Update on Health Policy Pro

Paul Baldwin
Paul Baldwin

The first Health Policy Pro Newsletter has been published. We’re making some progress on the website and have completed drafts of our first three tutorials. These cover some prerequisites for understanding Medicare Part A payment policy.

Basic Medicare Part A Concepts

The first three Medicare modules focus on very basic concepts. Basic, but necessary to understanding how payment policy works in the Medicare program.

Medicare: The Very Basics

The journey to understanding Medicare payment policy begins with knowing some basic facts about Medicare.This short 5-minute tutorial is the starting point if you know absolutely nothing about Medicare, or if it’s been a very long time since you have been engaged with the program. We begin with definitions, discuss the services available under Medicare Parts A, B, D, and C, explain how the program is financed and even include a short quiz to check your knowledge.

This is a second draft, and has room for improvement. I welcome your constructive criticism, not just on this module but on all three tutorials.

Introduction to Prospective Payment and Patient Classification

Medicare Part A is paid prospectively and understanding how the payment system works relies on an understanding of two key concepts: prospective payment and the use of patient characteristics to modify payment formulas to arrive at an appropriate payment rate.

This is a concept many of you understand, but please try to look at this from the point of view of a novice. Does it make sense? Is there a better way to explain the concepts?

As with the first module there is a quiz included. Take the quiz and let me know if there are better questions to include.

Constructing a Payment Rate

Once Congress authorizes prospective payment for a Medicare Part A service how does CMS go about creating a payment rate? This, in a broad sense, of what this module tries to communicate.

The idea is that once you get the basic concept you should be able to follow the process to understand rate setting for Part A in hospitals, skilled nursing, home health and hospice.

We try to weave the concepts of prospective payment and case-mix adjustment together to present a simplified example of how the process works. Does the module achieve that? Please give me your suggestions.

What’s Next?

I will be putting together a PDF for each module that goes into a more thorough treatment of the subject and include links to deeper understanding and examples of the ideas presented.

I will also begin the task of creating a series for each Part A-covered service. These will go into much greater detail and, if successful, will lead the learner carefully from the basic concepts to the more complex until he/she arrives at a point where they can feel comfortable reading an annual PPS update rule and understand what CMS is saying.

Please subscribe to the updates and keep checking in to see how things are going. Thanks for reading this.

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