The federal Medicare program has an array of complex payment policies for health care providers, health plans, and prescription drug plans. Fortunately, the outstanding staff at the Medicare Payment Advisory Commission (MedPAC) offer a series of crisp primers on Medicare reimbursement policy. MedPAC updates these annually to reflect changes in CMS payment rules and Congressional legislation.

Medicare Hospital Payment Policies:

• Inpatient Hospital Payment (Inpatient Prospective Payment System or IPPS)
• Outpatient Hospital Services Payment (Outpatient Prospective Payment System)
• Critical Access Hospital (CAH) Payment
• Psychiatric Hospital Services Payment

Medicare Post-Acute Provider Payment Policies:

• Skilled Nursing Facility (SNF) Payment (SNF Prospective Payment)
• Home Health Care Services Payment (Home Health Agency Prospective Payment)
• Inpatient Rehabilitation Facility Payment
• Long-Term Care Hospital (LTCH) Payment
• Hospice Services Payment

Medicare Payment Policies for Physicians and Other Ambulatory Providers:

• Physician Services Payment System
• Ambulatory Surgical Centers (ASCs) Payment
• Outpatient Dialysis Services Payment (including new fully bundled payment method)

Medicare Health Plans and Prescription Drug Plan Payment Policies:

• Medicare Advantage Plan Payment (Medicare Part C)
• Medicare Prescription Drug Plan Payment (PDPs and MA-PDs in Medicare Part D)

Medicare Payment Policies for Other Providers, Labs, Medical Equipment, and Supplies:

• Durable Medical Equipment (DME) Reimbursement
• Clinical Laboratory Services Reimbursement
• Outpatient Therapy Payment
• Oxygen and Oxygen Equipment Payment