Tools
Benefit Eligibility Screening Tool (B.E.S.T.)
Web site
A tool to find out if a person could be eligible for benefits from any of the programs Social Security administers.
BenefitsCheckUpRX
Web site
Helps Medicare beneficiaries learn about and enroll in government benefits, including Medicare Part D, the new outpatient prescription drug benefit, and other federal, state and private programs that can help save money on health care and prescription drugs.
Centers for Medicare & Medicaid Services Regional Offices
Web site
Locator and contact information for the CMS Regional Representatives serving 10 regions across the United States.
CMS Hospitals Center
Web site
Contains Medicare manuals, forms, and regulations for hospitals.
CMS Recovery Audit Contractor (RAC)
Web site
Provides information on the Recovery Audit Contractor (RAC) project, implementation strategies, who the RACs are, RAC jurisdictions, RAC expansion and provider outreach schedules, and FAQs.
CMS State Survey Agency Directory
Web site
Directory of state agencies that handle survey and certification of certain health care facilities for compliance with the Medicare health and safety standards.
Home Health Compare
Web site
Provides detailed information about Medicare-certified home health agencies in your area.
Innovators' Guide to Navigating CMS
Web site
Assist stakeholders in understanding the 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.
KaiserEDU
Web site
Detailed resource lists and tutorials on health policy and public health topics, with links to publications, data, and organizations. Topics covered include Medicare, Medicaid, the uninsured, quality of care, and more. Designed for health policy students and faculty.
Medicare Certified Rural Health Clinics
Web site
Provides a list of all RHCs in each of the 50 states. Includes provider number, name, address, city-state-zip, phone number, and county.
Medicare Contracting Reform
Web site
Information and resources concerning the Part A/Part B Medicare Administrative Contractors (MACs), which will replace the current fiscal intermediaries and carriers and handle administration of both the Medicare Part A and Part B programs in specified geographic regions.
Medicare Health and Prescription Drug Plan Tracker
Web site
Interactive tool providing information about private plans participating in the Medicare Advantage program and the Medicare prescription drug program. Includes national statistics specific to rural areas.
Medicare Health Plans - General Information
Web site
Information for current and future contracting Medicare Advantage Organizations, other health plans, and other parties interested in the operational and regulatory aspects of the Medicare Advantage program.
Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)
Print publication
Provides the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) that passed by both Houses.
Medicare Information for Health Professional Shortage Areas (HPSAs) and Physician Scarcity Areas (PSAs)
Web site
Information and resources concerning Medicare bonus payments effective January 1, 2005 to 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
Medicare Interactive Counselor
Web site
A one-stop source for information about health care rights, options and benefits. Helps older and disabled Americans, their caregivers and the professionals who serve them, understand their health care rights and benefits.
Medicare Learning Network
Web site
Provides official CMS provider products designed to promote national consistency of Medicare provider information. Developed for CMS initiatives including Medicare fee-for-service providers.
Medicare Learning Network Publications
Web site
Contains publications and resources for the health care professional.
Medicare Modernization Act
Web site
Information on CMS implementation of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). Includes links to CMS fact sheets and press releases, as well as other resources for understanding the impact of the MMA.
Medicare Part D & Safety Net Providers
Web site
Provides contacts for the State Health Insurance Assistance Program.
Medicare Prescription Drug Coverage - General Information
Web site
Links to important information on the new Medicare prescription drug benefit. Includes prescription drug benefit pharmacy training information.
Medicare Prescription Drug Plan Finder
Web site
Online tool for identifying and enrolling in Medicare prescription drug plans. Includes information about plans available in each state. Available in Spanish.
Medicare RX: National Conversation-Friends and Family First
Web site
Aids faith-based and community organizations working with individuals eligible for the Medicare prescription drug benefit. Describes five steps to select a Medicare prescription drug plan.
Medicare State Health Facts
Web site
Provides current data about states' aged and disabled Medicare beneficiaries, such as enrollment, demographics (such as age, gender, race/ethnicity), spending, other sources of health coverage, managed care participation, and use of services.
Medicare.gov
Database
Searchable database on a host of Medicare related tools, including prescription drug plans, publications, and nursing home comparing.
MedlinePlus: Medicare Prescription Drug Plan
Web site
Links to resources, tools and news related to the Medicare prescription drug plan (Part D).
National Provider Identifer (NPI) Information for Medicare Fee-for-Service Providers
Web site
Provides information on how to apply for a National Provider Identifier (NPI), and links to resources and education materials related to the NPI.
National Provider Identifier Standard (NPI)
Web site
Overviews the National Provider Identifier (NPI) requirements. Includes links to resources and additional information. The purpose of the National Provider Identifier (NPI) is to uniquely identify a health care provider in standard transactions, such as health care claims.
Rural Health Research: Medicare
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of Medicare, produced by the Office of Rural Health Policy's funded rural health research centers.
Social Security Online
Web site
Identifies programs and online services of the Social Security Office. Visitors can qualify and apply online for disability and survivorship benefits. Also, replacement Medicare cards can be requested from this website.
Toolkit for Healthcare Professionals: Medicare Prescription Drug Coverage
Web site
Educational materials for physicians and other healthcare professionals to learn about Medicare's prescription drug coverage. Also includes materials physicians can distribute to Medicare patients.
Regulations, Forms & Other Useful Documents
Acute Inpatient Prospective Payment System: Fact Sheet
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides general information about the Acute Inpatient Prospective Payment System (IPPS) including IPPS payment rates and how IPPS payment rates are set.
Date: 01 / 2009
America's Seniors and Health Insurance Reform: Protecting Coverage and Strengthening Medicare
Sponsoring organization: U.S. Department of Health and Human Services
Report issued by HHS Secretary Kathleen Sebelius that highlights the problems, including access to care in rural areas, that leave seniors paying higher costs for health care. Outlines how health insurance reform can strengthen Medicare and protect coverage for seniors.
Date: 08 / 2009
Causes and Consequences of the Rural Uninsured and Underinsured
Author(s): Joe Blankenau, Jon M. Bailey, Julia Hudson
Sponsoring organization: Center for Rural Affairs
Details health insurance coverage in rural America. Includes how rural citizens get insurance coverage and how it differs from urban America, reviews research that explores obstacles in attaining health insurance, addresses the problem of underinsurance, and explores the impact of inadequate financing for health care and its effects on the community. Concludes that health care reform must address the employer-sponsored health insurance system.
Date: 04 / 2009
CMS Issues Proposed Changes in Conditions of Participation Requirements and Payment Provisions for Rural Health Clinics and Federally Qualified Health Centers
Sponsoring organization: Centers for Medicare and Medicaid Services
Proposed rule to update certification and participation regulations and payment provisions for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).
Date: 06 / 2008
Continuing Cost of Privatization: Extra Payments to Medicare Advantage Plans in 2008
Author(s): Brian Biles, Emily Adrion, Stuart Guterman
Sponsoring organization: Commonwealth Fund
Analyzes Medicare Advantage plans that increase payments to private health plans, addresses implications for rural areas, and displays related trends and estimations.
Date: 09 / 2008
Contracting with Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators
Summarizes the experience of CAH administrators with contracts offered by Medicare Advantage (MA) plans. Telephone surveys were conducted with CAH administrators across the country to learn about their experiences with MA plans. This brief includes information about the contract terms administrators have been offered, their experiences negotiating with MA plans, and their advice for others dealing with this issue.
Date: 12 / 2005
Cost Containment in Medicare: A Review of What Works and What Doesn't
Author(s): Robert Berenson, Michael Hash, Thomas Ault, Beth Fuchs, Stephanie Maxwell, Lisa Potetz, Stephen Zuckerman
Sponsoring organization: AARP Public Policy Institute
A study that looks at what has been tried in the Medicare laboratory to slow cost growth.
Date: 12 / 2008
December 2009: Rural Medicare Advantage Enrollment Grows 15% in 2009
Author(s): Leah Kemper, Timothy D. McBride, Keith Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Discusses how the rural enrollment in Medicare Advantage (MA) and other prepaid plans grew by 15% from December 2008 to December 2009, faster than the 10% national growth rate.
Date: 01 / 2010
Emerging Role of Group Medicare Private Fee-for-Service Plans (PFFS)
Author(s): Ruth Brown, Miryam Frieder, Jonathan Blum, Penny Mills
Sponsoring organization: Kaiser Family Foundation
Highlights changes in regulation, statute and the marketplace that are influencing employers’ interest in PFFS plans as an option for their retirees, drawing on interviews with employers, benefit consultants, insurers and consumer representatives. Includes references to rural.
Date: 12 / 2008
Enrollment in Medicare Part D for Rural Beneficiaries Is Encouraging
Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Provides updated findings about Medicare beneficiary enrollment in prescription drug plans (PDPs) in rural and urban areas across the United
States. Updates findings presented in RUPRI Center Policy Brief PB2006-8.
Journal citation: RUPRI Rural Policy Brief Volume 12 Issue 1
Date: 01 / 2007
Experience of Sole Community Rural Independent Pharmacies with Medicare Part D: Reports from the Field
Author(s): Andrea Radford, Rebecca Slifkin, Roslyn Fraser, Michelle Mason, Keith Mueller
The findings from this study, along with specific suggestions made by pharmacists during the interviews, suggest short-term actions that can be taken to address the challenges faced by rural independent pharmacies who are the sole providers in their communities. A joint publication of the North Carolina Rural Health Research & Policy Analysis Center and the RUPRI Center for Rural Health Policy Analysis.
Date: 11 / 2006
General Equivalence Mappings (GEM): ICD-9-CM to and from ICD-10-CM and ICD-10-PCS
Sponsoring organization: Centers for Medicare and Medicaid Services
Lists the top 10 frequently asked questions about the conversion of International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) codes to International Classification of Diseases, 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM.
Date: 03 / 2009
Health Care Opinion Leaders' Views on Medicare Reform
Author(s): Kristof Stremikis, Stuart Guterman, Karen Davis
Sponsoring organization: Commonwealth Fund
This data brief contains summarized results from a survey of leaders in health care and health care policy on the topics of Medicare and legislative reform measures.
Date: 11 / 2009
Health Insurance Coverage for Older Adults: Implications of a Medicare Buy-In
Author(s): Gretchen Jacobson, Karyn Schwartz, Tricia Neuman
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Examines the barriers to securing affordable coverage in the current marketplace for uninsured people ages 55 to 65, as well as the potential for a Medicare buy-in to improve the group’s health insurance coverage rate.
Date: 05 / 2009
Hospital Outpatient Prospective Payment System
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides general information about the Hospital Outpatient Prospective Payment System, ambulatory payment classifications, and how payment rates are set.
Date: 01 / 2009
Impacts of the Medicare Modernization Act on Rural Health Systems and Beneficiaries
Author(s): Keith J. Mueller, Andrew F. Coburn, Charles W. Fluharty, A. Clinton MacKinney, Timothy D. McBride, Rebecca T. Slifkin, Mary Wakefield
Sponsoring organization: Rural Policy Research Institute (RUPRI) Rural Health Panel
This paper offers an analysis of rural-pertinent provisions of the Medicare
Modernization Act of 2003. A highlights section summarizes legislative and
regulatory provisions of special significance to rural beneficiaries and
health care systems. The final section includes Panel analysis of all
provisions identified by the Panel as important to rural interests.
Date: 02 / 2005
July 2009: Rural Enrollment in Medicare Advantage Continues to Grow
Author(s): Leah Kemper, Timothy D. McBride, Keith Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Describes how enrollment in Medicare Advantage has grown in rural areas due to increased enrollment in preferred provider organization (PPO) plans and private fee-for-service plans.
Date: 08 / 2009
Low-Income & Rural Beneficiaries with Medigap Coverage, 2006
Author(s): Christelle Chen
Sponsoring organization: AHIP Center for Policy and Research
Data from the Medicare Current Beneficiary Survey serves as a reminder of the critical role played by Medigap coverage, especially for low- and moderate-income beneficiaries, and those living in rural areas.
Date: 09 / 2008
Low-Income & Rural Beneficiaries with Medigap Coverage, 2007
Sponsoring organization: AHIP Center for Policy and Research
Data from the Medicare Current Beneficiary Survey shows the critical role played by Medigap coverage, especially for low- and moderate-income beneficiaries, and those living in rural areas.
Date: 09 / 2009
May 2009: PPOs Driving Growth in Rural Medicare Advantage Enrollment
Author(s): Leah Kemper, Timothy D. McBride, Keith Mueller
Sponsoring organization: Rural Policy Research Institute
Describes the 2009 growth of rural Medicare Advantage (MA) enrollment and in preferred provider organization (PPO) plan enrollment, while the rate of enrollment in private fee-for-service (PFFS) plans declines.
Date: 06 / 2009
Measuring Regional Variation in Service Use
Sponsoring organization: Medicare Payment Advisory Commission
A report to Congress that presents data on the difference between regional variation in Medicare spending and regional variation in the use of Medicare-covered services. Date used was adjusted due to differences in small rural hospital and critical access hospital Medicare payment rates.
Date: 12 / 2009
Medicare & You: 2010
Sponsoring organization: Centers for Medicare and Medicaid Services
Highlights what's new, what's covered, health plans, prescription drug plans, and your rights.
Date: 09 / 2009
Medicare Advantage for Rural America?
Sponsoring organization: National Rural Health Association
Policy brief addressing Medicare Advantage (MA) implementation issues relevant to rural communities. Discusses potential impact of MA on access to health care in rural areas. Includes policy recommendations.
Date: 04 / 2007
Medicare Advantage in Rural Areas
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
Chapter from the 2007 Report to the Secretary: Rural Health and Human Service Issues. Addresses Medicare Advantage (MA), a program that provides health care benefits for elderly Americans through private insurance companies, and the impact that MA may have on rural beneficiaries and providers.
Date: 01 / 2007
Medicare Advantage Plans in Rural America
Author(s): Andrew F. Coburn, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
Sponsoring organization: Rural Policy Research Institute (RUPRI) Rural Health Panel
Identifies key policy issues and questions concerning the impact of Medicare
Advantage (MA) in rural areas.
Date: 10 / 2007
Medicare and Medicaid Participating Facilities: CMS Needs to Reexamine Its Approach for Funding State Oversight of Health Care Facilities
Sponsoring organization: Government Accountability Office
Reports on a survey and complaint investigation done by the states on the Medicaid program.
Date: 02 / 2009
Medicare at a Glance
Sponsoring organization: Kaiser Family Foundation
Provides an overview of the Medicare program, including how it is financed, who is eligible and what benefits are covered under the program. In addition, it describes supplemental health insurance, benefits provided by the new drug law and data on Medicare expenditures and financing.
Date: 11 / 2008
Medicare Billing Information for Rural Providers, Suppliers, and Physicians
Sponsoring organization: Centers for Disease Control and Prevention
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: 10 / 2008
Medicare Buy-in Program
Author(s): Gerry Smolka, Sarah Thomas
Sponsoring organization: AARP Public Policy Institute
Reviews the general advantages and disadvantages of a Medicare buy-in program in relation to the population in their 50s and early 60s and discusses geographic variation in Medicare spending and unsubsidized premiums.
Date: 06 / 2009
Medicare Dependent Hospital Fact Sheet
Sponsoring organization: Centers for Medicare and Medicaid Services
Describes this type of rural hospital in terms of bed size and the percentage of its patients that are beneficiaries of Medicare Part A.
Date: 04 / 2009
Medicare Disproportionate Share Hospital Fact Sheet
Sponsoring organization: Centers for Medicare and Medicaid Services
Overviews the Medicare Disproportionate Share
Hospital adjustment provision and lists how a hospital can qualify to receive it.
Date: 04 / 2009
Medicare Guide to Rural Health Services Information for Providers, Suppliers, and Physicians
Sponsoring organization: Centers for Medicare and Medicaid Services
Offers Medicare providers, suppliers, and physicians rural health information and resources including Ambulance Services, CAH's, FQHC's, HPSA, Home Health, Hospice, Medicare, Prescription Drug Plan, Quality Improvement, RHC's, Sole Community Hospital, Swing Bed, and Telehealth.
Date: 04 / 2007
Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries
Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Early information on enrollment in the Medicare prescription drug program in rural and urban areas. Includes findings from an
analysis of plans available to rural persons under
Medicare's Part D program.
Date: 04 / 2006
Medicare Physician Fee Schedule
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides general information about the Medicare Physician Fee Schedule (MPFS) including payment rates and MPFS payment rates formula.
Date: 01 / 2010
Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals
Sponsoring organization: Centers for Disease Control and Prevention
Offers general information about certain aspects of the Medicare program including enrollment, reimbursement, payment policies, evaluation and management services, protecting the Medicare Trust Fund, and inquiries, overpayments and fee-for-service appeals.
Date: 10 / 2009
Medicare Physician Payment Policy and the Rural Perspective (Final Report)
Author(s): A. Clinton MacKinney, Keith J. Mueller, Timothy D. McBride
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Examines the effects of Medicare payment changes on rural physician practice revenue.
Date: 11 / 2008
Medicare Physician Payment: Impacts of Changes on Rural Physicians
Author(s): Keith J. Mueller, A. Clinton MacKinney, Timothy D. McBride
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Overview of the effects of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 on physician payment rates in rural areas. Discusses the impact of creating a floor of 1.00 in the geographic practice cost index (GPCI) for work expense and the effects of the Medicare incentive payment (MIP) for providing services in shortage areas and of the bonus for practicing in a physician scarcity area.
Date: 09 / 2006
Medicare: A Primer
Sponsoring organization: Kaiser Family Foundation
Looks at the characteristics of the Medicare population, what benefits are covered, how much people with Medicare pay for their benefits and the program's overall costs and future financing challenges. Also provides information about the Medicare Advantage program and the Medicare drug benefit.
Date: 12 / 2008
National Health Expenditure Projections 2009-2019
Sponsoring organization: Centers for Medicare and Medicaid Services
An analysis of projected national health care expenditures (NHE) through 2019.
Date: 02 / 2010
Reforming America's Health Care Delivery System
Author(s): Glenn M. Hackbarth, J.D.
Sponsoring organization: Medicare Payment Advisory Commission
Articulates MedPAC chairman's positions on the current state of health care as well as the commission's recommendations for health care delivery reform. Includes specific suggested changes and addresses sustainability concerns.
Date: 04 / 2009
Report to the Congress: Medicare Payment Policy, 2009
Sponsoring organization: Medicare Payment Advisory Commission
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 / 2009
Report to the Congress: Reforming the Delivery System
Sponsoring organization: Medicare Payment Advisory Commission
Describes a direction for Medicare payment and delivery system reform; makes recommendations to promote primary care; and examines hospital–physician collaborative relationships.
Date: 06 / 2008
Rural Enrollment in Medicare Advantage Growing Rapidly in 2007, Especially in Private Fee-for-Service Plans
Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Provides findings about enrollment in the newly designed Medicare Advantage (MA) program in rural and urban areas, with state and national data. Updates early findings from analysis of the Medicare+Choice/MA program presented in previous RUPRI Center policy briefs.
Date: 07 / 2007
Rural Enrollment in Medicare Advantage Is Concentrated in Private Fee-for-Service Plans
Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Provides findings about enrollment in the newly
designed Medicare Advantage (MA) program in rural and urban areas. Includes rural and urban data on enrollment in Medicare Advantage and other pre-paid plans by type of plan. Also provides state-level information on MA enrollment.
Date: 04 / 2007
Rural Health Clinic and Federally Qualified Health Center Manual
Sponsoring organization: Centers for Medicare and Medicaid Services
Medicare manual for Rural Health Clinics and Federally Qualified Health Centers. Covers agreements and terminations, coverage and exclusions, payment and billing procedures. Available as a ZIP file download.
Rural Primary Care Physician Payment 2006–2009: What a Difference Three Years Doesn’t Make
Author(s): A. Clinton MacKinney, Keith J. Mueller, Mary Charlton
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Presents the impact of Medicare’s Evaluation and Management (E&M) physician services valuation adjustment (implemented January 1, 2007) on two prototypical primary care practices—one providing only cognitive (E&M) services (cognitive practice) and another providing a mix of procedures and E&M services (procedural practice).
Date: 11 / 2009
Rural Referral Center Fact Sheet
Sponsoring organization: Centers for Medicare and Medicaid Services
Overview of the Rural Referral Center (RCC) program, which supports high-volume rural
hospitals that treat a large number of complicated cases.
Date: 04 / 2009
Side-by-Side Comparison of Key Medicare Provisions in 2009 Health Reform Legislation
Sponsoring organization: Kaiser Family Foundation
Describes the major Medicare provisions relating to benefit changes, Medicare Advantage, the Medicare prescription drug benefit, physician and other provider payment reforms, and other health system reforms in the Senate Finance proposal and the House Tri-Committee bill. Includes measures related to rural and underserved communities.
Date: 10 / 2009
State Updates on Medicare Advantage Enrollment
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
These state-by-state reports compare MA enrollment in December 2005 to that in September 2007, including information on overall and rural enrollment in all MA plans.
Date: 2007
Telehealth Services Fact Sheet
Sponsoring organization: Centers for Medicare and Medicaid Services
Describes Medicaire benefits in terms of care via telehealth services received by patients in rural health professional shortage areas.
Date: 07 / 2009
Update on Rural Enrollment in Medicare Advantage: Growth Continues
Author(s): Timothy D. McBride, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Provides findings about rural enrollment in the Medicare Advantage (MA) program and other pre-paid plans, with state and national data. Updates early findings from analysis of the Medicare+Choice/MA program presented in previous RUPRI Center policy briefs.
Date: 10 / 2007
