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Resources by Topic: Reimbursement and payment models

Medicare Payment Basics: Long-term Care Hospitals Payment System
Overview of Medicare payments for long-term care hospitals (LTCH) and services. Discusses the LTCH prospective payment system (PPS) and payment rate settings for LTCH and site-neutral cases. Includes information on payment system changes during the COVID-19 public health emergency.
Date: 10/2022
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Inpatient Rehabilitation Facilities Payment System
Overview of Medicare's payment system for inpatient rehabilitation services in freestanding facilities or within acute care hospitals. Demonstrates how payment rates are adjusted to account for certain facility characteristics, including facilities in rural areas.
Date: 10/2022
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Inpatient Psychiatric Facilities Services Payment System
Overview of Medicare's payment system for inpatient psychiatric services provided in freestanding hospitals or specialized hospital-based units. Demonstrates how payments for these services are adjusted to reflect geographic differences in labor costs, and cost of care by facility and patient characteristics.
Date: 10/2022
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Hospital Acute Inpatient Services Payment System
Overview of Medicare payments to hospitals for acute inpatient care. Includes information on rate setting, Medicare payments for medical education, payments to Medicare Disproportionate Share Hospitals (DSH), new technology payments special payments for rural hospitals, quality incentive payments and penalties, and payment rate updates.
Date: 10/2022
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Hospice Services Payment System
Overview of the Medicare hospice benefit and Medicare payments to hospice providers. Describes the four levels of care of the hospice prospective payment system and payment rates.
Date: 10/2022
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Home Health Care Services Payment System
Overview of Medicare payments for home health care services. Includes information on rate-setting and payments based on quality reporting and performance. Describes the Patient-Driven Groupings Model (PDGM) and the home health resource groups (HHRGs) based on clinical and functional status.
Date: 10/2022
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Durable Medical Equipment Payment System
Overview of Medicare payments for medical equipment used to treat beneficiaries at home. Defines durable medical equipment (DME), details the DME fee schedule, and discusses the competitive bidding program (CBP) for DME. Includes information on adjustments to fee schedule payment rates outside of competitive bidding areas (CBAs) during the COVID-19 public health emergency.
Date: 10/2022
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Ambulance Services Payment System
Provides an overview of Medicare payments for ambulance services. Discusses rural add-on payment policies, geographic categories determining payment rates, super-rural ZIP codes, and ambulance fee schedules. Includes information on payment system changes during the COVID-19 public health emergency.
Date: 10/2022
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Accountable Care Organizations Payment Systems
Provides an overview of Medicare's Accountable Care Organization (ACO) programs. Discusses the payment mechanics of ACOs, including the maximum shared savings and losses of Medicare Shared Savings Program ACOs by track and level.
Date: 10/2022
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Critical Access Hospitals Payment System
Presents an overview of Medicare payments for Critical Access Hospitals (CAHs). Compares differences in Medicare payments for CAHs, Sole Community Hospitals, and Medicare-Dependent Hospitals.
Date: 10/2022
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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