Medicare program payment methods are highly complex and change constantly. The Affordable Care Act (ACA) makes further, very significant changes to how Medicare pays hospitals, physicians, post-acute providers, and Medicare Advantage health plans. In a series of excellent briefs, the Medicare Payment Advisory Commission (MedPAC) explains the basics of Medicare reimbusement, including payment reforms required under ACA.
MedPAC’s primers cover fee-for-service payment methods for all major types of providers and suppliers in Medicare Part A and Part B, Medicare Advantage health plans, and Medicare Part D prescription drug plans. MedPAC updates the briefs every year to incorporate changes in the law or in rules from the Centers for Medicare and Medicaid Services (CMS).
Links to the updated briefs are posted below.
Medicare Health Plans and Medicare Drug Plans:
Medicare Payment for Physician and Outpatient Services:
- Ambulance services payment system
- Ambulatory surgical center services payment system
- Clinical laboratory services payment system
- Durable medical equipment payment system
- Outpatient dialysis services payment system
- Outpatient hospital services payment system
- Outpatient therapy services payment system
- Physician and other health professionals payment system
- Skilled nursing facility services payment system
Medicare Payment for Post-Acute Providers:
- Home health care services payment system
- Hospice services payment system
- Inpatient rehabilitation facilities payment system
- Long-term care hospitals payment system
Medicare Payment for Inpatient Hospital Services:
- Hospital acute inpatient services payment system
- Critical access hospitals payment system
- Psychiatric hospital services payment system
Kip Piper is a Medicare, Medicaid, and health reform consultant, speaker, and author. A senior consultant with Sellers Dorsey, a national healthcare consultancy, as well as an advisor with Fleishman-Hillard and TogoRun. Kip advises health plans, hospitals and health systems, states, drug and device manufacturers, and investment firms throughout the U.S. For more, visit KipPiper.com. Follow on Twitter at @KipPiper and connect with Kip on LinkedIn.