The Medicare Payment Advisory Commission (MedPAC), the savvy nonpartisan shop that advises Congress on Medicare program issues, has updated its excellent series of primers. Extremely complex and changing constantly, Medicare payment policy will drive $479 billion in health spending in 2008. MedPAC’s primers, typically four crisply-written pages, explain the basic steps and methodologies Medicare uses to reimburse fee-for-service providers, Medicare Advantage plans, and Medicare prescription drug plans.
Here are MedPAC’s updated primers on the basics of Medicare reimbursement policy (click on links to open in PDF format):
Medicare Hospital Reimbursement:
- Hospital acute inpatient services payment system (inpatient prospective payment system or IPPS)
- Outpatient hospital services payment system (outpatient prospective payment system or OPPS)
- Critical access hospital payments
- Psychiatric hospital services payment system
Medicare Post-Acute Provider Reimbursement:
- Skilled nursing facility services payment system
- Inpatient rehabilitation facilities payment system
- Long-term care hospitals payment system
- Home health care services payment system
Medicare Physician Reimbursement:
- Physician services payment
- Medicare payment to physicians for professional liability insurance
- Geographic practice cost indexes
Medicare Managed Care (Part C and Part D):
Other Medicare Reimbursement Policies:
- Outpatient dialysis services payment system (ESRD facilities)
- Durable medical equipment payment system (DME reimbursement)
- Oxygen and oxygen equipment payment system
- Ambulatory surgical centers payment system
- Clinical laboratory services payment system
- Outpatient therapy services reimbursement
- Hospice services reimbursement















