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Rural Health
Resources by Topic: Reimbursement and payment models

Modeling the Frontier Extended Stay Clinic Conditions of Participation and Reimbursement Methodologies
Discusses the financial feasibility of the Frontier Extended Stay Clinic (FESC), a proposed provider type to expand services in remote and isolated primary care clinics. Compares Medicare reimbursement for FESC status with Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), and Critical Access Hospital (CAH) reimbursement. Includes detailed examples of financial impact for seven clinics in rural Alaska, Nevada, Washington, and Wyoming.
Date: 2004
Type: Document
Sponsoring organization: Federal Office of Rural Health Policy
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Rural-Urban Issues in the Wage Index Adjustment for Prospective Payment in Skilled Nursing Facilities
Discusses the use of the hospital wage index for the skilled nursing facility prospective payment system (SNF PPS) and how a change to an SNF wage index would impact rural and urban skilled nursing facilities. Also identifies some related issues that impact reimbursement to SNFs in both urban and rural areas.
Additional links: Findings Brief, January 2004
Author(s): Kathleen Dalton, Rebecca Slifkin
Date: 11/2003
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Medicare Physician Payment: Practice Expense
Describes the variation in Medicare payment for practice expense using the Geographic Practice Cost Indexes (GPCIs). Explains the factors that are used to calculate GPCIs and lists the 2003 GPCIs. Discusses potential impact of lower Medicare reimbursement to rural physicians for practice expense.
Author(s): A. Clinton MacKinney, Timothy D. McBride, Michael D. Shambaugh-Miller, Keith J. Mueller
Citation: RUPRI Rural Policy Brief, 8(9)
Date: 10/2003
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Ambulance Services: Medicare Payments Can be Better Targeted to Trips in Less Densely Populated Rural Areas
Covers factors that affect ambulance costs per trip, how these factors vary across geographic areas, and how well Medicare payments account for geographic cost differences.
Additional links: Full Report
Date: 09/2003
Type: Document
Sponsoring organization: Government Accountability Office
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MedPAC Report to the Congress: Variation and Innovation in Medicare
Analyzes variation within the Medicare program and explores a variety of possible payment innovations. Includes some rural-specific information. Geographic, market, quality, hospital financial performance, and use of physician services variations are covered. Also examines Medicare's reimbursement for Part B drugs. Recommendations include quality incentives and competitive pricing.
Date: 06/2003
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Report to the Congress: Medicare Payment Policy, 2003
Report to the Congress. Reviews the Medicare prospective payment systems (PPSs) for seven sectors: hospital inpatient, hospital outpatient, physician, skilled nursing, home health, outpatient dialysis, and ambulatory surgical center services. Also discusses broader issues related to Medicare payments. Includes recommendations. Appendix with data on hospital financial performance for 1991-2000.
Date: 03/2003
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Physician Payment
Provides an overview of how physicians are paid by Medicare, with a focus on the adjustments made related to geographic practice cost indexes (GPCIs). Discusses rural issues related to Medicare physician payment, including impact on physician recruitment and retention and healthcare access.
Author(s): A. Clinton MacKinney, Michael D. Shambaugh-Miller, Keith Mueller
Citation: RUPRI Rural Policy Brief, 8(2)
Date: 01/2003
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce
Examines licensure statutes and administrative rules for social workers, psychologists, professional counselors, and marriage and family therapists in the 40 states that have at least 10% of the population living in rural areas. Covers scope of practice, training and supervision, and reimbursement.
Additional links: Executive Summary, May 2002
Author(s): David Hartley, Erika C. Ziller, David Lambert, Stephenie L. Loux, Donna C. Bird
Date: 10/2002
Type: Document
Sponsoring organization: Maine Rural Health Research Center
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Trends in Special Medicare Payments and Service Utilization for Rural Areas in the 1990s
Presents the findings of an analysis of payment trends for providers qualifying under Medicare special payment provisions for rural providers. Covers payment trends for rural hospitals, Rural Health Clinics, Federally Qualified Health Centers, and physicians.
Author(s): Donna O. Farley, Lisa R. Shugarman, Pat Taylor, et al.
Date: 06/2002
Type: Document
Sponsoring organization: RAND Corporation
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Financial Incentives for Rural Hospitals to Expand the Scope of Their Services
Examines the financial incentives that rural hospitals have to conduct surgery and treat more complex medical conditions. Evaluates whether rural hospitals that offer broader services are more profitable than hospitals with very limited inpatient services. A low-volume adjustment considered by the Medicare Payment Advisory Commissions (MedPAC) is discussed.
Author(s): Jeffrey Stensland, Michelle Brasure, Ira Moscovice, Tiffany Radcliff
Date: 06/2002
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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