Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
The Pennsylvania Rural Health Model (PARHM): Third Annual Evaluation Report
Evaluates the third performance 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 from 2016, the model's baseline, through 2021. Includes three case studies discussing three themes: the recruitment and retention of system-affiliated hospitals, engagement and coordination with community organizations and providers, and exploring service line changes.
Additional links: Appendix, Findings at a Glance
Date: 09/2023
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
view details
Evaluates the third performance 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 from 2016, the model's baseline, through 2021. Includes three case studies discussing three themes: the recruitment and retention of system-affiliated hospitals, engagement and coordination with community organizations and providers, and exploring service line changes.
Additional links: Appendix, Findings at a Glance
Date: 09/2023
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
view details
Health Panel Comment Letter - 2024 Physician Fee Schedule and Medicare Part B Proposed Rule
Comments offered in response to a July 13, 2023, Federal Register proposed rule revising the Medicare Physician Fee Schedule. Includes discussions on telehealth services, services addressing health-related social needs, advancing access to behavioral health services, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), and the Medicare Shared Savings Program.
Date: 09/2023
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
view details
Comments offered in response to a July 13, 2023, Federal Register proposed rule revising the Medicare Physician Fee Schedule. Includes discussions on telehealth services, services addressing health-related social needs, advancing access to behavioral health services, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), and the Medicare Shared Savings Program.
Date: 09/2023
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
view details
MedPAC Comment on CMS's Proposed Rule on the Outpatient Prospective Payment System for FY 2024
Comment on the July 31, 2023, Federal Register proposed rule revising the physician fee schedule to improve Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ACS) payments for calendar year 2024. Includes discussions on extending the use of the hospital market basket to update ASC payment rates, a proposed quality measure for emergency department visits in Rural Emergency Hospitals (REHs), and more.
Date: 09/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
view details
Comment on the July 31, 2023, Federal Register proposed rule revising the physician fee schedule to improve Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ACS) payments for calendar year 2024. Includes discussions on extending the use of the hospital market basket to update ASC payment rates, a proposed quality measure for emergency department visits in Rural Emergency Hospitals (REHs), and more.
Date: 09/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
view details
MedPAC Comment on CMS's Proposed Rule on the Physician Prospective Payment System for FY 2024
Comment on the August 7, 2023, Federal Register proposed rule revising the physician fee schedule to improve payment systems for physicians and other Medicare Part B revisions. Includes discussions on payment rates for Medicare telehealth services; the Medicare Shared Savings Program, including regional adjustments; incorporating Medicare Advantage data into public reporting; and more.
Date: 09/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
view details
Comment on the August 7, 2023, Federal Register proposed rule revising the physician fee schedule to improve payment systems for physicians and other Medicare Part B revisions. Includes discussions on payment rates for Medicare telehealth services; the Medicare Shared Savings Program, including regional adjustments; incorporating Medicare Advantage data into public reporting; and more.
Date: 09/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
view details
Rural Health Value Summit: Driving Value Through Community-Based Partnerships
Provides an overview of a June 2023 summit regarding the intersection of rural providers and communities, value-based care and payment models, and social determinants of health (SDOH). Describes the efforts of Arkansas, Michigan, Oregon, and South Carolina communities that had representatives at the summit. Discusses opportunities for policymakers, payers, and health system leaders to build and support infrastructure to address social determinants of health in rural communities and offers possible next steps.
Date: 09/2023
Type: Document
Sponsoring organization: Rural Health Value
view details
Provides an overview of a June 2023 summit regarding the intersection of rural providers and communities, value-based care and payment models, and social determinants of health (SDOH). Describes the efforts of Arkansas, Michigan, Oregon, and South Carolina communities that had representatives at the summit. Discusses opportunities for policymakers, payers, and health system leaders to build and support infrastructure to address social determinants of health in rural communities and offers possible next steps.
Date: 09/2023
Type: Document
Sponsoring organization: Rural Health Value
view details
Merit-Based Incentive Payment System (MIPS): Traditional MIPS Scoring Guide for the 2023 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: 09/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
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: 09/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
A Consensus Panel Approach to Estimating the Start-Up and Annual Service Costs for Rural Ambulance Agencies
Policy brief exploring the costs of running ambulance services for 3 population-based service tiers. Establishes a minimum access standard for ambulances servicing a 25-minute travel time from the ambulance station, and enables policymakers and community stakeholders to develop strategic plans for the financing and provision of ambulance services. Features statistics on number of calls, population ranges of service areas, and fixed, depreciation, variable, and administrative costs.
Author(s): Yvonne Jonk, Gary Wingrove, Nikiah Nudell, Kevin McGinnis
Date: 08/2023
Type: Document
Sponsoring organization: Maine Rural Health Research Center
view details
Policy brief exploring the costs of running ambulance services for 3 population-based service tiers. Establishes a minimum access standard for ambulances servicing a 25-minute travel time from the ambulance station, and enables policymakers and community stakeholders to develop strategic plans for the financing and provision of ambulance services. Features statistics on number of calls, population ranges of service areas, and fixed, depreciation, variable, and administrative costs.
Author(s): Yvonne Jonk, Gary Wingrove, Nikiah Nudell, Kevin McGinnis
Date: 08/2023
Type: Document
Sponsoring organization: Maine Rural Health Research Center
view details
Distributional Analysis of Variation in Medicare Advantage Participation Within and Between Metropolitan, Micropolitan, and Noncore Counties
Policy brief identifying penetration rates, number of plans, and enrollment patterns and trends in Medicare Advantage participation in metropolitan and nonmetropolitan counties from 2017-2022. Features statistics with breakdowns by year and metropolitan, micropolitan, and noncore areas.
Author(s): Dan Shane, Ufuoma Ejughemre, Fred Ullrich, Keith Mueller
Date: 08/2023
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
view details
Policy brief identifying penetration rates, number of plans, and enrollment patterns and trends in Medicare Advantage participation in metropolitan and nonmetropolitan counties from 2017-2022. Features statistics with breakdowns by year and metropolitan, micropolitan, and noncore areas.
Author(s): Dan Shane, Ufuoma Ejughemre, Fred Ullrich, Keith Mueller
Date: 08/2023
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
view details
Merit-Based Incentive Payment System (MIPS): 2024 Payment Year - Payment Adjustment User Guide
Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2024. Describes how 2022 MIPS scores relate to 2024 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 08/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2024. Describes how 2022 MIPS scores relate to 2024 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 08/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
FY 2024 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule — CMS-1785-F and CMS-1788-F Fact Sheet
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2024 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the low-wage index hospital policy, Rural Emergency Hospitals (REHs) being allowed to receive Medicare Graduate Medical Education (GME) payments, changes to the rural wage index calculation methodology, and more.
Date: 08/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2024 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the low-wage index hospital policy, Rural Emergency Hospitals (REHs) being allowed to receive Medicare Graduate Medical Education (GME) payments, changes to the rural wage index calculation methodology, and more.
Date: 08/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Additional resources are available related to this guide. See the full list of resources by topic for:
- Accountable Care Organizations
- Care coordination
- Health insurance
- Healthcare business and finance
- Medicaid
- Medicare
- Policy
- Reimbursement and payment models
- Service delivery models
Last Updated: 9/14/2023