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Medicare and Rural Health Resources

Selected recent or important resources focusing on Medicare and Rural Health.

Rural-Urban Enrollment in Part D Prescription Drug Plans: June 2017 Update
Updates prior policy briefs and shows state-to-state variation in stand-alone prescription drug plans and Medicare Advantage with Prescription Drug plans. Features statistics with breakdowns by rural and urban enrollment in 2008 and 2017.
Author(s): Paula Weigel, Fred Ullrich, Keith Mueller
Date: 12/2017
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Telehealth Services Proposed for Medicare Part B Reimbursements, 2018: Fact Sheet
Identifies the five conditions that a telehealth service must meet in order to be covered by Medicare Part B, provides an overview of how telehealth services get added to Medicare's reimbursable list, and outlines proposed services that may be added for calendar year 2018.
Date: 11/2017
Type: Document
Sponsoring organization: Congressional Research Service
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Medicare Payment Basics: Outpatient Dialysis Services Payment System
Provides an overview of how Medicare pays for the outpatient dialysis services of beneficiaries with end-stage renal disease (ESRD). Includes information about the facility-level rural adjustment.
Date: 10/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Skilled Nursing Facility Services Payment System
Provides an overview of Medicare payments for skilled nursing facility services. Discusses rates for small, rural hospitals and Critical Access Hospitals.
Date: 10/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Long-term Care Hospitals Payment System
Provides an overview of Medicare payments for long-term care services. Discusses rate setting, payment updates, the 25 percent rule, and more.
Date: 10/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Inpatient Psychiatric Facilities Services Payment System
Provides an overview of Medicare payments for beneficiaries receiving psychiatric treatment. Discusses rural location adjustments.
Date: 10/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Hospital Acute Inpatient Services Payment System
Provides an 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), special payments for rural hospitals, and more.
Date: 10/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Hospice Services Payment System
Provides an overview of Medicare payments to hospice and palliative care providers for beneficiaries who have a life expectancy of six months or less.
Date: 10/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Home Health Care Services Payment System
Provides an overview of Medicare payments for home health care services. Includes information on rate setting and payments based on quality reporting and performance.
Date: 10/2017
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: 10/2017
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 counties including rural and super-rural zip codes, metropolitan statistical areas, rural add-on payments, ambulance fee schedules, and payment rates.
Date: 10/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Accountable Care Organization Payment Systems
Provides an overview of the payment mechanisms associated with Medicare's three Accountable Care Organization (ACO) programs: the Medicare Shared Savings Program (MSSP), the Next Generation ACO demonstration, and the Medicare ACO Track 1+ model.
Date: 10/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Physician and Other Health Professional Payment System
Presents an 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: 10/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Medicare Advantage Program Payment System
Presents an overview of Medicare payments to Medicare Advantage (MA) plans. Includes information on Medicare Advantage regions.
Date: 10/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Part D Payment System
Presents an overview of the Medicare Part D prescription drug benefit.
Date: 10/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Learning Network: Long-Term Care Hospital Prospective Payment System
Provides an overview of Long-Term Care Hospital (LTCH) certification, along with information on patient classification, payment rates and adjustments, and quality reporting requirements. Includes a list of additional resources and helpful websites.
Date: 09/2017
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Performance-Based Payment Adjustment Programs
Briefly explains the three Medicare Performance-Based Payment Adjustment programs for hospitals and how such programs may affect rural hospitals. The programs are the Hospital Acquired Condition Reduction Program (HACRP), the Hospital Readmission Reduction Program (HRRP), and the Hospital Value-Based Purchasing Program (HVBPP).
Date: 09/2017
Type: Document
Sponsoring organization: National Organization of State Offices of Rural Health
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MedPAC Report to the Congress: Regional Variation in Medicare Part A, Part B, and Part D Spending and Service Use
Compares Medicare spending and service use based on geographic location, including across metropolitan and nonmetropolitan areas. Seeks to identify factors that influence regional variation and determine if higher service use and/or spending results in higher quality care and outcomes. Utilizes updated data to build on findings that were published in the January 2011 Report to the Congress: Regional Variation in Medicare Service Use. Data is adjusted to account for differences in payment rates to certain providers, such as Critical Access Hospitals.
Date: 09/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Advantage Enrollment Update 2017
Reports on the percentage of rural Medicare beneficiaries enrolled in Medicare Advantage (MA) and other prepaid enrollment plans by metropolitan and non-metropolitan location, and variability by state.
Author(s): Fred Ullrich, Keith Mueller
Date: 08/2017
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Differences in Medicare Service Use in the Last Six Months of Life among Rural and Urban Dual-Eligible Beneficiaries
Reports on a study of healthcare utilization by Medicare beneficiaries in the last six months of life in both urban and rural areas. Compares beneficiaries with dual eligibility with those who are eligible for Medicare only. Looks specifically at inpatient care, outpatient care, and home health, as well as other types of healthcare services.
Author(s): Elizabeth Crouch, Kevin J. Bennett, Janice C. Probst
Date: 08/2017
Type: Document
Sponsoring organization: South Carolina Rural Health Research Center
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Rural-Urban Differences in Medicare Service Use in the Last Six Months of Life
Details a study on healthcare utilization by Medicare beneficiaries in the last six months of life in both urban and rural areas. Looks specifically at inpatient care, outpatient care, and home health, as well as other types of healthcare services.
Author(s): Elizabeth Crouch, Kevin J. Bennett, Janice C. Probst
Date: 08/2017
Type: Document
Sponsoring organization: South Carolina Rural Health Research Center
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2017 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds
Report detailing the current state of the Medicare Hospital Insurance (HI) and Supplemental Medical Insurance (SMI) Trust Funds. Discusses Medicare expenditures as a percentage of Gross Domestic Product (GDP), and makes short and long-range sustainability projections based on variable economic, demographic, and healthcare trends. Also explains the actuarial methods used to calculate the estimates.
Date: 07/2017
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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State Innovation Model Testing Awards From the Center for Medicare & Medicaid Innovation: Highlighting Rural Focus
Summarizes the activities and accomplishments of rural-specific State Innovation Models (SIM) in six states: Arkansas, Colorado, Idaho, Oregon, Minnesota, and Vermont. The SIM initiative was started in 2012 to support states that are committed to designing and testing strategies for payment model and delivery system reform.
Date: 07/2017
Type: Document
Sponsoring organization: Rural Health Value
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Medicare Fee-For-Service Beneficiaries with Disabilities, by End Stage Renal Disease Status, 2014
Data highlight describing the characteristics of disabled Medicare beneficiaries by end stage renal disease (ESRD) status. Uses data from the Centers for Medicare and Medicaid Services' (CMS) Chronic Conditions Data Warehouse (CCW) and includes a breakdown of metropolitan, micropolitan, or rural residence of disabled Medicare beneficiaries with ESRD.
Author(s): Elsa Haile, Sonya Bowen, Kenneth Lindenfelser, Chris Haffer
Date: 07/2017
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Emergency Preparedness Final Rule Interpretive Guidelines and Survey Procedures
Interpretive guidelines clarifying several provisions of the emergency preparedness final rule for Medicare- and Medicaid-participating providers, which affects Rural Health Clinics (RHCs), Critical Access Hospitals (CAHs), Federally Qualified Health Centers (FQHCs), and other rural facilities.
Date: 06/2017
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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MedPAC Data Book: Health Care Spending and the Medicare Program, 2017
Provides an overview of Medicare spending in addition to data on Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care provided through the Medicare program, and other payer liability. Examines settings of care, including rural specific provider sites, as they relate to spending, access to care, and profit margins. Compares rural to urban throughout.
Date: 06/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Report to the Congress: Medicare and the Health Care Delivery System, June 2017
Includes chapters on implementing a unified payment system for post-acute care, Part B drug payment issues, the redesign of the Merit-based Incentive Payment System (MIPS) and other alternative payment models, manufacturers payments to physicians and teaching hospitals, stand-alone emergency departments, skilled nursing facility use, and more. Rural hospitals, rural referral centers, and rural patient populations are discussed throughout the report.
Date: 06/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Report to the Congress: Medicare Payment Policy, 2017
Annual review of Medicare payment policies, with recommendations to Congress. Includes discussions on Medicare payment policies that directly affect rural providers and beneficiaries.
Date: 03/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program
Describes the Medicare Hospital Readmission Reduction Program (HRRP), analyzes the impact of the program on Medicare beneficiaries and healthcare facilities, and highlights identified issues regarding its implementation. Tables and charts display differences in penalties incurred by urban and rural facilities, and include estimates for FY 2017.
Author(s): Cristina Boccuti, Giselle Casillas
Date: 03/2017
Type: Document
Sponsoring organization: Kaiser Family Foundation
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Getting Started with the Quality Payment Program: An Overview of MIPS for Small, Rural, and Underserved Practices
Webinar recording from a February 1, 2017 presentation discussing the effects of the Merit-based Incentive Payment System (MIPS) on small, rural, and underserved practices. Includes sections on eligibility, participation, reporting, performance categories, and submission and scoring methods. Outlines specific eligibility requirements for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs), and provides a checklist for preparing and participating in MIPS.
Additional links: Presentation Slides, Transcript, Webinar Playlist by Section
Date: 02/2017
Type: Video/Multimedia
Sponsoring organization: Centers for Medicare and Medicaid Services
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MLN Suite of Products & Resources for Rural Health Providers
Provides links to rural-specific sites and Medicare Learning Network (MLN) resources that can help you understand Medicare program requirements and processes. Includes learning resources for topics such as Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs), swing bed services, Federally Qualified Health Centers (FQHCs), and more.
Date: 01/2017
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Inpatient Rehabilitation Facility Prospective Payment System
Fact sheet outlining various aspects of the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS). Covers topics such as rates, classification criterion, reasonable and necessary services criteria, and the IRF Quality Reporting Program. Includes fiscal year 2017 and 2018 payment rate updates for IRFs previously or currently located in rural areas.
Date: 01/2017
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid
Provides an overview of dual-eligible beneficiaries who receive benefits from both Medicare and Medicaid. Uses data from calendar year 2012 to examine beneficiary demographics, utilization and spending patterns, eligibility pathways, annual program growth rates, and more. Chart on page 35 includes a breakdown of beneficiaries based on urban or rural residence.
Date: 01/2017
Type: Document
Sponsoring organizations: Medicaid and CHIP Payment and Access Commission, Medicare Payment Advisory Commission
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Health Professional Shortage Area Physician Bonus Program
Provides an overview of the Health Professional Shortage Area (HPSA) Physician Bonus Program and explains how bonus payments are calculated and paid. Includes information related to Critical Access Hospitals (CAHs) as well as primary care and mental health HPSAs.
Date: 01/2017
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Hurricane Response: CMS Waivers and Exceptions for Facilities
Outlines the Centers for Medicare and Medicaid Services' response to Hurricanes Nate, Maria, Irma, and Harvey. The actions are focused on maintaining access to care for affected Medicare and Medicaid beneficiaries. Includes information about administrative actions and waivers for Critical Access Hospitals, Medicare-dependent small rural hospitals, low-volume providers, and other participating facilities.
Date: 2017
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Report to Congress: Social Risk Factors and Performance Under Medicare’s Value-Based Purchasing Program
Uses Medicare data to examine the relationship between social risk factors and the performance of value-based purchasing programs. Discusses policy considerations that could help ensure value-based purchasing programs achieve their intended results, especially among high social risk populations. Categorizes rurality as a community risk factor and discusses whether beneficiaries with social risk factors such as rurality have worse outcomes due to their social risk profile, or because of the providers they see. Also provides rural-specific statistics, and recommendations for using value-based purchasing to improve health outcomes among high social risk populations. Appendices summarize and provide additional details for each of the nine programs evaluated.
Additional links: Appendices
Date: 12/2016
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Rural Health Clinic and Federally Qualified Health Center - Medicare Benefit Policy Manual Chapter 13 Update
Highlights key revisions effective March 9, 2017 made by the Centers for Medicare & Medicaid Services (CMS) to Chapter 13 of the Medicare Benefit Policy Manual for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.
Date: 12/2016
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Value-Based Payment Models: Participation Challenges and Available Assistance for Small and Rural Practices
Identifies challenges faced by small and rural physician practices when participating in Medicare's new value-based payment models, and groups them into five key areas: financial resources and risk management, health IT and data, population health management care delivery, quality and efficiency performance measurement and reporting, and effects of model participation and managing compliance with requirements. Also identifies two types of organizations, partner and non-partner, along with the services they provide, that can help small and rural practices overcome these challenges.
Additional links: Highlights
Date: 12/2016
Type: Document
Sponsoring organization: Government Accountability Office
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Federal Requirement for Physician Supervision of CRNAs
Discusses the federal requirement affecting participation in the Medicare program by Critical Access Hospital (CAH) or Ambulatory Surgical Center (ASC) regarding physician supervision of Certified Registered Nurse Anesthetists (CRNAs). Addresses the conditions for states to opt out of the physician supervision Medicare rule if they meet certain conditions, and the research comparing the outcomes between states that opt-out and those that do not.
Author(s): Steve Barnett, John H Everett, Pat Schou
Date: 11/2016
Type: Document
Sponsoring organization: National Rural Health Association
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MACRA and You
Primer covering the key components of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), focusing on participation requirements, payment models, and implementation options for rural healthcare providers.
Date: 11/2016
Type: Document
Sponsoring organization: National Rural Health Association
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How the Changing Marketplace Creates Challenges and Opportunities in Rural Health
Slides from a SORH Regional Partnership Meeting for Region E addressing the evolution of Medicare payments to population-based payments based on quality and value. Discusses the growth of Medicare Advantage and Medicare Accountable Care Organizations (ACOs). Compares rural and urban health insurance marketplace enrollment. Makes recommendations for SORHs when assisting healthcare organizations in their transition to community-focused health improvement.
Author(s): Keith J. Mueller
Date: 08/2016
Type: Presentation Slides
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Frontier Community Health Integration Project (FCHIP) Demonstration Fact Sheet
Provides an overview of the Frontier Community Health Integration Project (FCHIP) Demonstration, which will test new models of health care delivery in the most sparsely populated rural counties. Identifies the participating Critical Access Hospitals and the interventions they will address.
Date: 08/2016
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Medicare Advantage Market Dynamics and Quality: Historical Context and Current Implications
Policy brief assessing ways in which market dynamics affect rural beneficiaries of Medicare Advantage (MA) plans and the variation in Medicare's star ratings of these plans. Features statistics including star ratings by urban and rural counties; MA contracts by star rating, rural characteristics, and experience; and percent enrollment in 4+ star plans with breakdowns by rural and urban counties.
Author(s): Leah Kemper, Abigail R. Barker, Lyndsey Wilbers, Timothy D. McBride, Keith Mueller
Date: 07/2016
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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MedPAC Report to the Congress: Medicare and the Health Care Delivery System, June 2016
Includes chapters on pricing and payment systems, Medicare drug spending, Part B drug and oncology payment policy issues, improving Part D, improving efficiency and preserving access to emergency care in rural areas, telehealth services and Medicare, and issues affecting dual-eligible beneficiaries. Rural hospitals, rural referral centers, and rural patient populations are discussed throughout the report.
Date: 06/2016
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Accountable Care Organizations: Beneficiary Assignment Update
Clarifies the changes issued in June 2015 regarding the Centers for Medicare & Medicaid Services (CMS) Accountable Care Organization (ACO) regulations affecting the ACO’s beneficiary assignment.
Author(s): Thomas Vaughn, A. Clinton MacKinney, Keith J. Mueller, Fred Ullrich, Xi Zhu
Date: 06/2016
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Utilization of Telemedicine Among Rural Medicare Beneficiaries
Demonstrates the trends in the use of telemedicine utilization by rural Medicare beneficiaries between 2004 and 2013. Data is derived from Current Procedural Terminology (CPT) codes or telemedicine-specific codes, using Medicare’s definition for rural. Includes a table comparing patient characteristics for Medicare beneficiaries with and without a telemedicine visit in 2013.
Location: Journal of the American Medical Association, 315(18), 2015–2016
Date: 05/2016
Type: Document
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Quality Improvement Implementation Guide and Toolkit for Critical Access Hospitals
A guide for Critical Access Hospitals to help them navigate the Medicare Beneficiary Quality Improvement Project (MBQIP) and find ways to support quality improvement in their facilities. Includes ways to organize quality improvement programs, what to focus on, federal program examples, and info-graphics.
Date: 05/2016
Type: Document
Sponsoring organization: Stratis Health
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Flexibilities and Support for Small Practices
Describes flexibilities and supports for medical practices in rural or health professional shortage areas, in response to provisions of the proposed CMS Quality Payment Program as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Date: 05/2016
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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2017 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter
Announces the final calendar year (CY) 2017 Medicare Advantage (MA) capitation rates, and provides detailed information for MA organizations and prescription drug plan sponsors regarding MA and Part D payment policies.
Date: 04/2016
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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An Overview of Medicare
Provides a basic overview of the Medicare program, including how it is financed, who is eligible and what benefits are covered under the program. Describes supplemental health insurance, benefits provided by the new drug law, and data on Medicare expenditures and financing.
Date: 04/2016
Type: Document
Sponsoring organization: Kaiser Family Foundation
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Medicare Costs and Utilization Among Beneficiaries in Rural Areas
A study evaluating the association of Medicare beneficiary spending patterns with the differences in cost for services across rural hospital service areas (HSAs). Concludes with strategies and policies to address the geographic variability of higher costs of care in rural HSAs.
Author(s): Carrie Henning-Smith, Doug Wholey, Michelle Casey, Ira Moscovice
Date: 03/2016
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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MedPAC Report to the Congress: Medicare Payment Policy, 2016
Annual review of Medicare payment policies, with recommendations to Congress. Discussions of rural aspects of Medicare payment policies are included throughout the report.
Date: 03/2016
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Shared Savings Program and Rural Providers
Provides an overview of Accountable Care Organizations (ACOs) for rural providers. Reports that the Medicare Shared Savings Program will reward Accountable Care Organizations that lower their growth in healthcare costs while meeting performance standards on quality of care. The regulations provide for FQHCs and RHCs to participate in the Shared Savings Program by becoming their own ACOs, or by joining an ACO as an ACO participant along with other organizations.
Date: 03/2016
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Benefit Policy Manual: Chapter 13 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services
Revised regulations, as of January 15, 2016, regarding Medicare payment policies for Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC).
Date: 01/2016
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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The Basics: The Medicare Drug Benefit (Part D)
Describes the coverage gap within the Medicare prescription drug benefit (Part D), known as the "donut hole," and its impact on beneficiaries. Describes the provisions in the Patient Protection and Affordable Care Act of 2010 (PPACA) that will fill in this gap in coverage by 2020.
Date: 01/2016
Type: Document
Sponsoring organization: National Health Policy Forum
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The Basics: Medicare
Provides an overview of the Medicare program including eligibility, covered services, cost-sharing requirements, and program financing.
Date: 01/2016
Type: Document
Sponsoring organization: National Health Policy Forum
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MACRA 101 Video Series: Preparing for the New Physician Quality Payment Program
Videos designed to educate hospitals, clinics, and stakeholders about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Discusses MACRA from both a policy and physician perspective, and offers insights about how MACRA applies to rural providers.
Date: 2016
Type: Video/Multimedia
Sponsoring organization: American Hospital Association
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Rural Medicare Advantage Plan Payment in 2015
Examines how changes to the Medicare Advantage (MA) payment policy formula, which were implemented as part of the Affordable Care Act (ACA), are impacting MA plans and beneficiaries in rural and urban areas.
Author(s): Leah Kemper, Abigail Barker, Timothy McBride, Keith Mueller
Date: 12/2015
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Medicare Value-based Payment Reform: Priorities for Transforming Rural Health Systems (Policy Brief)
Proposes strategies to ensure rural providers and their interests are included in Medicare value-based payment and delivery system reform.
Author(s): Keith J. Mueller, Charles Alfero, Andy Coburn, et al.
Date: 11/2015
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Medicare Value-based Payment Reform: Priorities for Transforming Rural Health Systems
Analyzes the provisions within the Affordable Care Act (ACA) regarding Medicare payment and delivery system reforms that affect rural health providers and rural health services. Proposes recommendations that support the inclusion of rural appropriate payment systems.
Author(s): Keith Mueller, Charles Alfero, Andy Coburn, et al.
Date: 11/2015
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Chronic Care Management (CCM) Services for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
Provides instructions for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) on how to submit claims for chronic care management services according to the RHC All-Inclusive Rate and the FQHC Prospective Payment System, effective January 1, 2016.
Date: 11/2015
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Disabled Medicare Beneficiaries Spend More Out-of-Pocket Than Their Urban Counterparts
Analyzes differences in healthcare out-of-pocket spending, supplemental coverage, and spending by type of service between rural and urban Medicare beneficiaries. Also examines rural-urban differences for Medicare beneficiaries that qualify based on disability status.
Author(s): Erika C. Ziller, Jennifer D. Lenardson, Andrew F. Coburn
Date: 11/2015
Type: Document
Sponsoring organization: Maine Rural Health Research Center
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Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016
Presents the final rule effective January 1, 2016 regarding revisions to the Medicare physician fee schedule and other Medicare Part B payment policies, and their affect on Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).
Date: 11/2015
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Competition Among Medicare’s Private Health Plans: Does It Really Exist?
Measures rates of competition among private Medicare Advantage (MA) plans across the country and across rural/urban geographies.
Author(s): Brian Biles, Giselle Casillas, Stuart Guterman
Date: 08/2015
Type: Document
Sponsoring organization: Commonwealth Fund
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What Do the Medicare and Medicaid Programs Mean to Rural Health?
On the 50th anniversary of the Medicare and Medicaid programs, five rural health experts share their insights on the impact of these programs in rural America.
Author(s): Alan Morgan, Wayne Myers, Thomas Hoyer, Thomas Ricketts, Keith Mueller
Location: Rural Monitor
Date: 07/2015
Type: Document
Sponsoring organization: Rural Health Information Hub
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Rural and Urban Differences in Choice of and Satisfaction with Medicare Part D Plans
Examines how drug plan selection experiences and satisfaction levels differ for rural and urban Medicare beneficiaries. Includes breakdowns by three locations types, considerations in choosing plans, and percentage of people who felt satisfied and confident in their coverage.
Author(s): Carrie Henning-Smith, Heidi O’Connor, Michelle Casey, Ira Moscovice
Date: 07/2015
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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Differences in Part D Plans Offered to Rural and Urban Medicare Beneficiaries
Analyzes how Medicare Part D plan options differ for rural and urban residents in terms of premiums, deductibles, and copayments, as well as differences in plan options within more-densely and less-densely populated rural areas. Includes statistical breakdowns by three location types, number of available plans, average premiums, deductible amounts, and average co-pays.
Author(s): Heidi O’Connor, Carrie Henning-Smith, Michelle Casey, Ira Moscovice
Date: 07/2015
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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2015: Rural Medicare Advantage Enrollment Update
Reports on the percentage of rural Medicare beneficiaries enrolled in Medicare Advantage (MA) plans and other prepaid enrollment plans. Compares national and rural MA enrollment, and variability by state.
Author(s): Chance Finegan, Fred Ullrich, Keith Mueller
Date: 07/2015
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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MedPAC Report to the Congress: Medicare and the Health Care Delivery System, June 2015
Includes chapters on coordinating Medicare policy across payment models, Part B drug payment policy, value-based incentives for managing Part B drug use, multiple drug use including opioids among Medicare Part D enrollees, hospital short-stays, and new methods of measuring quality of care. Rural hospitals, rural referral centers, and rural patient populations are discussed throughout this report.
Date: 06/2015
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Comment on: CMS's Skilled Nursing Facilities: Prospective Payment System, Value Based Purchased and Quality Reporting Proposed Rule
MedPAC comment letter on the Centers for Medicare & Medicaid Services' (CMS) proposed rule entitled Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2016.
Date: 05/2015
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Statement by Tim Wolters, Citizens Memorial Hospital and Lake Regional Health System, before the Committee on Appropriations Subcommittee on Labor, Health and Human Services, and Education and Related Agencies
Testimony presented at a May 7, 2015 Labor-HHS Subcommittee hearing on rural health. Discusses the impact rural hospitals have on their communities and the challenges rural Prospective Payment System (PPS) hospitals face that make them vulnerable to cuts in Medicare reimbursement.
Author(s): Tim Wolters
Date: 05/2015
Type: Document
Sponsoring organization: Senate Committee on Appropriations
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Statement of Sean Cavanaugh, Centers for Medicare & Medicaid Services, on Rural Health before the U.S. Senate Appropriations Committee Subcommittee on Labor, Health and Human Services, Education, and Related Agencies
Testimony presented at a May 7, 2015 Labor-HHS Subcommittee hearing on rural health. Provides an overview of the Centers for Medicare & Medicaid Services (CMS) activities to improve access to services for rural Medicare beneficiaries. Discusses telehealth, Critical Access Hospitals, Rural Health Clinics, and rural projects being tested through the Health Care Innovation Awards.
Author(s): Sean Cavanaugh, Centers for Medicare & Medicaid Services
Date: 05/2015
Type: Document
Sponsoring organization: Senate Committee on Appropriations
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Beneficiaries with Medigap Coverage
Reports on demographics of Medicare beneficiaries with Medigap coverage, including statistics specific to those beneficiaries living in rural areas, highlighting the importance of the Medigap program for rural areas.
Date: 04/2015
Type: Document
Sponsoring organization: AHIP Center for Policy and Research
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Acceptance of New Patients With Public and Private Insurance by Office-based Physicians: United States, 2013
Provides data on office-based physicians accepting new patients with Medicaid, Medicare, and private insurance. See Figure 2 for comparison of metropolitan to non-metropolitan acceptance rates by patient payment source. Also includes state-level data.
Author(s): Esther Hing, Sandra L. Decker, Eric Jamoom
Date: 03/2015
Type: Document
Sponsoring organization: National Center for Health Statistics
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A Critique of the Office of the Inspector General’s Report on Swing Beds in Critical Access Hospitals
Policy brief evaluating a March 2015 report from the Office of the Inspector General (OIG), U.S. Department of Health and Human Services, commenting on Medicare reimbursement policy for swing bed services in Critical Access Hospitals (CAHs). Evaluates the methods and data of the OIG report.
Author(s): Kristin Reiter, Mark Holmes
Date: 03/2015
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Medicare Could Have Saved Billions at Critical Access Hospitals If Swing-Bed Services Were Reimbursed Using the Skilled Nursing Facility Prospective Payment System Rates
Reports the Inspector General’s findings from a study of swing bed services and reimbursement at Critical Access Hospitals (CAHs). Concludes that swing bed usage has significantly increased in recent years and that there would be significant savings to the Medicare program if swing bed services were reimbursed at skilled nursing facility (SNF) prospective payment system (PPS) rates.
Date: 03/2015
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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Calendar Year (CY) 2015 Rural Health Clinic (RHC) and Federally Qualified Health Centers (FQHC) Updates: Payment Rate Increases for RHCs and FQHCs Billing Under the All-Inclusive Rate System (AIR), and Urban and Rural Designations for FQHCs Billing Under
Provides updates for RHCs and FQHCs that are submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries.
Date: 01/2015
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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2014: Rural Medicare Advantage Enrollment Update
Reports that the percentage of rural Medicare beneficiaries enrolled in Medicare Advantage (MA) plans varies considerably by state. Also provides Medicare Advantage enrollment by type of plan.
Author(s): Leah Kemper, Abigail Barker, Timothy McBride, Keith Mueller
Date: 01/2015
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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The Need to Reform Medicare’s Payments to Skilled Nursing Facilities Is as Strong as Ever
Compares payments made to Skilled Nursing Facilities (SNFs) and costs over time to see if changes made by the Centers for Medicare and Medicaid Services to the payment system have improved payment accuracy. Table 3 and Table 4 compare healthcare facility characteristics, including rural.
Author(s): Carol Carter, Bowen Garrett, Doug Wissoker
Date: 01/2015
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Innovators' Guide to Navigating Medicare
Discusses processes used to determine coverage, coding, and payment for new technologies under the Medicare fee-for-service program. Guide is intended as a general summary.
Date: 2015
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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The State HIE Program Four Years Later: Key Findings on Grantees’ Experiences from a Six-State Review
Provides information on health information exchange (HIE) efforts in six states: Iowa, Mississippi, New Hampshire, Utah, Vermont and Wyoming. Includes the population density for each of those states. Discusses supportive factors and challenges in implementing state-wide health information exchange services.
Date: 12/2014
Type: Document
Sponsoring organization: NORC at the University of Chicago
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The Role of Medicare and the Indian Health Service for American Indians and Alaska Natives: Health, Access and Coverage
Examines the health, healthcare access, income, and education disparities that exist within the Native American and Alaskan Native population, as well as the roles of Medicare and the Indian Health Service (IHS) in addressing these disparities.
Author(s): Cristina Boccuti, Christina Swoope, Samantha Artiga
Date: 12/2014
Type: Document
Sponsoring organization: Kaiser Family Foundation
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Rural-Urban Differences in Continuity of Care among Medicare Beneficiaries
Analyzes emerging care and payment models such as patient-centered medical homes, Accountable Care Organizations (ACOs), and bundled payments to identify differences in continuity of care when applied to rural vs. urban settings.
Author(s): Matthew Toth, Caroleen Quach, Mark Holmes
Date: 12/2014
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Medicare Physician Fee Schedule: Payment System Fact Sheet Series
Provides general information about the Medicare Physician Fee Schedule (MPFS) including payment rates and MPFS payment rates formula.
Date: 12/2014
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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The ACA and Beyond: Public Policy and Marketplace Changes Affecting the Future of Rural Health
Slides from a presentation by Keith Mueller of the Rural Policy Research Institute discussing the changing landscape of rural healthcare. Highlights how changes initiated by the Affordable Care Act (ACA), particularly in the areas of insurance coverage, quality requirements, and payment and system reform, have led to paradigm shifts in rural healthcare service delivery.
Author(s): Keith Mueller
Date: 11/2014
Type: Presentation Slides
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Intensity of Service Provision for Medicare Beneficiaries Utilizing Home Health Services: A Closer Look at Cerebrovascular Disease, Diabetes, and Joint Replacement
Reports on the impact of home health services provided to the rural elderly receiving Medicare based on the number of visits, the use of rehabilitation specialists, and the median payment per claim. Includes a rural/urban comparison throughout the report.
Additional links: Key Facts
Author(s): Medha Iyer, Janice C. Probst, Kevin Bennett, Grishma Bhavsar
Date: 11/2014
Type: Document
Sponsoring organization: South Carolina Rural Health Research Center
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Characteristics, Utilization Patterns, and Expenditures of Rural Dual Eligible Medicare Beneficiaries
Study analyzes the rural-urban differences regarding dual eligible beneficiaries and their race, region of residence, patterns of utilizing health services and Medicare expenditures.
Author(s): Kevin J. Bennett, Ashley S. Robertson, Janice C. Probst
Date: 11/2014
Type: Document
Sponsoring organization: South Carolina Rural Health Research Center
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Observation Care Services for Medicare Beneficiaries in Rural Hospitals: Policy Issues and Stakeholder Perspectives
Seeks to provide a greater understanding of rural-specific issues surrounding hospital outpatient observation status and the related implications for rural hospitals, skilled nursing facilities (SNFs), and Medicare beneficiaries. Results are based on a multi-state, qualitative analysis of input from three respondent groups: state hospital associations, long-term care ombudsman offices, and Quality Improvement Organizations (QIOs). Analysis focuses on the use of observation status by Medicare beneficiaries from 2010-2013.
Author(s): Walter Gregg, Samantha Mills, Yvonne Jonk
Date: 10/2014
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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Medicare Beneficiaries Paid Nearly Half of the Costs for Outpatient Services at Critical Access Hospitals Report
Analyzes the system that Medicare used to calculate outpatient coinsurance amounts for patients who receive services at CAHs versus the system used for patients who receive services at acute-care hospitals. Recommends the Centers for Medicare and Medicaid Services seek legislative authority to modify the coinsurance calculation.
Date: 10/2014
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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Medicare Billing Information for Rural Providers and Suppliers
Provides Medicare billing charts and information on where to submit claims for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Skilled Nursing Facilities, Home Health Agencies, Critical Access Hospitals, and Swing Bed services.
Date: 08/2014
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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The Effect of Medicare Payment Policy Changes on Rural Primary Care Practice Revenue
Discusses the effect of Medicare payment adjustments on Medicare-derived revenues to rural primary care providers.
Additional links: Supplemental Table
Author(s): Paula Weigel, A. Clinton MacKinney, Fred Ullrich, Keith J. Mueller
Date: 07/2014
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Medicare Program; Prospective Payment System for FQHCs; Changes to Contracting Policies for RHCs; and Changes to Clinical Laboratory Improvement Amendments of 1988 Enforcement Actions for Proficiency Testing Referral
The final rule with comment period that implements the methodology and payment rates for a prospective payment system (PPS) for Federally Qualified Health Centers (FQHCs) services beginning October 1, 2014 under Medicare Part B, in compliance with the Affordable Care Act (ACA). Identifies the policy allowing Rural Health Clinics (RHCs) to contract with nonphysician practitioners when statutory requirements for employment of nurse practitioners and physician assistants are met, and incorporated are other technical changes to FQHC and RHC regulations. Changes to the Clinical Laboratory Improvement Amendments of 1988 enforcement actions for proficiency testing referral are included.
Date: 05/2014
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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The Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A Second Look
Addresses the impact of the Patient Protection and Affordable Care Act on rural communities including the issues of health insurance coverage, Medicare and Medicaid payment, quality and delivery system reform, public health, healthcare workforce, and long-term care.
Author(s): Andrew F. Coburn, Jennifer P. Lundblad, A. Clinton MacKinney, et al.
Date: 04/2014
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Medicare Accountable Care Organizations: Program Eligibility, Beneficiary Assignment, and Quality Measures
Discusses the Medicare Shared Savings Program (MSSP) eligibility, participation requirements, and quality measures relative to Accountable Care Organization (ACO) formation to assist rural providers.
Author(s): A. Clinton MacKinney, Keith J. Mueller, Xi Zhu, Thomas Vaughn
Date: 04/2014
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Rural/Urban Differences in Inpatient Related Costs and Use among Medicare Beneficiaries
Reports that Medicare beneficiaries who are admitted to rural hospitals tend to have lower outpatient costs than Medicare beneficiaries who are admitted to urban hospitals. Also examines 30- and 60-day readmission rates by hospital location and beneficiary residence, adjusted for beneficiary rural status, health status, and socio-demographic characteristics.
Author(s): Matthew Toth, Mark Holmes, Victoria A. Freeman, George H. Pink
Date: 03/2014
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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2012 Rural Medicare Advantage Quality Ratings and Bonus Payments
Analyzes differences in rural Medicare Advantage (MA) quality ratings and payments and suggests reasons why quality ratings vary by geography. Authors report that overall, the quality rating of MA plans in rural areas is lower than in urban areas, a result of the availability of, and enrollment in, different types of MA plans.
Author(s): Leah Kemper, Abigail R. Barker, Timothy D. McBride, Keith Mueller
Date: 01/2014
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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March 2013: Medicare Advantage Update
Policy brief discussing current rural Medicare Advantage enrollment data.
Author(s): Sarah Sayavong, Leah Kemper, Abigail Barker,Timothy McBride
Date: 09/2013
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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The Impact of Payment Reform on Rural Medicare Advantage Enrollment and Quality
Examines the implications of changes in Medicare Advantage (MA) payment implemented in the Affordable Care Act of 2010 and in the current Centers for Medicare and Medicaid demonstration of quality-based bonus payments. MA plan quality in both rural and urban areas is discussed to monitor the effects of the payment policies on quality improvement.
Author(s): Leah M. Kemper, Timothy D. McBride, Abigail R. Barker
Date: 07/2013
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Examination of the Relative Importance of Hospital Employment in Non-Metropolitan Counties Using Location Quotients
Examines the intensity of hospital employment in rural counties relative to the nation as a whole using location quotients and to draw conclusions regarding how potential changes in Medicare and Medicaid might affect rural populations.
Author(s): J.L. Smith
Location: Rural and Remote Health, 13, 2497
Date: 07/2013
Type: Document
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Accountable Care Organizations in Rural America
Reports that Medicare Accountable Care Organizations (ACOs) operate in 16.7% of non-metropolitan counties.
Additional links: National and Regional Maps
Author(s): A. Clinton MacKinney, Thomas Vaughn, Xi Zhu, Keith J. Mueller, Fred Ullrich
Date: 07/2013
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Comparing Rural and Urban Medicare Part D Enrollment Patterns and Prescription Drug Coverage Rates
Examines Medicare Part D enrollment rates in rural and urban areas and the resulting impact on rural beneficiaries’ overall prescription drug coverage rates.
Author(s): Yvonne Jonk, Heidi O’Connor, Michelle Casey, Ira Moscovice
Date: 05/2013
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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September 2012: Medicare Advantage Enrollment Update
Policy brief discussing current rural Medicare Advantage enrollment data.
Author(s): Sarah Sayavong, Leah Kemper, Abby Barker, Timothy McBride, Keith Mueller
Date: 04/2013
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Medigap: Spotlight on Enrollment, Premiums, and Recent Trends
Provides a detailed look at the Medigap market, including national and state trends in enrollment and premiums for the various Medigap plans. Mentions that one quarter of the Medicare population (24%) has a Medigap policy, with higher Medigap enrollment rates among beneficiaries living in rural states.
Author(s): Jennifer T. Huang, Gretchen A. Jacobson, Tricia Neuman, Katherine A. Desmond, Thomas Rice
Date: 04/2013
Type: Document
Sponsoring organization: Kaiser Family Foundation
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June 2012: Rural MA Enrollment and Premium Update
Presents key findings on Rural Medicare Advantage (MA) enrollment and on Rural Preferred Provider Organization (PPO) enrollment.
Author(s): Leah Kemper, Abigail Barker, Timothy D. McBride, Keith Mueller
Date: 02/2013
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Medicare Advantage 2013 Data Spotlight: Plan Availability and Premiums
Presents an overview of changes made to the Medicare Advantage program and trends affecting both rural and urban populations in plan participation, premiums, and certain benefits.
Author(s): Marsha Gold, Gretchen Jacobson, Anthony Damico, Tricia Neuman
Date: 12/2012
Type: Document
Sponsoring organization: Kaiser Family Foundation
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Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 2 (Final Rule)
Specifies the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and Critical Access Hospitals (CAHs) must meet in order to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments.
Location: Federal Register, 77(171), 53968-54162
Date: 09/2012
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Primary Care Incentive Payment Program (PCIP) 2011
Reports on Medicare incentive payments to primary care providers in 2011 as authorized by the Affordable Care Act. Identifies bonus payment distribution by specialty, state, type of provider and urban/rural location.
Date: 05/2012
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Relevance Under Healthcare Reform
Highlights the level of comparative performance achieved by rural hospitals in regards to quality, patient satisfaction and operational efficiency for the types of healthcare most applicable to rural communities. Published by iVantage Health Analytics.
Date: 04/2012
Type: Document
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Anticipating the Rural Impact of Medicare Value-Based Purchasing
Discusses the design and implementation of Medicare value-based purchasing (VBP) programs and describes the five provider types: prospective payment hospitals, Critical Access Hospitals, skilled nursing facilities, home health agencies, and physician office practices.
Author(s): A. Clinton MacKinney, Keith J. Mueller, Nicholas P. Lillios, et al.
Date: 04/2012
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Rural-Urban Differences in End-of-Life Nursing Home Care: Facility and Environmental Factors
Examines urban-rural difference in end-of-life (EOL) quality of care provided in nursing homes from 2005 to 2007 based on 3 quality measures: in-hospital death, hospice referral before death, and presence of severe pain.
Author(s): Helena Temkin-Greener, Nan Tracy Zheng, Dana B. Mukamel
Location: Gerontologist, 52(3), 335-344
Date: 01/2012
Type: Document
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Medicare Shared Savings Program: Accountable Care Organizations, Final Rule
Summarizes segments of the rule on Medicare Accountable Care Organizations (ACOs) as they affect family practitioners in small and medium-sized practices, including Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs).
Date: 11/2011
Type: Document
Sponsoring organization: American Academy of Family Physicians
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New Project Targets CAH Quality Measures and Reporting
Discusses MBQIP, the Flex Medicare Beneficiary Quality Improvement Project, which is helping Critical Access Hospitals improve patient care quality and operations, and more accurately report rural health care quality.
Author(s): Candi Helseth
Location: Rural Monitor, 2011(Fall)
Date: 11/2011
Type: Document
Sponsoring organization: Rural Health Information Hub
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Medicare Beneficiary Quality Improvement Project (MBQIP)
Video discussing the goal of the Flex Medicare Beneficiary Quality Improvement Project (MBQIP), which is to improve rural quality care access for Medicare beneficiaries served by Critical Access Hospitals (CAHs).
Date: 05/2011
Type: Video/Multimedia
Sponsoring organization: Health Resources and Services Administration
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Medicare’s Accountable Care Organization Regulations: How Will Medicare Beneficiaries who Reside in Medically Underserved Communities Fare?
Examines impact of ACO rule on medically underserved areas, including rural areas, and Federally Qualified Health Centers (FQHCs).
Author(s): Sara Rosenbaum, Peter Shin
Date: 04/2011
Type: Document
Sponsoring organization: George Washington University Department of Health Policy and Management
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The 2011 Report to the Secretary: Rural Health and Human Services Issues
Report to the Secretary of the U.S. Department of Health and Human Services focused on rural childhood obesity, place-based initiatives for rural early childhood development, and rural implications of accountable care organizations and payment bundling. Includes recommendations to address these issues and provides appendices describing the 2010 site visits.
Date: 03/2011
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Medicare Chartbook, 2010
Provides data on the Medicare program, including information on beneficiaries, benefits, and utilization. Includes data on access to care, prescription drugs, spending, and financing. Covers rural and urban data on selected topics.
Date: 11/2010
Type: Document
Sponsoring organization: Kaiser Family Foundation
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A Comparison of Rural Hospitals with Special Medicare Payment Provisions to Urban and Rural Hospitals Paid Under Prospective Payment
Compares the financial performance and condition of rural hospitals with special Medicare payment provisions - Critical Access Hospitals (CAHs), Medicare Dependent Hospitals (MDHs), Sole Community Hospitals (SCHs), and Rural Referral Centers (RRCs) - to urban and rural hospitals paid under prospective payment.
Additional links: Findings Brief: Profitability of Rural Hospitals Paid Under Prospective Payment Compared to Rural Hospitals with Special Medicare Payment Provisions
Author(s): G. Mark Holmes, George H. Pink, Sarah A. Friedman, Hilda A. Howard
Date: 08/2010
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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The Medicare Physician Quality Reporting Initiative: Implications for Rural Physicians (Final Report)
Discusses the impact of rurality on office-based physicians' participation in the 2007 Physician Quality Reporting Initiative (PQRI), a voluntary pay-for-reporting program in Medicare.
Author(s): Alycia Infante, Michael Meit, Elizabeth Hargrave
Date: 08/2010
Type: Document
Sponsoring organization: NORC Walsh Center for Rural Health Analysis
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MedPAC Report to Congress: Aligning Incentives in Medicare, June 2010
Focuses on how incentives in the Medicare program can be leveraged to promote quality of care and efficient use of resources - key elements of a high-value health care delivery system. Mentions rural throughout. Includes chapters focused on graduate medical education financing and inpatient psychiatric care.
Date: 06/2010
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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February 2010: A Dramatic Shift Away from Private Fee-for-Service Plans in Rural Medicare Advantage Enrollment
Discusses the 2010 decline in private fee-for-service (PFFS) enrollment in rural areas and as a result, Medicare Advantage (MA) enrollment in those areas (excluding other prepaid plans) fell slightly in early 2010 for the first time in years.
Author(s): Leah Kemper, Timothy D. McBride, M. Katherine Stone, Keith Mueller
Date: 03/2010
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)
Provides the full text of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which extended various Medicare provisions that were set to expire and focused heavily on improving or maintaining access to care in rural areas.
Date: 07/2008
Type: Document
Sponsoring organization: U.S. Congress
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CMS: Rural Health
Provides information about the Centers for Medicare and Medicaid Services' (CMS) rural health initiatives, including the CMS Rural Health Council. Also provides links to rural-specific resources, publications, and reports.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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List of Skilled Nursing Facility (SNF) Federal Regulations
Lists federal regulations and notices related to the Prospective Payment System (PPS) for Skilled Nursing Facilities (SNFs), including information on annual payment rate updates. Contains copies of proposed and final rules, along with any relevant corrections, as published in the Federal Register.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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End-Stage Renal Disease (ESRD) Payment Regulations and Notices
Lists federal regulations and notices related to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS), including information on annual payment rate updates. Contains copies of proposed and final rules, along with any relevant corrections, as published in the Federal Register.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Physician Fee Schedule (PFS) Federal Regulation Notices
Lists federal regulations and notices related to the Medicare Physician Fee Schedule (PFS), including information on annual payment rate updates. Contains copies of proposed and final rules, along with any relevant corrections, as published in the Federal Register.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Regulations and Notices
Lists federal regulations and notices related to the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS), including information on annual payment rate updates. Contains copies of proposed and final rules, along with any relevant corrections, as published in the Federal Register.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Hospital Outpatient Regulations and Notices
Lists federal regulations and notices related to the Hospital Outpatient Prospective Payment System (OPPS), including information on annual payment rate updates. Contains copies of proposed and final rules, along with any relevant corrections, as published in the Federal Register.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Hospice Regulations and Notices
Lists federal regulations and notices related to Medicare hospice payment, including information on annual payment rate updates. Contains copies of proposed and final rules, along with any relevant corrections, as published in the Federal Register.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Home Health Prospective Payment System Regulations and Notices
Lists federal regulations and notices related to the Home Health Prospective Payment System, including information on annual payment rate updates. Contains copies of proposed and final rules, along with any relevant corrections, as published in the Federal Register.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Ambulatory Surgical Center (ASC) Regulations and Notices
Lists federal regulations and notices related to the Ambulatory Surgical Center (ASC) Payment System, including information on annual payment rate updates. Contains copies of proposed and final rules, along with any relevant corrections, as published in the Federal Register.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Acute Inpatient Prospective Payment System (IPPS) Regulations and Notices
Lists federal regulations and notices related to the Acute Inpatient Prospective Payment System (IPPS), including information on annual payment rate updates. Contains copies of proposed and final rules, along with any relevant corrections, as published in the Federal Register.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Care Management Medicare Reimbursement Strategies for Rural Providers
Information for rural healthcare providers on Medicare billing codes for services to keep beneficiaries healthy and better coordinate services to support beneficiaries at home. Addresses Annual Wellness Visits, Chronic Care Management, and Transitional Care Management.
Type: Website
Sponsoring organizations: NORC Walsh Center for Rural Health Analysis, Rural Health Information Hub
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Market Saturation and Utilization Data Tool
Provides an interactive map and access to information on national, state, and county-level provider services and utilization based on Medicare claims data. Includes the following services: ambulance, hospice, home health, long-term care, physical and occupational therapy, and more. To see county-level data, select View Interactive Data Set below the map display.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Support and Available Options for Small, Underserved, and Rural Practices
Section of the Quality Payment Program (QPP) website, enabling practices with 15 or fewer clinicians to receive free, customized technical assistance, including help choosing and reporting on quality measures, guidance with strategic planning, and support optimizing health information technology.
Type: Website
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Medicare Physician Bonus Payment Eligibility Analyzer
Tool to determine if an address is in a Health Professional Shortage Area (HPSA) eligible for a Medicare Physician Bonus.
Type: Tool
Sponsoring organization: Health Resources and Services Administration
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Mapping Medicare Disparities
County-by-county interactive map providing information on geographic disparities in chronic disease among Medicare beneficiaries. Indicates disparities in health outcome, utilization, and spending among racial and ethnic minorities and geographic location.
Type: Map/Mapping System
Sponsoring organization: Centers for Medicare and Medicaid Services
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Frontier Extended Stay Clinics (FESC) Demonstration
An overview of a completed CMS demonstration that looked at an enhanced clinic model in frontier areas to address the needs of seriously ill or injured patients who cannot be transferred to a hospital, or who need monitoring and observation for a limited period of time.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Frontier Community Health Integration Project Demonstration (FCHIP)
An overview of a CMS demonstration to develop and test new models for the delivery of healthcare services in frontier areas through improving access to, and better integration of, the delivery of healthcare to Medicare beneficiaries.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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State Innovation Models (SIM)
An overview of a CMS initiative that supports statewide healthcare system transformation. Aims to create multi-payer models that raise community health status and reduce long term health risks for beneficiaries. Statewide approaches include rural areas, although few include a particular rural focus.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Health Care Innovation Awards (HCIA)
Overview of a CMS demonstration to test a wide range of innovative projects to deliver better health, improved care, and lower costs via Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), particularly for beneficiaries with the highest healthcare needs. Includes projects that serve rural populations.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Community Hospital Demonstration
An overview of a CMS demonstration project which provides cost-based reimbursement for small rural hospitals too large to be Critical Access Hospitals. Examines the community benefits and financial impact for participating hospitals.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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CMS Data Navigator
Interactive tool for identifying Centers for Medicare and Medicaid Services (CMS) data and information resources. Sources can be narrowed by the geographic level available, including state, county, hospital referral region, and more. Sources can also be viewed by CMS program, topic, setting of care, and resource type. Includes publicly available and restricted use data files.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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ICD-10 Toolkit
Provides guidance and assistance to rural healthcare providers in making the transition from ICD-9 to ICD-10. This toolkit is designed to be used in conjunction with any coder or physician training that a rural hospital or clinic may be doing.
Type: Tool
Sponsoring organization: National Rural Health Resource Center
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Medicare Chronic Conditions Dashboards
Provides access to national, state, county and hospital referral region statistics on Medicare beneficiaries related to chronic disease prevalence, utilization, and Medicare spending.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Geographic Variation Dashboards: State and County
Access to state and county-level data on variations in standardized per-capita costs for the Medicare fee-for-service population. Includes trend data and comparison to national and state averages. In the county dashboard, select a state by clicking the map.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Find Shortage Areas: HPSA & MUA/P by Address
Searchable tool for identifying Health Professional Shortage Areas (HPSAs), Medically Underserved Areas/Populations (MUA/P) by address.
Type: Website
Sponsoring organization: Health Resources and Services Administration
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Medicare Telehealth Payment Eligibility Analyzer
Helps providers determine geographic eligibility for Medicare telehealth services. Identifies HPSAs located in rural census tracts, consistent with the Federal Office of Rural Health Policy’s definition of rural.
Type: Tool
Sponsoring organization: Health Resources and Services Administration
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Medicare Advantage: National and State Enrollment Tables and Maps
A listing of tables and maps identifying enrollment in Medicare Advantage and other prepaid plans by state. Tables 3, 4, and 5 show rural by state.
Type: Website
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Acute Care Hospital Inpatient Prospective Payment System
Provides general information about the Acute Inpatient Prospective Payment System (IPPS), including IPPS payment rates and how IPPS payment rates are set. Includes sections on the Rural Referral Center (RRC) Program and the Sole Community Hospital (SCH) designation.
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Dartmouth Atlas of Health Care
Provides access to Medicare data on enrollee demographics, reimbursement, utilization and quality. Map-based interface with profiles by hospital and region. Also includes national maps and data by topic.
Type: Website
Sponsoring organization: The Dartmouth Institute for Health Policy and Clinical Practice
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CMS Regional Office Rural Health Coordinators
Contains a list of CMS regional rural health coordinators who provide technical, policy, and operational assistance on rural health issues.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Quarterly Provider Compliance Newsletter
A quarterly newsletter to help healthcare providers to address and avoid common Medicare billing errors and comply appropriately with payment audits.
Type: Journal/Newsletter
Sponsoring organization: Centers for Medicare and Medicaid Services
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PubMed Search: Medicare and Rural Health
Searches PubMed's collection of journal article citations on the topic of Medicare and rural health.
Type: Literature Search
Sponsoring organization: National Library of Medicine
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Medicare Learning Network
Provides access to Center for Medicare and Medicaid Services (CMS) program information and resources for healthcare providers.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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CMS Regional Offices
Provides contact information for the CMS Regional Representatives serving 10 regions across the United States.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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State Survey Agency Directory
Contains a directory of state agencies that handle survey and certification of certain health care facilities including Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) for compliance with the Medicare health and safety standards. Updated quarterly.
Type: Directory
Sponsoring organization: Centers for Medicare and Medicaid Services
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MLN Matters
Presents articles for Medicare health care providers to help them understand new or changed Medicare policy.
Type: Journal/Newsletter
Sponsoring organization: Centers for Medicare and Medicaid Services
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Physician Bonuses
Presents information and resources concerning Medicare bonus payments for physicians who provide services to Medicare beneficiaries in areas that are designated as Physician Scarcity Areas (PSAs) and Geographic Health Professional Shortage Areas (HPSAs). Includes lists of eligible zip codes for receiving the bonus payments.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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State Health Facts
Contains state-level data on demographics, health status, healthcare costs and access, healthcare providers, and more. Individual state profiles and 50-state comparisons.
Type: Database
Sponsoring organization: Kaiser Family Foundation
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Medicare & Medicaid Research Review (MMRR)
Peer-reviewed, online journal published from 2011 through 2014. Reported data and research on Medicare, Medicaid, and the Children's Health Insurance programs. Examined and evaluated health care coverage, quality and access to care for beneficiaries, and payment for health services.
Type: Journal/Newsletter
Sponsoring organization: Centers for Medicare and Medicaid Services
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Additional resources are available related to this guide. See the full list of resources by topic for:


Last Updated: 12/11/2017