Tools
2011 CMS Statistics
Web site
Contains annual booklets of information about health expenditures and the Centers for Medicare & Medicaid Services' (CMS) programs. Booklets cover years from 2003 through 2011.
2011 Medicare Health and Drug Plans by State
Web site
Presents a page for each state containing fast facts, important dates, number of plans, and data regarding plan costs and coverage.
Accountable Care Organizations: Commonwealth Fund Resources
Web site
Provides an annotated list and links to Commonwealth Fund publications on Accountable Care Organizations (ACOs).
Benefit Eligibility Screening Tool (BEST)
Web site
Assists people in finding out what benefits they are eligible for from any of the programs Social Security administers.
BenefitsCheckUp
Web site
Helps Medicare beneficiaries learn about and enroll in government benefits, including Medicare Part D, the Supplemental Nutrition Assistance Program, and Eldercare Assistance.
CMS Contacts
Web site
Provides access to the CMS.gov Contacts Database. Allows for searching by state, region, contact type, and organization.
CMS Critical Access Hospitals Center
Web site
Presents regulations and notices, press releases, program memorandums, and other information from CMS related to the Critical Access Hospitals (CAH) program.
CMS EHR Meaningful Use Overview
Web site
Discusses the Medicare and Medicaid EHR Incentive Programs, which provide a financial incentive for the "meaningful use" of certified EHR technology to achieve health and efficiency goals.
CMS Hospitals Center
Web site
Contains Medicare manuals, forms, and regulations for hospitals.
CMS Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs
Web site
Provides information about the Electronic Health Record (EHR) incentive programs (HITECH programs) offered by Centers for Medicare and Medicaid Services. Includes the definition of "Meaningful Use" that outlines the requirements needed to receive EHR incentive payments.
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 Regional Offices
Web site
Provides contact information for the CMS Regional Representatives serving 10 regions across the United States.
CMS Sponsored ICD-10 Teleconferences
Web site
Presents a list of archived teleconferences discussing the change to ICD-10 for medical diagnosis and inpatient procedure coding.
CMS State Survey Agency Directory
Web site
Contains a directory of state agencies that handle survey and certification of certain health care facilities for compliance with the Medicare health and safety standards. Updated quarterly.
Enrollment in Medicare Advantage and Other Prepaid Plans: June 2010
Web site
Includes national and state enrollment tables and maps. Statistics also available by location, including rural, rural micro, and rural non-micro.
Find Shortage Areas: HPSAs Eligible for the Medicare Physician Bonus Payment
Web site
Determines whether or not a HPSA address is eligible for the Medicare HPSA Physician Bonus. Also called The Geographic Eligibility Advisor for Medicare HPSA Bonus Payments.
Flex Medicare Beneficiary Quality Improvement Project (MBQIP)
Technical assistance
The goal of the Flex Medicare Beneficiary Quality Improvement Project (MBQIP) is to improve rural quality care access for Medicare beneficiaries served by critical access hospitals. These resources address the challenges of defining and reporting rural-relevant quality measurements and adopting proven clinical delivery models that drive quality and performance-based value. They also provide an overview of the goals, expectations, and measures for MBQIP.
Health IT - Meaningful Use Resources
Web site
Resource devoted to helping hospital leaders better understand the Medicare and Medicaid electronic health records incentive programs and their associated "meaningful use" requirements.
Health Professional Shortage Areas (HPSAs) and Physician Scarcity Areas (PSAs)
Web site
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.
Health Reform and Medicare: Overview of Key Provisions
Tutorial
Presents an audio-visual tutorial that describes provisions of the Affordable Care Act (ACA) that affect the many Medicare programs.
Home Health Compare
Web site
Provides information about Medicare-certified home health agencies in your area including skilled nursing care, physical and occupational therapy, and home health aide services.
Hospital Compare
Web site
Provides consumers with information on how well hospitals care for patients with specific medical conditions such as heart attacks, heart failure, or pneumonia, as well as surgical procedures.
ICD-10 Overview: CMS ICD-10 Website
Web site
Provides fact sheets, resources, timelines, and news to help vendors, payers, and providers prepare for the U.S. health care's transition to Version 5010 and ICD-10. Includes information on the 2012 ICD-10-CM diagnosis coding system. Version 5010 standards pertain to electronic health transactions and ICD-10 pertain to medical diagnosis and inpatient procedure coding.
KaiserEDU
Web site
Presents resource lists and tutorials on health policy and public health topics, with links to publications, data, and organizations. Topics covered include Medicare, Medicaid, SCHIP, the uninsured, quality of care, and more. Designed for health policy students and faculty.
List of CMS Regional Office and Other External Entity Contacts
Web site
Lists regional contacts for reaching experts on the HITECH (Health Information Technology for Economic and Clinical Health) Act.
Medicare A/B MAC Jurisdictions
Web site
Discusses the Medicare A/B Jurisdictions, including Medicare Administrative Contractors (MAC). Includes a map of the 15 jurisdictions.
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
Provides information and resources concerning the Part A/Part B Medicare Administrative Contractors (MACs).
Medicare Interactive Counselor
Web site
Includes 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. Contains publications and resources for the health care professional.
Medicare Modernization Act
Web site
Includes 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 State Health Facts
Web site
Provides current data about states' aged and disabled Medicare beneficiaries, Medicare Prescription Drug Plans, and Medicare Advantage 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 (English)
Database
Provides a searchable website on a host of Medicare related resources: The four parts of Medicare, Medicare basics, applying online for Medicare, enrolling in a prescription drug plan, ordering a Medicare replacement card, finding a doctor, and comparing hospitals and nursing homes.
Medicare.gov Support Center
Web site
Presents the official U.S. Government site for Medicare which provides an interactive tool that responds to inquiries about Medicare.
MedlinePlus: Medicare
Web site
Presents links to resources, tools and news related to Medicare.
National Provider Identifier Standard (NPI)
Web site
Provides an overview of the National Provider Identifier (NPI) requirements, which uniquely identifies a health care provider in standard transactions, such as health care claims. Includes links to resources and additional information.
Physician Quality Reporting System
Web site
Consists of a voluntary physician quality reporting program established by CMS providing financial incentive for eligible professionals.
Research Data Assistance Center
Research instrument
A Centers for Medicare and Medicaid Services (CMS) contractor that provides free assistance to academic, government and non-profit researchers interested in using Medicare and/or Medicaid data for their research.
Rural Health Clinics Center
Web site
Provides links to manuals, billing codes, enrollment and certification information, legislation, regulations, and contacts related to Medicare and Medicaid services in the rural health clinics.
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, including information on qualifying and applying online for disability and survivorship benefits.
Regulations, Forms & Other Useful Documents
2010 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds
Author(s): Timothy F. Geithner, Hilda L. Solis, Kathleen Sebelius, Michael J. Astrue, Donald M. Berwick
Presents the report to Congress on the financial and actuarial status of Medicare's Health Insurance (HI) and Supplementary Medical Insurance (SMI) trust funds. Includes provisions of the new Affordable Care Act (ACA) that affect Medicare and rural areas.
Date: 08 / 2010
2011 Physician Fee Schedule
Sponsoring organization: Centers for Medicare and Medicaid Services
Presents a corrected Relative Value Unit (RVU) for 2011 that incorporates the changes included in the Medicare and Medicaid Extenders Act of 2010 that was signed into law by President Obama on December 15, 2010.
Date: 12 / 2010
2011 Report to the Secretary: Rural Health and Human Services Issues
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
Report to the Secretary of the U.S. Department of Health and Human Services. Includes chapters 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. Includes appendices regarding June 2010 and September 2010 site visits.
Date: 03 / 2011
Acute Care Hospital Inpatient Prospective Payment System: Payment System Fact Sheet Series
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: 11 / 2011
America's Seniors and Health Insurance Reform: Protecting Coverage and Strengthening Medicare
Sponsoring organization: U.S. Department of Health and Human Services
Presents a 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
Basics: Medicare
Sponsoring organization: National Health Policy Forum
Highlights what Medicare is, it's parts, who is eligible, and services covered.
Date: 01 / 2011
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.
Date: 04 / 2009
Comparison of Rural Hospitals with Special Medicare Payment Provisions to Urban and Rural Hospitals Paid Under Prospective Payment (Final Report)
Author(s): G. Mark Holmes, George H. Pink, Sarah A. Friedman, Hilda A. Howard
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Compares the financial performance and condition of rural hospitals with special Medicare payment provisions to urban and rural hospitals paid under prospective payment (U-PPS and R-PPS hospitals, respectively).
Date: 08 / 2010
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
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
Reviews approaches and lessons with cost-containment strategies since the mid-1970s. Identifies and describes nine approaches that represent prominent and extensive research policies aimed at reducing the growth in program expenditures.
Date: 12 / 2008
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
Fact Sheet: Critical Access Hospital
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides information about Critical Access Hospital (CAH) providers; CAH designation; CAH payments; reasonable cost payment principles that do not apply to CAHs; election of Standard Payment Method or Optional (Elective) Payment Method; Medicare Rural Pass-Through funding for certain anesthesia services; Health Professional Shortage Area Incentive payments; Physician Scarcity Area Bonus payments; Medicare Prescription Drug, Improvement, and Modernization Act of 2003 provisions that impact CAHs; and grants to states under the Medicare Rural Hospital Flexibility Program.
Date: 04 / 2009
Fact Sheet: Medicare Shared Savings Program and Rural Providers
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides an overview of Accountable Care Organizations (ACOs) for rural providers. Discusses rules to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients.
Date: 10 / 2011
Fact Sheet: Medicare Spending and Financing
Sponsoring organization: Kaiser Family Foundation
Provides an overview of spending on the Medicare program, how the program is financed. Includes data on Medicare financing and incorporates reductions in the rate of growth of Medicare spending attributable to the 2010 health reform law.
Date: 09 / 2011
FAQs: Versions 5010 and D.O Transition Basics
Sponsoring organization: Centers for Medicare and Medicaid Services
Answers frequently asked questions regarding the transition to Version 5010 and D.O software. Version 5010 pertains to standards for electronic administrative transactions. D.O is the version of the National Council for Prescription Drug (NCPDP) standards for pharmacy transactions that replaces version 5.1.
Date: 07 / 2011
Focus on Health Reform: Summary of Key Changes to Medicare in 2010 Health Reform Law
Sponsoring organization: Kaiser Family Foundation
Provides a detailed look at the improvements in Medicare benefits, changes to payments for providers and Medicare Advantage plans, various demonstration projects and other Medicare provisions in the law.
Date: 2010
Geographic Adjustment in Medicare Payment Phase I: Improving Accuracy, Second Edition
Sponsoring organization: Institute of Medicine
Report brief that expands on recommendations made in an earlier IOM report for improving how the Medicare program calculates geographic practice cost indexes resulting in payments to hospitals, physicians, and other clinical practitioners according to the geographic locations.
Date: 06 / 2011
Guide to Medicare Preventive Services
Sponsoring organization: U.S. Department of Health and Human Services
Includes coverage, coding, billing, and reimbursement information for each of the
preventive benefits covered by Medicare. Includes information for Rural Health Clinics and FQHCs.
Date: 03 / 2011
Health Care Opinion Leaders' Views on Medicare Reform
Author(s): Kristof Stremikis, Stuart Guterman, Karen Davis
Sponsoring organization: Commonwealth Fund
Contains 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 Centers and Health Care Reform: Accountable Care Organizations and Medical Homes
Sponsoring organization: National Association of Community Health Centers
Summarizes the new programs and demonstration projects from the Patient Protection and Affordable Care Act (PPACA) that promote patient-centered, quality, primary care delivery in a medical home setting.
Date: 04 / 2010
Health Centers and Health Care Reform: Medicare Reimbursement for Health Centers
Sponsoring organization: National Association of Community Health Centers
Examines the changes to Federally Qualified Health Center (FQHC) services and the associated Medicare reimbursements as dictated in the Patient Protection and Affordable Care Act (PPACA).
Date: 04 / 2010
Health Centers and Health Care Reform: Public Insurance Programs
Sponsoring organization: National Association of Community Health Centers
Describes the expansion of Medicaid, the expansion of Medicare reimbursement rates, and the maintenance of the Children's Health Insurance Program (CHIP) income eligibility levels as dictated in the Patient Protection and Affordable Care Act (PPACA).
Date: 04 / 2010
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
Health Reform: The Nursing Home Provisions
Sponsoring organization: Center for Medicare Advocacy
Focuses on provisions affecting nursing homes as a result of the Affordable Care Act.
Date: 06 / 2010
High Performance Accountable Care: Building on Success and Learning from Experience
Author(s): Stuart Guterman, Stephen C. Schoenbaum, Karen Davis, et al.
Sponsoring organization: Commonwealth Fund
Describes accountable care organizations (ACOs) and the Medicare Shared Savings Program, a provision of the Affordable Care Act (ACA). Provides recommendations for ensuring the successful implementation and spread of ACOs to achieve the goals of a high performance health system.
Date: 04 / 2011
Home Health Face-to-Face Encounter: A New Home Health Certification Requirement
Sponsoring organization: Centers for Medicare and Medicaid Services
Discusses the home health certification requirement, effective January 1, 2011, which requires a physician to have a face-to-face encounter with any patient who is eligible for the home health benefit.
Date: 12 / 2010
Home Health Study Report: Literature Review
Author(s): Judy Goldberg Dey, Margaret Johnson, William Pajerowski, Myra Tanamor, Alyson Ward
Sponsoring organization: Centers for Medicare and Medicaid Services
Presents a literature search which was used as a background to aid the development of a study and report on potential revisions to the Home Health Prospective Payment System (HH PPS). Report includes rural and underserved populations.
Date: 01 / 2011
Hospital Outpatient Prospective Payment System: Payment System Fact Sheet Series
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 / 2010
Impacts of the Medicare Modernization Act on Rural Health Systems and Beneficiaries
Author(s): Keith Mueller, Andrew Coburn, Charles Fluharty, A. Clinton MacKinney, Timothy McBride, Rebecca Slifkin, Mary Wakefield
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
Offers an analysis of rural-pertinent provisions of the Medicare Modernization Act of 2003. Summarizes legislative and regulatory provisions of special significance to rural beneficiaries and health care systems. Includes Panel analysis of all provisions identified by the Panel as important to rural interests.
Date: 02 / 2005
Innovators' Guide to Navigating CMS
Sponsoring organization: Centers for Medicare and Medicaid Services
Assists 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.
Date: 2010
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
June 2011: Rural Medicare Advantage Enrollment Update
Author(s): Leah Kemper, Lisa Pollack, Abigail Barker, Timothy D. McBride, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Shows increases in enrollment into Medicare Advantage plans in rural America. The enrollment is concentrated in plans offered by three firms, especially in the types of plans with high rural enrollment which are preferred provider organizations and private fee-for-service plans.
Date: 09 / 2011
Low-Income & Rural Beneficiaries with Medigap Coverage, 2008
Author(s): Lisa Carpenter, Christelle Chen, Kelly Buck
Sponsoring organization: AHIP Center for Policy and Research
Discusses data from the 2008 Medicare Current Beneficiary Survey (MCBS) that shows how Medigap is particularly important to low- and moderate-income beneficiaries, especially those living in rural areas. Medigap supplemental coverage helps Medicare beneficiaries fill gaps in their benefits.
Date: 12 / 2010
Low-Income & Rural Beneficiaries with Medigap Coverage, 2009
Sponsoring organization: AHIP Center for Policy and Research
Data from the 2009 Medicare Current Beneficiary Survey (MCBS) shows that Medigap is important to low- and moderate-income beneficiaries, especially those living in rural areas.
Date: 09 / 2011
March 2011: Growth in PPOs Dominates the Rural MA Market in 2011
Author(s): Leah Kemper, Lisa Pollack, Timothy D. McBride, Keith Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Outlines Medicare Advantage enrollment numbers and trends for March 2011.
Date: 04 / 2011
May 2009: PPOs Driving Growth in Rural Medicare Advantage Enrollment
Author(s): Leah Kemper, Timothy D. McBride, Keith Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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
Medicare & You: 2012
Sponsoring organization: Centers for Medicare and Medicaid Services
Highlights what's new, what's covered, health plans, prescription drug plans, and consumer rights.
Date: 08 / 2011
Medicare Advantage Fact Sheet
Sponsoring organization: Kaiser Family Foundation
Provides an overview of the Medicare Advantage program. Describes program changes made by the new health reform law in plan participation and beneficiary enrollment, presents data on benefits and premiums, and explains changes in Medicare payments to participating plans.
Date: 11 / 2011
Medicare Advantage for Rural America?
Sponsoring organization: National Rural Health Association
Addresses 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
Presents a 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 Rural Health Panel
Identifies key policy issues and questions concerning the impact of Medicare
Advantage (MA) in rural areas.
Date: 10 / 2007
Medicare and Home Health Care
Sponsoring organization: Centers for Medicare and Medicaid Services
Explains how to find home health agencies, the Medicare Home Health Benefit, what Medicare covers, and where to get help with questions.
Date: 05 / 2010
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 and Medicaid Programs; Electronic Health Record Incentive Program (Final Rule)
Sponsoring organization: Centers for Medicare and Medicaid Services
Includes the final rule which implements the provisions of the American Recovery and Reinvestment Act of 2009 (ARRA) (Pub. L. 111-5). This ruling provides incentive payments to eligible professionals, hospitals and critical access hospitals (CAHs) participating in Medicare and Medicaid programs that adopt and successfully demonstrate meaningful use of certified electronic health record (EHR) technology.
Date: 07 / 2010
Medicare and Nonelderly People With Disabilities
Sponsoring organization: Kaiser Family Foundation
Presents an overview of Medicare's role in providing health care to 8 million people under age 65 who qualify for coverage due to a permanent disability.
Date: 09 / 2010
Medicare and the New Health Care Law - What It Means for You
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides information about Medicare services and benefits in regards to the new health care law. Spanish version
Date: 05 / 2010
Medicare at a Glance: Fact Sheet
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. Describes supplemental health insurance, and data on Medicare expenditures and financing.
Date: 11 / 2011
Medicare Beneficiary Access to Primary Care Physicians – Better in Rural, but Still Worrisome (Policy Brief)
Author(s): A. Clinton MacKinney, Liyan Xu, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Presents results from a national physician survey used to assess U.S. primary care physician and general surgeon willingness to accept Medicare patients and physician-reported reasons for not accepting Medicare patients.
Date: 01 / 2011
Medicare Beneficiary Quality Improvement Project (MBQIP)
Sponsoring organization: Health Resources and Services Administration
Discusses 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
Medicare Billing Information for Rural Providers and Suppliers
Sponsoring organization: Centers for Medicare and Medicaid Services
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: 09 / 2011
Medicare Chartbook, 2010
Sponsoring organization: Kaiser Family Foundation
Provides the most recent and reliable data available about the Medicare program and the 47 million seniors and younger people with disabilities who get health insurance coverage through the program. Includes both rural and urban data.
Date: 11 / 2010
Medicare Dependent Hospital: Rural Health Fact Sheet Series
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides information about Medicare Dependent Hospitals (MDH), including classification criteria, MDH payments, and resources.
Date: 01 / 2011
Medicare Guide to Rural Health Services Information for Providers, Suppliers, and Physicians
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides 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: 09 / 2005
Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)
Sponsoring organization: U.S. Government Printing Office
Provides the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) that passed by both Houses, H.R.
Date: 2008
Medicare Physician Fee Schedule: Payment System Fact Sheet Series
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: 12 / 2011
Medicare Physician Guide
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides information about 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: 05 / 2011
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
Presents an overview of the effects of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 on physician payment rates in rural areas.
Date: 09 / 2006
Medicare Physician Quality Reporting Initiative: Implications for Rural Physicians (Final Report)
Author(s): Alycia Infante, Michael Meit, Elizabeth Hargrave
Sponsoring organization: NORC Walsh Center for Rural Health Analysis
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.
Date: 08 / 2010
Medicare Physician Quality Reporting Initiative: Implications for Rural Physicians (Policy Brief)
Author(s): Alycia Infante, Michael Meit, Elizabeth Hargrave
Sponsoring organization: NORC Walsh Center for Rural Health Analysis
Explores the implementation and design of a P4R program, the Physician Quality
Reporting Initiative (PQRI), in order to identify the implications for rural physicians.
Date: 08 / 2010
Medicare 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.
Medicare Shared Savings Program: Accountable Care Organizations, Final Rule
Sponsoring organization: American Academy of Family Physicians
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
Medicare: A Primer
Sponsoring organization: Kaiser Family Foundation
Covers what is Medicare and who is eligible, characteristics, covered benefits, how it's financed, the Medicare Advantage program, and the Medicare drug benefit.
Date: 04 / 2010
Medicare’s Accountable Care Organization Regulations: How Will Medicare Beneficiaries who Reside in Medically Underserved Communities Fare?
Author(s): Sara Rosenbaum, Peter Shin
Sponsoring organization: George Washington University Department of Health Policy
Examines impact of ACO rule on medically underserved areas.
Date: 04 / 2011
MedPAC A Data Book: Health Care Spending and the Medicare Program, 2011
Sponsoring organization: Medicare Payment Advisory Commission
Provides data, including some rural-specific statistics, on various aspects of the Medicare program. Covers beneficiary demographics, quality and access, national health care spending, acute inpatient services, ambulatory and post-acute care, prescription drugs, and Medicare Advantage.
Date: 06 / 2011
MedPAC Report to Congress: Aligning Incentives in Medicare, June 2010
Sponsoring organization: Medicare Payment Advisory Commission
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.
Date: 06 / 2010
MedPAC Report to Congress: Regional Variation in Service Use, January 2011
Sponsoring organization: Medicare Payment Advisory Commission
Presents data on the difference between regional variation in Medicare spending and regional variation in the use of Medicare-covered services. Data used was adjusted due to differences in small rural hospital and critical access hospital Medicare payment rates.
Date: 01 / 2011
MedPAC Report to the Congress: Medicare Payment Policy, 2011
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 / 2011
MedPAC 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
MedPAC Testimony - Report to the Congress: Medicare Payment Policy, March 15, 2011
Sponsoring organization: Medicare Payment Advisory Commission
Presents the annual review with recommendations for Medicare fee-for-service (FFS) payment systems and the Medicare Advantage (MA) program.
Date: 03 / 2011
National Health Expenditure Projections 2009-2019
Sponsoring organization: Centers for Medicare and Medicaid Services
Presents an analysis of projected national health care expenditures (NHE) through 2019.
Date: 02 / 2010
New Project Targets CAH Quality Measures and Reporting
Author(s): Candi Helseth
Sponsoring organization: Rural Assistance Center
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.
Journal citation: Rural Monitor
Date: 11 / 2011
Patient Protection and Affordable Care Act
Sponsoring organization: U.S. Government Printing Office
Includes the entire text of the 2010 health care reform law - The Patient Protection and Affordable Care Act, commonly referred to as the Affordable Care Act (ACA).
Date: 01 / 2010
Patient Protection and Affordable Care Act - Positive Steps for Rural
Sponsoring organization: National Rural Health Association
Examines the provisions in the Patient Protection and Affordable Care Act, and the subsequent Reconciliation Package that contains building blocks to improve the access to health care crisis faced by rural patients. Improvements include provisions to help resolve the workforce shortage crisis in rural areas and to eliminate long-standing payment inequities for rural providers.
Date: 04 / 2010
Reforming America's Health Care Delivery System
Author(s): Glenn M. Hackbarth, J.D.
Sponsoring organization: Medicare Payment Advisory Commission
Presents 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 and the Health Care Delivery System
Sponsoring organization: Medicare Payment Advisory Commission
Includes chapters on Medicare payment accuracy, technical assistance, fee-for-service, care coordination, FQHC's, and private-sector payment rates.
Date: 06 / 2011
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 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 Health Clinic: Rural Health Fact Sheet Series
Sponsoring organization: Centers for Medicare and Medicaid Services
Presents facts about the Rural Health Clinics program that includes the requirements for a facility to become an RHC, Medicare payments for RHC services, and a list of rural health websites.
Date: 10 / 2011
Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing Guide
Sponsoring organization: Centers for Medicare and Medicaid Services
Describes the information FQHCs are required to submit for a Prospective Payment System (PPS), and it explains how RHCs should bill for certain preventive services under the Affordable Care Act.
Date: 2009
Rural Issues Related to Bundled Payments for Acute Care Episodes (Policy Brief)
Author(s): Robert Town, Walter Gregg, Ira Moscovice, Shailendra Prasad, Jill Klingner, Christopher Dickerson
Sponsoring organization: Upper Midwest Rural Health Research Center
Describes challenges to implementing bundled payments in rural settings and discusses potential contracting and reimbursement strategies to address these challenges.
Date: 06 / 2009
Rural Medicare Advantage 2011: Enrollment Trends and Plan Characteristics
Author(s): Leah Kemper, Lisa Pollack, Abigail Barker, Timothy D. McBride, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Addresses the current and future plan characteristics and enrollment trends of the Medicare Advantage program specific to rural America.
Date: 10 / 2011
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: Rural Health Fact Sheet Series
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides information on the Rural Referral Center (RCC) program, which supports high-volume rural hospitals that treat a large number of complicated cases. Includes list of CMS Regional Office Rural Health Coordinators.
Date: 01 / 2011
Sole Community Hospital: Rural Health Fact Sheet Series
Sponsoring organization: Centers for Medicare and Medicaid Services
Presents information on Sole Community Hospitals including classification payments and criteria, resources, and a list of regional office rural health coordinators.
Date: 10 / 2010
Telehealth Services: Rural Health Fact Sheet Series
Sponsoring organization: Centers for Medicare and Medicaid Services
Contains information on originating sites, distant site practitioners, telehealth services (including CPT Codes), billing and payment for professional services furnished via telehealth as well as for the originating site facility fee and a list of helpful websites.
Date: 03 / 2011
Timeline for Health Care Reform Implementation: Health Insurance Provisions
Sponsoring organization: Commonwealth Fund
Presents a timeline which outlines when the various health insurance provisions will go into effect.
Date: 04 / 2010
Uninsured: A Primer - Key Facts About Americans Without Health Insurance
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Reviews the basic profile of the uninsured population, how they receive care, the latest trends in health insurance coverage, and what the options are for increasing coverage. Includes Supplemental Data Tables.
Date: 10 / 2011
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
Terms & Acronyms
Accountable Care Organization (ACO) Team of doctors, hospitals, and other health care providers working together to coordinate and optimize care for enrolled Medicare recipients.
Approved Amount The fee Medicare sets as reasonable for a covered medical service. It may be less than the actual amount charged. Approved amount is sometimes called "approved charge."
CMS (Centers for Medicare and Medicaid Services) Federal agency responsible for the Medicare and Medicaid programs. Part of the U.S. Department of Health & Human Services.
Critical Access Hospital (CAH) Rural hospitals with fewer than 25 acute care beds located at least 35 miles, or 15 by mountainous terrain or secondary roads, from the nearest hospital unless designated as a “Necessary Provider” by a state plan.
Durable Medical Equipment (DME) As defined by Medicare, is equipment which can 1) withstand repeated use, 2) is primarily and customarily used to serve a medical purpose, 3) generally not useful to a person in the absence of an illness or injury, and 4) is appropriate for use in the home (e.g. wheelchairs, hospital beds, walkers).
Federally Qualified Health Center (FQHC) FQHCs include all organizations receiving grants under section 330 of the Public Health Service Act, certain tribal organizations, and FQHC Look-Alikes. FQHCs benefit from enhanced reimbursement from Medicare and Medicaid under the prospective payment system.
ICD-10 (International Statistical Classification of Diseases and Related Health Problems) The 10th version of the International Statistical Classification of Diseases and Related Health Problems. Medical classification list for the coding of diseases, signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the World Health Organization. Comprised of over 14,000 codes and permits the tracking of many new diagnoses.
Interim Payment Rate Medicare all-inclusive rate calculated by dividing the Medicare allowable costs by number of Medicare allowable encounters. Each RHC receives this amount for each Medicare covered RHC visit throughout the clinic's fiscal year. At the end of the fiscal year, payments for the year are reconciled based on a cost report. The interim payment rate is recalculated annually.
Meaningful Use Refers to the meaningful use of certified electronic health record technology to achieve certain healthcare quality, safety, and efficiency goals. Eligible professionals, hospitals, and critical access hospitals must attest that they've met their respective meaningful use criteria and are eligible to receive Medicare incentive payments for the installation and use of electronic health record systems under the American Recovery and Reinvestment Act of 2009.
Medicaid Federal assistance program that helps pay for medically necessary services for needy and low income individuals. The program uses state and federal funds to compensate medical providers serving these populations.
Medicare Federal health care insurance program for most adults age 65 and older and certain disabled individuals. It pays for long term care under limited circumstances and for limited periods of time.
Medicare Administrative Contractor (MAC) Will replace the current Medicare fiscal intermediaries and carriers and handle administration of both the Medicare Part A and Part B programs in specified geographic regions.
Medicare Advantage Prescription Drug Plan (MAPD) Plans that cover both drugs and other Medicare benefits, such as HMO's.
Medicare Conditions of Participation (CoP) CMS conditions that health care organizations must meet to participate in the Medicare and Medicaid programs. Used to improve quality and protect the health and safety of beneficiaries.
Medicare Economic Index (MEI) Medical inflation rate. Used to adjust reimbursement caps on annual basis.
Medicare Health Plan A plan offered by a private company that contracts with Medicare to provide Part A and Part B benefits to people with Medicare who enroll in the plan.
Medicare Part A (Hospital Insurance Program) Hospital insurance that helps pay for inpatient hospital care, limited skilled nursing care, hospice care, and some home health care. Most people get Medicare Part A automatically when they turn 65.
Medicare Part B (Supplementary Medical Insurance Program) Medical insurance that helps pay for doctors' services, outpatient hospital care, and some other medical services that Part A does not cover (like some home health care). Part B helps pay for these covered services and supplies when they are medically necessary. A monthly premium must be paid to receive Part B.
Medicare Part C (Medicare Advantage) (MA) Covers Part A and B services and most prescription drugs for beneficiaries who enroll in private health insurance plans such as health maintenance organization (HMO), preferred provider organization (PPO), or private fee-for-service (PFFS) plan. These plans receive payments from Medicare to provide Medicare-covered benefits, including hospital and physician services, and in some cases, prescription drug benefits. These plans offer combined coverage of Part A, Part B, and in some cases, Part D (prescription drug) benefits.
Medicare Part D (Prescription Drug Plans) (PDPs) Provides outpatient prescription drug coverage that is delivered through private plans that contract with Medicare. The benefit includes additional assistance with plan premiums and cost-sharing amounts for low-income beneficiaries. People enrolled in Medicare drug plans pay a monthly premium. Prescription drug benefit added to Medicare in 2006. Created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
Medicare Payment Advisory Commission (MedPAC) An independent Congressional agency established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare program.
Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) Legislation passed in 2003 that included significant Medicare reforms including a prescription drug benefit for Medicare beneficiaries and reimbursement improvements for rural healthcare facilities.
Medicare Prospective Payment System (PPS) Medicare reimbursement method in which rates for services are established in advance, based on the patient's diagnosis.
Medicare Rural Hospital Flexibility Program (Flex Program) Federal initiative created by the Balanced Budget Act of 1997 that provides funding to State Governments to strengthen rural health. Requires the development of state rural health plan. Provides funding to States network development, quality improvement, designation of Critical Access Hospitals (CAHs), and improvement of rural EMS.
Medigap A Medicare supplement insurance policy sold by private insurance companies to fill gaps in Original Medicare Plan coverage.
MedPAC Stands for Medicare Payment Advisory Commission
Out-of-Pocket Costs Health care costs that you must pay on your own because they are not covered by Medicare.
Patient Protection and Affordable Care Act (PPACA) Is a Federal statute, signed into law on March 23, 2010. This Act, along with the Health Care and Education Reconciliation Act of 2010 (signed into law on March 30, 2010) make up the health care reform of 2010. The laws focus on reform of the private health insurance market, provide better coverage for those with pre-existing conditions, improve prescription drug coverage in Medicare, and extend the life of the Medicare Trust fund by at least 12 years.
Private Pay Patients Patients who pay for their own care or whose care is paid for by their family or another private third party, such as an insurance company. The term is used to distinguish patients from those whose care is paid for by governmental programs (Medicaid, Medicare, and Veterans Administration).
Provider Identification Number (PIN) Unique number issued by payers to each provider to identify that provider as a credentialed and approved provider. Also known as a Medicare billing number.
Quality Improvement Organization (QIO) QIOs review Medicare services. They work with consumers, physicians, hospitals, and other caregivers to make sure patients get the right care at the right time, particularly among underserved populations.
Regional Home Health Intermediaries A private company that contracts with Medicare to process claims and make checks of home health care.
Rural Health Clinic (RHC) Clinic certified to receive special Medicare and Medicaid reimbursement. RHCs must be located in underserved rural areas and provide primary care services. RHCs use a team approach of physicians, nurse practitioners, physician assistants, and certified nurse midwives to provide services. Payment is based on a cost-related basis for outpatient physician and certain nonphysician services.
Swing beds Licensed acute-care beds designated by a hospital to provide either acute or long-term care services. A swing bed hospital is a hospital or critical access hospital (CAH) participating in Medicare that has CMS approval to provide post-hospital skilled nursing facility care and meets certain requirements.
TASC (Technical Assistance and Services Center) The technical assistance center for the Medicare Rural Hospital Flexibility Program (Flex Program). Provides information, tools and resources on all aspects of the Flex Program, including CAH, networking, EMS, and quality improvement. TASC is run by the Rural Health Resource Center in Duluth, MN.
True Out-of-Pocket Costs (TrOOP) Drug costs paid by a Medicare enrollee, or on behalf of an enrollee by a family member, charitable organization, or State Pharmacy Assistance Program.
UPIN (Unique Provider Identification Number) Six-character alphanumeric identifier assigned to all Medicare physicians, medical groups and non-physician practitioners.
Version 5010 Also referred to as HIPAA X12 Version 5010. This is a new set of standards that regulates the electronic transmission of specific healthcare transactions. Covered entities, such as health plans, health care clearinghouses, and health care providers, are required to conform to these standards by January 1, 2012.
Version D.O This is the new version of the National Council for Prescription Drug Programs (NCPDP) standards for pharmacy transactions that replaces version 5.1. Mandatory compliance date is January 1, 2012.
