubbard, Bárbara Baquero
Citation: Journal of Public Health Management and Practice, 30, S3167-S174
Date: 09/2024
Type: Document
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Evaluated the effectiveness of a self-monitoring blood pressure program (SMBP) involving a nonphysician team for 205 patients with recent hypertension diagnoses in a rural Washington Federally Qualified Health Center (FQHC). Discusses facilitators and barriers to implementation including COVID-19, telehealth, community health workers, working with limited English proficiency populations, reimbursement, and collaborations.
Author(s): Magali Sanchez, KeliAnne Hara-Hubbard, Bárbara Baquero
Citation: Journal of Public Health Management and Practice, 30, S3167-S174
Date: 09/2024
Type: Document
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Merit-based Incentive Payment System (MIPS): 2024 What's New for Small Practices
Summarizes new elements of the Merit-based Incentive Payment System (MIPS) for small practices - a group of 15 or fewer clinicians billing under a practice's Taxpayer Identification Number (TIN) - during the 2024 performance year. Discusses changes to performance category requirements and flexibilities, new MIPS Value Pathways (MVPs), and performance threshold and payment adjustments. Includes information on performance category redistribution policies for small practices.
Date: 09/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Summarizes new elements of the Merit-based Incentive Payment System (MIPS) for small practices - a group of 15 or fewer clinicians billing under a practice's Taxpayer Identification Number (TIN) - during the 2024 performance year. Discusses changes to performance category requirements and flexibilities, new MIPS Value Pathways (MVPs), and performance threshold and payment adjustments. Includes information on performance category redistribution policies for small practices.
Date: 09/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-based Incentive Payment System (MIPS): 2024 MIPS Quick Start Guide for Small Practices
Provides an overview of the Merit-based Incentive Payment System (MIPS). Outlines 6 steps for small practices regarding participation in the 2024 performance year. Includes information on performance category redistribution policies for small practices.
Date: 09/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of the Merit-based Incentive Payment System (MIPS). Outlines 6 steps for small practices regarding participation in the 2024 performance year. Includes information on performance category redistribution policies for small practices.
Date: 09/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-Based Incentive Payment System (MIPS): 2024 Improvement Activities Performance Category Quick Start Guide
Provides an overview of Merit-based Incentive Payment System (MIPS) requirements, data collection, and data submission for the improvement activities performance category for the 2024 performance year. Includes information about special status scoring for small practices and clinicians located in a rural or Health Professional Shortage Area.
Date: 09/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of Merit-based Incentive Payment System (MIPS) requirements, data collection, and data submission for the improvement activities performance category for the 2024 performance year. Includes information about special status scoring for small practices and clinicians located in a rural or Health Professional Shortage Area.
Date: 09/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-Based Incentive Payment System (MIPS): 2023 Opt-in and Voluntary Reporting Election Process Guide
Discusses the eligibility of clinicians, groups, and Alternative Payment Model (APM) participants that exceed some low-volume threshold criteria to opt-in to the Merit-Based Incentive Payment System (MIPS) and the APM Performance Pathway (APP) for the 2023 performance period. Compares opting in and voluntarily reporting MIPS data and provides an overview of the election process.
Date: 09/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Discusses the eligibility of clinicians, groups, and Alternative Payment Model (APM) participants that exceed some low-volume threshold criteria to opt-in to the Merit-Based Incentive Payment System (MIPS) and the APM Performance Pathway (APP) for the 2023 performance period. Compares opting in and voluntarily reporting MIPS data and provides an overview of the election process.
Date: 09/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Billing for Telehealth Encounters: An Introductory Guide on Fee-for-Service
Presents an overview of how to bill fee-for-service Medicare and Medicaid for telehealth encounters. Includes information on originating and distant sites, virtual healthcare, and coding telehealth services. Lists types of practice sites, including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), and implications for billing telehealth services. Provides contact information for Regional Telehealth Research Centers (RTRC).
Date: 09/2024
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Presents an overview of how to bill fee-for-service Medicare and Medicaid for telehealth encounters. Includes information on originating and distant sites, virtual healthcare, and coding telehealth services. Lists types of practice sites, including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), and implications for billing telehealth services. Provides contact information for Regional Telehealth Research Centers (RTRC).
Date: 09/2024
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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