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Rural Health
Resources by Topic: Reimbursement and payment models

Medicaid Telehealth Policies in Response to COVID-19
Provides an overview Medicaid telehealth policies before and in response to the COVID-19 Public Health Emergency (PHE). Discusses how states have utilized existing flexibilities and PHE-specific federal authorities to increase the number of services, provider types, and other telehealth coverage options under Medicaid.
Date: 10/2020
Type: Document
Sponsoring organization: Congressional Research Service
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Volume to Value Transition for Rural Health Systems
Policy position paper providing an overview of the transition from volume-based payment models to value-based payment models. Identifies opportunities and barriers to rural healthcare success in value-based payment models. Presents policy recommendations to promote rural healthcare facility participation in value-based payment models.
Author(s): Kim Breidenbach, Tammy Moore
Date: 10/2020
Type: Document
Sponsoring organization: National Rural Health Association
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Merit-Based Incentive Payment System (MIPS) 101 Guide for the 2020 Performance Year
Provides an overview of the Merit-based Incentive Payment System (MIPS) track for clinicians participating in Medicare, one of two options under the Quality Payment Program. Details the 4 performance categories that are weighted as part of MIPS scoring: quality, cost, improvement activities, and promoting interoperability. Addresses calculation of the low-volume threshold exclusion, opt-in options, and the impact of special status designations such as rural and small practices.
Date: 10/2020
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Health System Affiliation and Characteristics of Inpatient Stays at Rural and Metropolitan Hospitals, 2016
Presents statistics on inpatient stays at rural and metropolitan hospitals. Compares the number of inpatient hospitals stays by metropolitan status, health system affiliation, census region, and selected characteristics of the patients and hospital stays.
Author(s): Zeynal Karaca, Kathryn R. Fingar
Date: 10/2020
Type: Document
Sponsoring organization: Agency for Healthcare Research and Quality
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MedPAC Comment on CMS's Proposed Rule on Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs for CY 2021
Comments on an August 12, 2020, Federal Register proposed rule revising the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ACS) payment system for calendar year 2021. Includes comments on payment rates for separately payable non–pass-through drugs obtained through the 340B Drug Pricing Program.
Date: 10/2020
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Comment on CMS's Proposed Rule on the Physician Fee Schedule and Other Revisions to Part B for CY 2021
Comment on an August 17, 2020 Federal Register proposed rule revising the physician fee schedule to improve payment systems for physicians and other Medicare Part B revisions. Includes a discussion of COVID-19-related telehealth expansion.
Date: 10/2020
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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CMS Coronavirus Waivers & Flexibilities
Lists Centers for Medicare and Medicaid Services (CMS) waivers and flexibilities available to healthcare providers to ensure healthcare access during the COVID-19 pandemic. Includes blanket waivers and fact sheets for specific types of providers, as well as approved states' other coronavirus 1135 waivers.
Date: 10/2020
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing
Addresses issues related to Medicare fee-for-service (FFS) billing during the COVID-19 public health emergency. Covers COVID-19 test specimen collection, diagnostic laboratory services, hospital services, ambulance services, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), telehealth, skilled nursing facility services, home health, and other services.
Date: 10/2020
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Fact Sheet: Expansion of the Accelerated and Advance Payments Program for Providers and Suppliers During COVID-19 Emergency
Explains the expansion of the CMS Accelerated and Advance Payment Program to a broader group of Medicare Part A providers and Part B suppliers under the COVID-19 public health emergency (PHE). Explains eligibility for the payments and offers a step-by-step guide on how facilities can request accelerated or advance payment. As of October 8, 2020, CMS will no longer accept applications for accelerated or advance payments related to the COVID-19 PHE.
Date: 10/2020
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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CMS: Current Emergencies: Coronavirus Disease 2019
Guidance from CMS for healthcare facilities and labs related to COVID-19. Includes clinical and technical guidance on infection control and prevention for specific types of facilities, information on billing and coding, coverage for services related to COVID-19, and other topics.
Date: 10/2020
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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