Medicare: The Benchmark That Commercial Plans Follow

Medicare’s payment policy decisions have a dramatic effect on the overall health care system: Commercial health plans tend to follow many of Medicare’s decisions.

Each spring, Medicare releases a proposed inpatient hospital payment proposed rule for the upcoming fiscal year. In addition, Medicare releases a proposed payment rule for the upcoming calendar year every summer that affects the Medicare Physician Fee Schedule, ambulatory surgery center, and hospital outpatient department payment policies.

CMS released the calendar year 2020 proposed payment rules for the physician fee schedule (PFS) and hospital outpatient/ASC on July 29, 2019. Click here to read TOA’s summary of the hospital outpatient/ASC and click here to read the PFS summary. TOA members are provided complete summaries in TOA’s member newsletters.

TOA members are invited to click here to learn more about Medicare’s latest proposals.