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Kip Piper, Editor
Health care strategist, speaker, and writer. Expert on Medicare, Medicaid, and pharma, biotech, and device industries. President, Health Results Group LLC. Senior Counselor, Fleishman-Hillard. Senior Consultant, Sellers Dorsey. Visit KipPiper.com. Or email Kip here.
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Medicare Payment Policy: MedPAC Primers on Medicare Reimbursement
posted: October 5, 2007

Medicare%20Payment%20Policy%20Primers.jpgThe 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):


  • Medicare Advantage plan payment system


  • Medicare Part D payment system (PDPs and MA-PDs)


    • 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

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    Consider This
    In ancient China, physicians were paid only when their patients were kept well and often not paid if the patient got sick. If a patient died, a special lantern was hung outside the doctor's house. Upon each death, another lantern was added. This is the first known use of the two most powerful drivers for health care performance - incentives and transparency.
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