Medicare is the federal program that pays for certain health care expenses for people aged 65 or older. Enrolled individuals must pay deductibles and co-payments, but much of their medical costs are covered by the program. Medicare is less comprehensive than some other health care programs, but it is an important source of post-retirement health care.
Medicare is divided into three parts. Part A covers hospital bills, Part B covers physician and nurse practitioner bills, and Part C provides the option to choose from a package of managed health care plans.
- NMEP Open Enrollment Webinar Announcement, CMS, (September 20, 2012)
- CMS Medicare FFS Provider e-News contains program and policy details, updates and announcements, press releases, National Provider Call and other event reminders, Medicare Learning Network® (MLN) educational material announcements, and other news and information for Medicare FFS providers.
- One-Year Delay on ICD-10 to October 2014 Finalized, CMS, August 30, 2012
- Time for Action Now: Ensure NPs Ability to Order Portable X-Ray Services, AANP, August 3, 2012
- CMS to Propose Rule Clarifying NP Authority to Order Portable X-rays, CMS, July 2012
Proposed Rule to be Published July 30, 2012.
- CMS Announces Policy, Payment Rate Changes for the Physician Fee Schedule in 2012
- CMS Adopts Policy and Payment Changes for Outpatient Care in Hospitals and Ambulatory Surgical Centers
- Medicare Finalizes the Provisions for the End-Stage Renal Disease Prospective Payment System (CMS-1577-F)
Accountable Care Organizations (ACO) / Shared Savings
- Release of Public Comment Draft, Standard Clinically Integrated Networks Accreditation Deadline 12/28/12 - URAC, 2012
- Fact Sheet: Accountable Care Organizations (ACO) - AANP, 2012
- Final Rule for Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations - PDF - HHS, 2011
- New Accountable Care Organization (ACO) Models - 2011
- ACO Medicare Question and Answer - PDF
- ACO Sample Letter - AANP, 2012
Electronic Health Records
- HHS Releases New Rules for Use of Electronic Medical Records and Health Information Exchange - Announcement, AANP, 2012
- 2012 Electronic Prescribing (eRx) Incentive Program Available - Announcement, AANP, 2012
Home Health Care & Hospice
- Roundtable Letter on Home Health Care Planning Improvement Act - PDF - AANP, 2012
- Fact Sheet: Ordering Medicare Hospice - AANP, 2012
- Senate Sample Letter: Home Health Care for Nurse Practitioner Programs (S 227) - PDF - AANP, 2012
- House Sample Letter: Home Health Care for Nurse Practitioner Programs - PDF - AANP, 2012
- Sample Letter: Hospice Care for Nurse Practitioner Programs - PDF - AANP, 2012
Independence at Home
Long Term Care
- Fact Sheet: The Medical Home - What Is It? How Do Nurse Practitioners Fit In? - AANP
- Nurse Practitioners: Promoting Access to Coordinated Primary Care - PDF - AANP, 2008
- The Advanced Medical Home: A Patient-Centered, Physician-Guided Model of Health Care - PDF - A Policy Monograph, American College of Physicians, 2006
- Fact Sheet: Nurse Practitioners - Medical Home/Coordinated Primary Care Providers - PDF - Multiple advanced practice and NP organizations, 2011
- ACP Nurse Practitioners in Primary Care, Executive Summary - PDF - Acknowledgement of NPs as health care professionals with the capability to provide important and critical access to primary care, American College of Physicians, 2009
- Multi-payer Advanced Primary Care Initiative - AANP, 2010
- S 3463 Medicare Diabetes Prevention Act of 2012 - AANP, August 8, 2012
- Medicare Payments to Inpatient Psychiatric Facilities to Increase 1.9 Percent in FY 2013 - CMS, August 2, 2012
- Medicare Payments To Skilled Nursing Facilities To Increase 1.8 Percent In FY 2013 - CMS, July 27, 2012
- Fact Sheet - Medicare Reimbursement - AANP, 2011
- Medicare Update - AANP, 2011
- Fact Sheet: Pay for Performance - Congressional Blueprint for Saving Medicare Dollars - AANP, 2009
- Medicare Part D (Medicare Prescription Program)
Patient Protection and Affordable Care Act (ACA)
- Obama Administration Moves Forward to Implement Health Care Law, Ban Discrimination Against People With Pre-Existing Conditions - Dept of Health and Human Services, November 20, 2012
- URAC releases clinically integrated network standards - URAS, November 13, 2012
- One-Year Delay on ICD-10 to October 2014 Finalized - Dept of Health and Human Services, August 30, 2012
- Obama Administration Announces Ground-Breaking Public-Private Partnership to Prevent Health Care Fraud - CMS, July 26, 2012
A preliminary analysis of the final Health Care Reform legislation includes: a nondiscrimination provision that includes nurse practitioners, recognition of nurse practitioners as primary care providers and leaders in public and home care medical home pilots and demonstrations, funding for nurse managed clinics; funding for graduate nurse education and post graduate experience demonstrations, inclusion in primary care Medicare payment increases, and inclusion in ACOs (Accountable care organizations). The bill language is replete with provider neutral language that will facilitate the utilization of nurse practitioners in many venues.
The bill, as passed protects provider choice of health care provider. It also protects individuals with preexisting conditions, protects against caps and out of pocket requirements by insurance companies, provides for universal coverage, provides protections for small businesses, expands Medicaid and provides funding for health promotion and disease prevention.
Stay tuned for further discussion of the impact of this legislation on nurse practitioners and their patients.
- A complete summary provided by the Kaiser Family Foundation
- Health Disparities and the Affordable Care Act - HealthCare.gov, 2012
Please join officials from the US Department of Health and Human Services at one of the upcoming Affordable Care Act implementation forums across the country. These sessions are intended to provide an opportunity for states and stakeholders to learn more about the next steps in implementation of the health care law and ask questions about work needed to build Affordable Insurance Exchanges in every state. HHS leadership will provide an overview of topics related to coverage provisions of the Affordable Care Act effective in 2014.
- Congress Passes Bill to Fix Sustainable Growth Rate and Therapy Cap Exception for 2012 - PDF - PT Billing Services announcement, 2012