The Affordable Care Act included several new Medicare payment system reforms designed to improve coordination and collaboration among physicians and other healthcare providers. AdvaMed and its team of policy experts study these changes and determine their impact on patients, future medical innovation and our member companies.
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Payment & Health Policy
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Medicare covers health care items and services, including medical devices and diagnostic tests, for almost 50 million Medicare beneficiaries. In most cases, local contractors, called Medicare Administrative Contractors (or MACs) – the entities that process and pay Medicare claims –make coverage decisions, as long as those decisions do not conflict with a national policy. In some cases, Medicare develops a National Coverage Determination (NCD) for an item or service that applies to all Medicare beneficiaries that meet certain criteria for coverage.
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The Payment & Policy Review is a new monthly communication from AdvaMed’s Payment and Health Care Delivery Policy Department that provides a short summary of important activities, reports, letters, meetings, etc. that relate to Medicare payment, coverage and quality issues.
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AdvaMed’s Value Initiative is designed to provide stakeholders across the health care spectrum – patients, providers, payers, innovators etc. – with tools to objectively determine the value of a medical technology or diagnostic test and the evidence needed to support its use.
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The AdvaMed Physician Service Market Analysis Report provides a resource for members to access detailed reports from data sets provided by CMS. The reports provide key Medicare Part-B service utilization and payment for a physician HCPCS code(s) to help members identify strategic opportunities in the market.