Rural Health
Resources by Topic: Reimbursement and payment models
CMS Bundled Payments for Care Improvement Advanced Model: Sixth Annual Evaluation Report
Sixth annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which tests whether linking payments for a clinical episode of care can reduce Medicare expenditures while maintaining or improving the quality of care. Examines the impact of BPCI Advanced on episode payments, utilization, and quality of care, as well as estimates of Medicare program savings in Model Year 5. Also explores the impact of the model on accountable care relationships, strengthening primary care, and care for patients eligible for both Medicare and Medicaid. Includes data on the percentage of BPCI Advanced episodes with and without ACO attribution by patient characteristics, including rural residents.
Additional links: Appendices, Executive Summary, Findings at a Glance, Transformation Spotlight
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Sixth annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which tests whether linking payments for a clinical episode of care can reduce Medicare expenditures while maintaining or improving the quality of care. Examines the impact of BPCI Advanced on episode payments, utilization, and quality of care, as well as estimates of Medicare program savings in Model Year 5. Also explores the impact of the model on accountable care relationships, strengthening primary care, and care for patients eligible for both Medicare and Medicaid. Includes data on the percentage of BPCI Advanced episodes with and without ACO attribution by patient characteristics, including rural residents.
Additional links: Appendices, Executive Summary, Findings at a Glance, Transformation Spotlight
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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April 2025 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2025 meeting. Covers physician fee schedule updates and improving the accuracy of relative payment rates; structural differences between the stand-alone prescription drug plan (PDP) and Medicare Advantage–Prescription Drug plan (MA–PD) markets; the utilization and delivery of Medicare Advantage supplemental benefits; the effect of Medicare Advantage on rural hospitals; paying for software technologies in Medicare; access to hospice and certain services under the hospice benefit for beneficiaries with end-stage renal disease and beneficiaries with cancer; and regulations, star ratings, and fee-for-service Medicare policies aimed at improving nursing home quality.
Additional links: Exploring the Effect of Medicare Advantage on Rural Hospitals
Date: 04/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2025 meeting. Covers physician fee schedule updates and improving the accuracy of relative payment rates; structural differences between the stand-alone prescription drug plan (PDP) and Medicare Advantage–Prescription Drug plan (MA–PD) markets; the utilization and delivery of Medicare Advantage supplemental benefits; the effect of Medicare Advantage on rural hospitals; paying for software technologies in Medicare; access to hospice and certain services under the hospice benefit for beneficiaries with end-stage renal disease and beneficiaries with cancer; and regulations, star ratings, and fee-for-service Medicare policies aimed at improving nursing home quality.
Additional links: Exploring the Effect of Medicare Advantage on Rural Hospitals
Date: 04/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Fiscal Year 2026 Medicare Inpatient Psychiatric Facility Prospective Payment System and Quality Reporting Updates Proposed Rule CMS-1831-P Fact Sheet
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2026 inpatient psychiatric facility (IPF) prospective payment system (PPS) proposed rule. Covers proposed annual updates to the prospective payment rates, outlier threshold, and wage index. Also describes proposed changes to facility-level adjustment factors for teaching status and rural location.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2026 inpatient psychiatric facility (IPF) prospective payment system (PPS) proposed rule. Covers proposed annual updates to the prospective payment rates, outlier threshold, and wage index. Also describes proposed changes to facility-level adjustment factors for teaching status and rural location.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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2025 Merit-Based Incentive Payment System (MIPS) At-A-Glance Reporting Options for Small Practices
Provides a comparison of the three Merit-Based Incentive Payment System (MIPS) reporting options for MIPS-eligible clinicians in small practices: Traditional MIPS, MIPS Value Pathways (MVP), and Alternative Payment Model (APM) Performance Pathway (APP). Highlights data submission and performance category weighting and flexibilities for small practices.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides a comparison of the three Merit-Based Incentive Payment System (MIPS) reporting options for MIPS-eligible clinicians in small practices: Traditional MIPS, MIPS Value Pathways (MVP), and Alternative Payment Model (APM) Performance Pathway (APP). Highlights data submission and performance category weighting and flexibilities for small practices.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Small Practice After-Action Review: 2023 Performance Year Final Score
Tool for small practices interested in examining their 2023 Merit-based Incentive Payment System (MIPS) final score to identify opportunities to improve performance in 2025.
Additional links: Video: Small Practice Action Planning Tool for MIPS
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Tool for small practices interested in examining their 2023 Merit-based Incentive Payment System (MIPS) final score to identify opportunities to improve performance in 2025.
Additional links: Video: Small Practice Action Planning Tool for MIPS
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-based Incentive Payment System (MIPS) 2025 Small Practice Eligibility and Participation Frequently Asked Questions
Provides answers to frequently asked questions regarding small practice participation and eligibility for the Merit-based Incentive Payment System (MIPS) for the 2025 performance year. Covers individual and group eligibility, the low-volume threshold, changes to group composition during the performance year, and more.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides answers to frequently asked questions regarding small practice participation and eligibility for the Merit-based Incentive Payment System (MIPS) for the 2025 performance year. Covers individual and group eligibility, the low-volume threshold, changes to group composition during the performance year, and more.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-Based Incentive Payment System (MIPS): 2025 Merit-Based Incentive Payment (MIPS) Value Pathways (MVPs) Implementation Guide
Provides an overview of the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs), a voluntary reporting option that can be used to meet MIPS reporting requirements for the 2025 performance year. Describes subgroup reporting, reporting requirements, scoring, performance feedback and public reporting, and how to register to report an MVP. Includes information on considerations and exceptions for small practices and clinicians in a rural or Health Professional Shortage Area.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs), a voluntary reporting option that can be used to meet MIPS reporting requirements for the 2025 performance year. Describes subgroup reporting, reporting requirements, scoring, performance feedback and public reporting, and how to register to report an MVP. Includes information on considerations and exceptions for small practices and clinicians in a rural or Health Professional Shortage Area.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-Based Incentive Payment System (MIPS): 2025 Reporting MIPS Quality Measures through Medicare Part B Claims Quick Start Guide for Small Practices
Provides details on how small practices can report quality measures through Medicare Part B claims measures. Highlights changes to these measures in 2025, score redistribution policies for small practices, and information for clinicians at Critical Access Hospitals.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides details on how small practices can report quality measures through Medicare Part B claims measures. Highlights changes to these measures in 2025, score redistribution policies for small practices, and information for clinicians at Critical Access Hospitals.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-Based Incentive Payment System (MIPS): Traditional MIPS Scoring Guide for the 2024 Performance Year
Provides details on how scores are calculated for the Merit-Based Incentive Payment System (MIPS), one of two tracks 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 practices.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides details on how scores are calculated for the Merit-Based Incentive Payment System (MIPS), one of two tracks 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 practices.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-based Incentive Payment System (MIPS): Eligibility and Participation in the 2025 Performance Year
Provides an overview of the Merit-Based Incentive Payment System (MIPS) eligibility criteria. Addresses calculation of the low-volume threshold exclusion at the individual and group levels, opt-in and voluntary reporting options, and the impact of special status designations such as rural and small practices.
Date: 03/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of the Merit-Based Incentive Payment System (MIPS) eligibility criteria. Addresses calculation of the low-volume threshold exclusion at the individual and group levels, opt-in and voluntary reporting options, and the impact of special status designations such as rural and small practices.
Date: 03/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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