Traditional Medicare Provider Payment—General

Background

Traditional fee-for-service MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). uses several payment systems to pay providers for services in the traditional program: prospective, episode-based, and fee-schedule payment systems. Congress defines the payment systems. The Centers for MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). & MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. Services designs the payment mechanisms within the legal framework. Under a prospective payment system, providers get a predetermined amount based on the patient’s diagnosis and other factors that affect providers’ costs, such as local wage levels. The amount is intended to reflect the average cost of providing services to patients with a similar diagnosis. With episode-based payment, a single payment is made for all services provided during a specified episode. As with prospective payment, the amount depends on the patient’s diagnosis. With fee-schedule payment systems, providers are paid a set amount for each service they provide.

TRADITIONAL MEDICARE PROVIDER PAYMENT—GENERAL: Policy

TRADITIONAL MEDICARE PROVIDER PAYMENT—GENERAL: Policy

Adequate provider payment

MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). payment rates should be fair and should provide incentives for providing preventive services, evidence-based practice, person- and family-centered care, provider efficiency, management of chronic conditions, and access to affordable, high-quality care.

The Centers for MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). & MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. Services and the MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). Payment Advisory Commission must monitor the effects of MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). payment reforms. They must alert Congress if payments are inadequate. They should discourage providers from offering services to MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). beneficiaries—such as those with complex conditions or beneficiaries in rural areas—or compromise the quality of care.