MedPAC Payment Basics – Our Christmas in October


It’s Christmas in October!  For policy geeks like us, the release of the Medicare Payment Advisory Commission’s (MedPAC) payment basics are like a gift that keeps on giving.

Not familiar with these beauties?  Well, read on, my friend.  MedPAC’s payment basics are a Medicare 101 for every payment system within Medicare.  They cover all players in the Medicare healthcare work from hospitals to physicians to all post-acute care providers.  Want to know how DSH payments for hospitals work? It’s in there.  Want to know about GPCIs for physicians?  In there.  Medicare Donut hole?  Yep.

In addition to the well laid out explanation of each intricate aspect of each payment system, the payment basics also contain excellent graphics that outline the “flow” of each payment system and how one adjustment (for example, a rural payment adjustment) fits into an overall payment rate for each provider.  They are great power point fodder and really help visually explain all of the payment adjustors in the system.  The Basics also cover payments for Accountable Care Organizations (ACOs), Durable Medical Equipment (DME), Federally Quality Healthcare Centers (FQHCs), Medicare Advantage Plans, and Part B and Part D drugs.

The payment basics are not just used by us policy nerds to brush up on our conversion factor calculations, but they are also used to train new Members of Congress and their staff.  And even those of us who have been doing this for far too many years, return to them year after year as the Basics are updated for all new legislative/administrative changes.

Happy Reading!

Leave a Reply

Your email address will not be published. Required fields are marked *

Connect With Us

Ready to connect? Let’s talk