Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
Air Ambulance Use and Surprise Billing
Provides an overview of air ambulance services, including the types and number of air ambulance providers and suppliers, utilization rates by patients, average costs, and the potential for balance billing for air ambulance transport. Summarizes key policies and legislation related to air ambulances, including the No Surprises Act. Presents data on air ambulance utilization by rurality between 2014-2018.
Author(s): Gina Turrini, Joel Ruhter, Andre R. Chappel, Nancy De Lew
Date: 09/2021
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Provides an overview of air ambulance services, including the types and number of air ambulance providers and suppliers, utilization rates by patients, average costs, and the potential for balance billing for air ambulance transport. Summarizes key policies and legislation related to air ambulances, including the No Surprises Act. Presents data on air ambulance utilization by rurality between 2014-2018.
Author(s): Gina Turrini, Joel Ruhter, Andre R. Chappel, Nancy De Lew
Date: 09/2021
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Medicare Covers a Lower Percentage of Outpatient Costs in Hospitals Located in Rural Areas
Policy brief describing differences in Medicare Outpatient Prospective Payment System (OPPS) payments between urban and rural hospitals. Features statistics on OPPS payments as a percent of total net patient revenue, as a percent of Medicare outpatient cost by hospital payment classification, and as a percent of Medicare outpatient cost by number of acute beds, with breakdowns by urban and rural location.
Author(s): Pranathi Sana, George H. Pink
Date: 09/2021
Sponsoring organization: North Carolina Rural Health Research Program
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Policy brief describing differences in Medicare Outpatient Prospective Payment System (OPPS) payments between urban and rural hospitals. Features statistics on OPPS payments as a percent of total net patient revenue, as a percent of Medicare outpatient cost by hospital payment classification, and as a percent of Medicare outpatient cost by number of acute beds, with breakdowns by urban and rural location.
Author(s): Pranathi Sana, George H. Pink
Date: 09/2021
Sponsoring organization: North Carolina Rural Health Research Program
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Understanding the Rural Swing Bed: More than Just a Reimbursement Policy
Provides an overview of the swing bed program and its role as a patient-centric post-acute care solution that helps rural hospitals serve their communities. Discusses the impact of the program, reimbursement, quality measures, and more.
Author(s): Kay Miller Temple
Citation: Rural Monitor
Date: 08/2021
Sponsoring organization: Rural Health Information Hub
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Provides an overview of the swing bed program and its role as a patient-centric post-acute care solution that helps rural hospitals serve their communities. Discusses the impact of the program, reimbursement, quality measures, and more.
Author(s): Kay Miller Temple
Citation: Rural Monitor
Date: 08/2021
Sponsoring organization: Rural Health Information Hub
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Basics of Value-based Care and Payment
Slides presented to the Rural Healthcare Provider Transition Project (RHPTP) providing an overview of value-based care and payment models. Includes examples of rural providers addressing patient social needs, tackling local health issues, and aligning services with community needs.
Author(s): Jennifer P. Lundblad
Date: 06/2021
Sponsoring organization: Rural Health Value
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Slides presented to the Rural Healthcare Provider Transition Project (RHPTP) providing an overview of value-based care and payment models. Includes examples of rural providers addressing patient social needs, tackling local health issues, and aligning services with community needs.
Author(s): Jennifer P. Lundblad
Date: 06/2021
Sponsoring organization: Rural Health Value
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Medicaid and Rural Health
Provides an overview of rural residents, including socioeconomic characteristics, insurance status, and health status. Explores the availability of healthcare providers in rural areas, with a focus on primary care providers and hospitals. Discusses the role of Medicaid in rural health, as well as Medicaid policies and services that are important for providing healthcare in rural communities.
Date: 04/2021
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Provides an overview of rural residents, including socioeconomic characteristics, insurance status, and health status. Explores the availability of healthcare providers in rural areas, with a focus on primary care providers and hospitals. Discusses the role of Medicaid in rural health, as well as Medicaid policies and services that are important for providing healthcare in rural communities.
Date: 04/2021
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Supporting and Sustaining Rural Hospitals
Describes state and federal actions to support and safeguard rural hospitals. Discusses appropriated funding opportunities for struggling hospitals, Medicaid coverage and eligibility, alternative payment models, and technical assistance programs.
Author(s): Noah Cruz
Date: 04/2021
Sponsoring organization: National Conference of State Legislatures
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Describes state and federal actions to support and safeguard rural hospitals. Discusses appropriated funding opportunities for struggling hospitals, Medicaid coverage and eligibility, alternative payment models, and technical assistance programs.
Author(s): Noah Cruz
Date: 04/2021
Sponsoring organization: National Conference of State Legislatures
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State-Driven Initiatives to Support Moving to Value-Based Care in the Era of COVID-19
Describes four areas where state-driven strategies can facilitate and promote the adoption of value-based payment (VBP) models. Presents case examples throughout, including the Pennsylvania Rural Health Model. Discusses how additional federal actions could support transitions to VBP at the state level.
Author(s): Caroline Picher, Lauren Block, Mark Japinga, Hemi Tewarson
Date: 03/2021
Sponsoring organizations: Duke-Margolis Center for Health Policy, National Governors Association
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Describes four areas where state-driven strategies can facilitate and promote the adoption of value-based payment (VBP) models. Presents case examples throughout, including the Pennsylvania Rural Health Model. Discusses how additional federal actions could support transitions to VBP at the state level.
Author(s): Caroline Picher, Lauren Block, Mark Japinga, Hemi Tewarson
Date: 03/2021
Sponsoring organizations: Duke-Margolis Center for Health Policy, National Governors Association
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How to Design Value‐based Care Models for Rural Participant Success: A Summit Findings Report
Summarizes a July 2020 virtual summit of rural participants in value‐based care (VBC) models and programs. Details six themes on VBC model design, implementation, and operation that can influence rural organization participation in VBC models. Provides recommendations for VBC model designers to improve rural healthcare provider participation and success in VBC models.
Author(s): Keith Mueller, Clint MacKinney, Jennifer Lundblad, Karla Weng
Date: 12/2020
Sponsoring organization: Rural Health Value
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Summarizes a July 2020 virtual summit of rural participants in value‐based care (VBC) models and programs. Details six themes on VBC model design, implementation, and operation that can influence rural organization participation in VBC models. Provides recommendations for VBC model designers to improve rural healthcare provider participation and success in VBC models.
Author(s): Keith Mueller, Clint MacKinney, Jennifer Lundblad, Karla Weng
Date: 12/2020
Sponsoring organization: Rural Health Value
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Evaluation of the Accountable Care Organization Investment Model: Final Report
Examines the ACO Investment Model (AIM) over three performance years. AIM tested the use of prepaid shared savings to encourage new ACOs to form in rural and underserved areas and to encourage current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk. Reports on AIM results related to ACO formation, risk-taking, and sustainability, including the impact of rurality. Also discusses impacts on healthcare costs, utilization, and quality of care.
Additional links: Appendices, CMS Perspective Report, Findings at a Glance
Date: 09/2020
Sponsoring organizations: Abt Associates, Centers for Medicare and Medicaid Services
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Examines the ACO Investment Model (AIM) over three performance years. AIM tested the use of prepaid shared savings to encourage new ACOs to form in rural and underserved areas and to encourage current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk. Reports on AIM results related to ACO formation, risk-taking, and sustainability, including the impact of rurality. Also discusses impacts on healthcare costs, utilization, and quality of care.
Additional links: Appendices, CMS Perspective Report, Findings at a Glance
Date: 09/2020
Sponsoring organizations: Abt Associates, Centers for Medicare and Medicaid Services
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Evaluation of the Health Care Innovation Awards, Round 2: Final Report
Summarizes the final evaluation results of 38 Health Care Innovation Awards Round Two projects. Discusses program impacts on healthcare service use and costs, factors associated with positive impacts, and awardees' experiences sustaining programs and implementing payment models after the end of the awards. Offers overall findings and awardee-specific evaluation reports. Includes some information on results for projects serving rural areas.
Additional links: Findings at a Glance
Date: 09/2020
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica Policy Research
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Summarizes the final evaluation results of 38 Health Care Innovation Awards Round Two projects. Discusses program impacts on healthcare service use and costs, factors associated with positive impacts, and awardees' experiences sustaining programs and implementing payment models after the end of the awards. Offers overall findings and awardee-specific evaluation reports. Includes some information on results for projects serving rural areas.
Additional links: Findings at a Glance
Date: 09/2020
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica Policy Research
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Additional resources are available related to this guide. See the full list of resources by topic for:
- Accountable Care Organizations
- Care coordination
- Health insurance
- Healthcare business and finance
- Medicaid
- Medicare
- Policy
- Reimbursement and payment models
- Service delivery models
Last Updated: 2/5/2025