Medicare and Medicaid Payment Systems

Current trends and activities surrounding Hospital Outpatient Prospective Payment System (HOPPS), Medicare Physician Fee Schedule (MPFS), alternative payment models and more.

Clinical Labor Update Proposal: ACR Urges CMS to Protect Patient Access to Care

Updates to clinical labor staff pricing in the 2022 Medicare Physician Fee Schedule (MPFS) proposed rule would significantly impact radiology reimbursement, especially for interventional radiology and radiation oncology.
Learn more about this threat to patient access to care


Evaluation and Management

ACR urges Congress to avoid radiology cuts by waiving budget neutrality for Medicare E/M changes.

Learn more and access resources


Quality Payment Program: Alternative Payment Models

Understand MACRA, stay informed on its implementation, and take steps to thrive in new payment and delivery models.
View resources


Medicare Physician Fee Schedule

CMS uses the MPFS to reimburse physician services; it is composed of resource costs associated with physician work, practice expense and professional liability insurance.
View current information


National and Local Coverage Determinations

By reviewing and commenting on Local Coverage Decisions and proposed policy changes, the ACR Carrier Advisory Committee networks help ensure members are appropriately reimbursed for medically reasonable and necessary services provided to Medicare patients.
Learn more about coverage


Development of Resource-Based Values

The ACR is represented on the RU and submits recommendations to the AMA on radiology-related codes.
See current information


Hospital Outpatient Prospective Payment System

CMS developed HOPPS to reimburse providers for hospital outpatient services using Ambulatory Payment Classifications.
Latest HOPPS information


Medicaid

The ACR monitors local Medicaid programs and reviews local coverage policies. In addition, our network's relationships with large, multistate Medicaid MCOs allows the ACR to have valued input in reviewing and commenting on medical coverage policies.
Additional Medicaid information


Related Articles