Rural Health
Resources by Topic: Reimbursement and payment models
The Rural Emergency Hospital Model: Year Two Progress Report
Provides an overview of the Rural Emergency Hospital (REH) payment designation, including the growth in REHs through September 1, 2024, factors that contribute to a hospital seeking REH conversion, and the impacts of REH conversion. Outlines concerns identified by REH leaders, facilities considering converting to REH status, and other rural stakeholders related to the REH designation, as well as policy recommendations to address these concerns.
Author(s): Emma Sheffert, Julia Harris, Marilyn Werber Serafini
Date: 10/2024
Sponsoring organization: Bipartisan Policy Center
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Provides an overview of the Rural Emergency Hospital (REH) payment designation, including the growth in REHs through September 1, 2024, factors that contribute to a hospital seeking REH conversion, and the impacts of REH conversion. Outlines concerns identified by REH leaders, facilities considering converting to REH status, and other rural stakeholders related to the REH designation, as well as policy recommendations to address these concerns.
Author(s): Emma Sheffert, Julia Harris, Marilyn Werber Serafini
Date: 10/2024
Sponsoring organization: Bipartisan Policy Center
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Northern Maine Medical Center: A Rural Hospital Gaining Momentum in its Work Toward Quality Improvement
Profiles a prospective payment hospital in northern Maine that engaged in the 2022-2023 Rural Healthcare Provider Transition Project (RHPTP), focusing on financial sustainability, cost efficiency, and quality improvement. Highlights hospital accomplishments and improvements via participation of the project.
Date: 10/2024
Sponsoring organization: National Rural Health Resource Center
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Profiles a prospective payment hospital in northern Maine that engaged in the 2022-2023 Rural Healthcare Provider Transition Project (RHPTP), focusing on financial sustainability, cost efficiency, and quality improvement. Highlights hospital accomplishments and improvements via participation of the project.
Date: 10/2024
Sponsoring organization: National Rural Health Resource Center
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Health Care Workforce: Key Issues, Challenges, and the Path Forward
Provides an overview of the supply and distribution of physicians, nurses, direct care workers, behavioral health workers, and oral healthcare providers. Describes persistent challenges related to the healthcare workforce, including supply and distribution of healthcare workers, especially in rural communities; racial and ethnic diversity; burnout; compensation; and administrative burden. Identifies opportunities to address these challenges and efforts supported by the U.S. Department of Health and Human Services to address these issues.
Date: 10/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Provides an overview of the supply and distribution of physicians, nurses, direct care workers, behavioral health workers, and oral healthcare providers. Describes persistent challenges related to the healthcare workforce, including supply and distribution of healthcare workers, especially in rural communities; racial and ethnic diversity; burnout; compensation; and administrative burden. Identifies opportunities to address these challenges and efforts supported by the U.S. Department of Health and Human Services to address these issues.
Date: 10/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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What to Know About Medicare Coverage of Telehealth
Discusses telehealth use by Medicare patients before, during, and after declaration of the COVID-19 public health emergency. Notes temporary telehealth provisions set to expire December 31, 2024, telehealth provisions made permanent, and trends in use since 2020. Includes rural and urban comparisons of telehealth use since 2020. Discusses payment models for Medicare and Medicare Advantage, current policies related to telehealth, fraud, and the cost of coverage through Medicare.
Author(s): Alex Cottrill, Juliette Cubanski, Tricia Neuman
Date: 10/2024
Sponsoring organization: KFF
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Discusses telehealth use by Medicare patients before, during, and after declaration of the COVID-19 public health emergency. Notes temporary telehealth provisions set to expire December 31, 2024, telehealth provisions made permanent, and trends in use since 2020. Includes rural and urban comparisons of telehealth use since 2020. Discusses payment models for Medicare and Medicare Advantage, current policies related to telehealth, fraud, and the cost of coverage through Medicare.
Author(s): Alex Cottrill, Juliette Cubanski, Tricia Neuman
Date: 10/2024
Sponsoring organization: KFF
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Merit-Based Incentive Payment System (MIPS): 2025 MIPS Payment Year (2023 Performance Year) - Payment Adjustment User Guide
Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2025. Describes how 2023 MIPS scores relate to 2025 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2025. Describes how 2023 MIPS scores relate to 2025 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Payment Basics: Federally Qualified Health Center and Rural Health Clinic Payment Systems
Presents an overview of Medicare payments for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Details how the all-inclusive rate (AIR) is calculated for RHCs and how the national statutory payment limit applies to provider-based RHCs enrolled in Medicare before December 31, 2020, and whether they part of a hospital with fewer than 50 beds. Includes information on special payment rules for certain services provided by FQHCs and RHCs.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Presents an overview of Medicare payments for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Details how the all-inclusive rate (AIR) is calculated for RHCs and how the national statutory payment limit applies to provider-based RHCs enrolled in Medicare before December 31, 2020, and whether they part of a hospital with fewer than 50 beds. Includes information on special payment rules for certain services provided by FQHCs and RHCs.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Skilled Nursing Facility Services Payment System
Overview of Medicare payments for skilled nursing and rehabilitation services. Describes what constitutes a skilled nursing facility and how small, rural hospitals and Critical Access Hospitals (CAHs) may be used to provide these services with CMS approval. Compares Medicare daily base rates for urban and rural skilled nursing facilities.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Overview of Medicare payments for skilled nursing and rehabilitation services. Describes what constitutes a skilled nursing facility and how small, rural hospitals and Critical Access Hospitals (CAHs) may be used to provide these services with CMS approval. Compares Medicare daily base rates for urban and rural skilled nursing facilities.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Physician and Other Health Professional Payment System
Overview of Medicare payments for physician services conducted in a variety of settings including physicians' offices, hospitals, ambulatory surgical centers, skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries' homes.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Overview of Medicare payments for physician services conducted in a variety of settings including physicians' offices, hospitals, ambulatory surgical centers, skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries' homes.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Part D Payment System
Overview of the Medicare Part D prescription drug benefit, including subsidy amounts, payments to plans, how enrollee premiums are calculated, and benefit and payment updates.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Overview of the Medicare Part D prescription drug benefit, including subsidy amounts, payments to plans, how enrollee premiums are calculated, and benefit and payment updates.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Outpatient Hospital Services Payment System
Outlines Medicare's payments for outpatient hospital services, including considerations for rural sole community hospitals.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Outlines Medicare's payments for outpatient hospital services, including considerations for rural sole community hospitals.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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