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Rural Health Information Hub

Rural Health
Resources by Topic: Reimbursement and payment models

2020 Quality Payment Program Experience Report
Reports on the clinician experience for those participating in the Quality Payment Program in 2020. Presents data on Merit-based Incentive Payment System (MIPS) eligibility and participation rates for clinicians in small practices and rural areas, as well as their mean payment adjustment scores.
Date: 07/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Emergency Hospitals Proposed Rulemaking
Provides an overview of Rural Emergency Hospitals, a Medicare provider type established by the Consolidated Appropriations Act, 2021. Details key policies outlined in two proposed rules, including payment policies, conditions or participation, REH provider enrollment, and exceptions to the physician self-referral law.
Date: 07/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Integrating Behavioral Health into Your RHC
Recording of a July 19, 2022, webinar regarding Rural Health Clinic (RHC) billing for behavioral health services. Part of the Rural Health Clinic Technical Assistance Series.
Additional links: Presentation Slides, Transcript
Date: 07/2022
Type: Video/Multimedia
Sponsoring organization: National Association of Rural Health Clinics
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Synthesis of Evaluation Results across 21 Medicare Models, 2012-2020
Summarizes results from evaluations of 21 Centers for Medicare & Medicaid (CMS) Innovation Center models. Examines measures related to gross and net Medicare spending, utilization, and quality of care. Identifies themes among models with similar participant types and interventions used. Offers considerations for acute or specialty care and targeted populations models and prevention and population management models.
Additional links: Findings at a Glance, Synthesis of Evaluation Results Across 21 Medicare Models Slides, Transcript, Webinar Recording
Date: 07/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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MedPAC Data Book: Health Care Spending and the Medicare Program, 2022
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 and urban beneficiaries and providers throughout. Chart 6-2 addresses rural hospital closures.
Date: 07/2022
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Engaging Your Board and Community in Value-Based Care Conversations
Provides starting points for healthcare organizations to engage in value-based care conversations with their board and community members to support strategic planning and informed decision-making.
Date: 07/2022
Type: Document
Sponsoring organization: Rural Health Value
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Report to Congress: Unified Payment for Medicare-Covered Post-Acute Care
Presents a prototype for a Unified Post-acute Care (PAC) prospective payment system (PPS) that would set payment for PAC services on the basis of the clinical characteristics of the patient rather than the type of provider. Details the structure of the prototype and the data used in the analyses to design and calibrate the PPS. Explores key considerations for unifying PAC payment, such as cost-sharing and value-based payment. Includes data on PAC provider characteristics, including facility size and rural status, as well as rural payment adjustments.
Additional links: Appendices
Author(s): Benjamin Silver, Anne Deutsch, Nicole Coomer, et al.
Date: 07/2022
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Behavioral Health and Primary Care Integration in Rural Health Facilities: Policy Brief and Recommendations to the Secretary
Provides an overview of the prevalence of mental illness and substance use disorders in rural areas. Discusses the role of rural primary care providers in treating these conditions. Outlines federal programs and resources to support behavioral health and primary care integration. Offers policy recommendations related to access to care; workforce recruitment and retention; telehealth, technology, and broadband; and reimbursement and sustainable revenue.
Date: 06/2022
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Merit-Based Incentive Payment System (MIPS): Traditional MIPS Scoring Guide for the 2022 Performance Year
Provides details on how scores are calculated for the Merit-Based Incentive Payment System (MIPS), one of two payment options under the Medicare Quality Payment Program. Explains the four performance categories that affect Medicare Physician Fee Schedule payments: quality, cost, improvement activities, and promoting interoperability. Includes information for small and rural practices.
Date: 06/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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The Pennsylvania Rural Health Model (PARHM): Second Annual Evaluation Report
Evaluates the second year of the Pennsylvania Rural Health Model (PARHM), an initiative designed to test if global budgets can help rural hospitals improve their financial viability, provide flexibility to meet locally defined community health needs, and reduce overall healthcare spending. Provides an overview of the model and describes the implementation experience of participating hospitals and payers. Presents a descriptive quantitative assessment of financial performance, spending and utilization, access to care, and quality of care outcomes during the second performance year.
Additional links: Appendix, Findings at a Glance
Date: 06/2022
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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