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Rural Health
Resources by Topic: Reimbursement and payment models

Rural Hospitals and Medicaid Payment Policy
Fact sheet describing how rural hospitals serve Medicaid beneficiaries and the process through which Medicaid programs pay rural hospitals. Features statistics from 2015 with breakdowns by urban hospitals, Critical Access Hospitals (CAHs), and other rural hospitals.
Date: 08/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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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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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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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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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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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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MedPAC Data Book: Health Care Spending and the Medicare Program, 2018
Provides an overview of Medicare spending and highlights data on Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care provided through the Medicare program, and other payer liability. Examines settings of care, including rural specific provider sites, as they relate to spending, access to care, and profit margins. Compares rural to urban throughout.
Date: 06/2018
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Global Surgical Days for Critical Access Hospital (CAH) Method II
Discusses Medicare payment regulations for the global surgical package, including pre-operative, intra-operative, and post-operative services, effective July 1, 2018.
Date: 06/2018
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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MedPAC Comment on CMS's Proposed Rule on the Hospital Inpatient Prospective Payment System and the Long-term Care Hospital Prospective Payment System for FY 2019
Comment on a May 7, 2018 Federal Register proposed rule revising the hospital inpatient prospective payment system, the long-term care hospital payment system, and quality reporting requirements for specific providers. Includes rural-specific discussion related to the hospital wage index and the related rural floor policy.
Date: 06/2018
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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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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