Medicare Coverage and Reimbursement
Medicare is a program for those age 65 and over, the disabled and end-stage renal disease patients. Consequently, Medicare beneficiaries make up a fairly small part of the typical midwife's patient population. For example, total Medicare payments to CNMs in 2011 amounted to just over $3 million.
Medicare's real importance to midwifery lies in its position as the steward of various payment methodologies and policy structures that are often adopted by state Medicaid programs and private insurers. Consequently, understanding Medicare is often key to understanding how other coverage and reimbursement systems operate.
Available Literature and Resources
- ACNM Issue Brief: Medicare's Proposed CY 2016 Physician Fee Schedule (July 16, 2015)
- ACNM Issue Brief: H.R. 2 - The Medicare Access and CHIP Reauthorization Act of 2015 (April 29, 2015)
- Congressional Research Service summary of the provisions of H.R. 2: The Medicare Access and CHIP Reauthorization Act of 2015, which contains significant modifications to Medicare's methodology for establishing payment for physician services (April 10, 2015)
- ACNM Issue Brief on Final Rule Modifying Physician Certification Policy (December 12, 2014)
- ACNM Issue Brief on CY 2015 Final Medicare Physician Fee Schedule (December 12, 2014)
- ACNM Issue Brief on CY 2015 Proposed Medicare Physician Fee Schedule (July 24, 2014)
- ACNM Issue Brief on FY 2015 Proposed Inpatient Prospective Payment System Regulation (May 30, 2014)
- ACNM Issue Brief on New Prospective Payment System for Federally Qualified Health Centers (May 30, 2014)
- ACNM Issue Brief on CMS Final Regulation Reducing Administrative Complexity and Burden in the Medicare Program (May 30, 2014)
- Section 180, Chapter 15, Medicare Benefits Policy Manual - outlining coverage for midwifery services under Medicare.
- Section 130, Chapter 12, Medicare Claims Processing Manual - outlining how payments are made for midwife services under Medicare.
- Medicare Physician Fee Look Up Tool - online tool to find Medicare allowable amount for any service paid under the physician fee schedule.
- Letter to CMS on requirement that physicians review all inpatient records for CNM patients in critical access hospitals (August 5, 2016)
- Letter to CMS on proposed changes to Medicare's Hospital Conditions of Participation (June 27, 2016)
- Letter to CMS on proposed CY 2016 Medicare Physician Fee Schedule (September 8, 2015)
- Letter to CMS on physician review of CNM inpatients of critical access hospitals (March 19, 2015)
- Comments on the CY 2015 Medicare Physician Fee Schedule (September 2, 2014)
- Comments on Physician Certification Issue in CY 2015 Medicare Hospital Outpatient Prospective Payment System Proposed Regulation (September 2, 2014)
- Letter to CMS regarding the proposed FY 2015 Medicare Inpatient Prospective Payment System (IPPS) regulation (June 30, 2014)
- H.R. 4663, the "Protect Patient Access and Promote Hospital Efficiency Act" - An issue brief on physician certification of inpatient admissions.
- Letter to CMS regarding physician certification policy. (January 30, 2014)