Moving Forward From the Sustainable Growth Rate (SGR) System

MedPAC  (The Medicare Payment Advisory Commission) produced a PDF on moving forward from the SGR, repealing the SGR formula and realigning fee-schedule payments to maintain access to primary care

In the PDF, MedPAC listed the following as recommendations:

1. Collecting data to improve payment accuracy
2. Identifying overpriced services
3. Accelerate delivery system changes to emphasize accountability and value over volume
4. Offsetting the cost of the SGR package

Figures on:

• Growth in spending for fee-schedule services
• Most-aged Medicare beneficiaries and older privately insured individuals
• Acceptance of new patients
• Potential Medicare offset options for repealing the SGR system

To view and download the fact sheet, please go to the following link: Moving Forward From the Sustainable Growth Rate (SGR) System

For additional billing and coding resources, please click the following link: Medical Reimbursement, Inc. Resources

Care Coordination in Fee-For-Service Medicare

MedPAC (The Medicare Payment Advisory Commission) published a data book in June 2012 on Health Care spending and the Medicare program. One section of this data book highlighted the following topics on Care Coordination in Fee-For-Service Medicare:

• Consequences of poor care coordination
• Reasons for poor care coordination
• Care coordination: Models and Types
• Illustrative models of care coordination
• Care coordination demonstrations in FFS Medicare
• Potential evidence of a reduction in hospitalizations in Medicare care coordination demonstrations
• Challenges of establishing an effective care coordination intervention
• Care coordination and Medicare payment policy

To view and download the full chapter, please go to the following link: Care Coordination in Fee-For-Service Medicare

For additional billing and coding resources, please click the following link: Medical Reimbursement, Inc. Resources

Medicare Beneficiary and Other Payer Financial Liability

MedPAC (The Medicare Payment Advisory Commission) published a data book in June 2012 on Health Care spending and the Medicare program. One section of this data book highlighted the following on Medicare Beneficiary and Other Payer Financial Liability:

• Sources of supplemental coverage among non-institutionalized Medicare beneficiaries
• Sources of supplemental coverage among non-institutionalized Medicare beneficiaries by beneficiaries characteristics
• Total spending on health care services for non-institutionalized FFS Medicare beneficiaries, by source of payment
• Per capita total spending on health care services among non-institutionalized FFS beneficiaries, by source of payment
• Variation in and composition of total spending among non-institutionalized FFS beneficiaries, by type of supplemental coverage
• Out-of-pocket spending for premiums and health services per beneficiary, by insurance and health status

* Additional web links on Medicare Beneficiary and Other Payer Financial Liability are also included in the data book. 

To view and download the full resource, please go to the following link: Medicare Beneficiary and Other Payer Financial Liability

For additional billing and coding resources, please click the following link: Medical Reimbursement, Inc. Resources

Quality of Care Statistics in the Medicare Program

MedPAC (The Medicare Payment Advisory Commission) published a data book on Health Care Spending and the Medicare Program.  A chapter in this data book was "Quality of Care Statistics in the Medicare Program". The following statistics (with charts) were discussed in the chapter:

• In-hospital and 30-day post-discharge mortality rates
• Hospital inpatient safety indicators
• Risk adjusted SNF quality indicators
• Home health quality measures
• Dialysis quality of care
• Medicare advantage quality measures

Additionally there are web links on the Quality of Care in the Medicare Program.

To view and download the full resource, please go to the following link: Quality of Care Statistics in the Medicare Program

For additional billing and coding resources, please click the following link: Medical Reimbursement, Inc. Resources

Medicare Advantage Program Payment System

MedPAC (The Medicare Payment Advisory Commission) published a fact sheet on payment basics for
Medicare Advantage Program Payment System. The fact sheet included the following topics:

• Defining the Medicare Advantage Products Medicare Buys
• Determining Medicare Payment for Local MA Plans
• Medicare Advantage Payment System for Non-Drug Benefits 2013
• Setting a Benchmark for Regional PPOs
• Determining Medicare Payment For Regional Medicare Advantage Plans

To view and download the full resource, please go to the following link: Medicare Advantage Program Payment System

For additional billing and coding resources, please click the following link: Medical Reimbursement, Inc. Resources

Guide on Medicare Beneficiary Demographics

MedPAC (The Medicare Payment Advisory Commission) published a data book: "Health care spending and the Medicare program" part of the data book includes a section on Medicare Beneficiary Demographics.

The data book highlights the following topics on Medicare Beneficiary demographics:

• Percent of beneficiaries and spending by age group
• Percent of beneficiaries and spending in poor health
• Enrollment in the Medicare program and growth in the next 20 years
• Characteristics of the Medicare population

The data book also has additional web links on Medicare beneficiary demographics.

To view the full resource, please go to the following link: Medicare Beneficiary Demographics

For additional billing and coding resources, please click the following link: Medical Reimbursement, Inc. Resources

Dual-Eligible Beneficiaries

MedPAC (The Medicare Payment Advisory Commission) published a data book in June 2012 on Health Care spending and the Medicare program. One section of this data book highlighted statistics on dual-eligible beneficiaries (those who qualify for both Medicare and Medicaid)

The data book discussed the following:

• Percent of fee-for-service beneficiaries
• Percent of fee-for-service spending
• Ages of dual-eligible beneficiaries and non-dual-eligible beneficiaries
• Health status of of dual-eligible beneficiaries and non-of dual-eligible beneficiaries
• Demographics differences among dual-eligible beneficiaries and non-dual-eligible beneficiaries
• Differences in spending and services use rate of dual-eligible beneficiaries and non-dual-eligible beneficiaries
• Medicare and total spending are concentrated among dual-eligible beneficiaries

In addition to these statistics, the data book has additional web resources on dual-eligible beneficiaries.

To view and download the full guide, please go to the following link: Dual-Eligible Beneficiaries

For additional billing and coding resources, please click the following link: Medical Reimbursement, Inc. Resources