Medicare Regulation

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shutterstock 77298424 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.

Accountable Care Organizations (ACO) / Shared Savings

Final Rule for Medicare Program: Medicare Shared Savings Program: Accountable Care Organizations - PDF - HHS, 2011

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

Health and Human Services (HHS) - PDF - May 10, 2012
Medicare Face-to-Face Encounter Rules - PDF - Medicare Learning Network (MLN), 2011
Clarifications for Home Health Face-to-Face Encounter Provisions - PDF - CMS Manual System Pub 100-02 Medicare Benefit Policy Transmittal 139, CMS, 2011

Independence at Home

New Affordable Care Act Demonstration To Provide Care At Home For Medicare Patients - PDF

Medical Home

NCQA Recognizes Nurse-Led Practices as Medical Homes - PDF - National Committee for Quality Assurance (NCQA), 2010

Medicare Learning Network

Medicare Learning Network® (MLN) (formerly, Medicare Fee-For-Service APN and PA Who Provide Services to Medicare Beneficiaries) - Products Overview page for Medicare Fee-For-Service provider education products, MLN, 2012

Primary Care

Comprehensive Primary Care Initiative - Center for Medicare & Medicaid Innovation, June 2012
The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients.
Medicare Improves Access to Preventive Services for 2011: New Physician Payment Policies Emphasize Role of Primary Care - PDF - Centers for Medicare & Medicaid Services (CMS) message, 2010

SGR Payment

Congress Passes Bill to Fix Sustainable Growth Rate and Therapy Cap Exception for 2012 - PDF - PT Billing Services announcement, 2012

Value-Based Purchasing

2011 Physician Quality Reporting System (Physician Quality Reporting, formerly known as PQRI) Program Announcement - PDF - Announcement regarding Physician Quality Reporting Educational Products, CMS, 2011
Fact Sheet: Pay for Performance: the Latest Concept in Saving Medicare Dollars - AANP, 2009
Important Information on Physician Quality Reporting System (PQRS) - CMS announcement regarding PQRS URL change, AANP, 2010
PQRI Information