Percent of Medicare comparisons: A primer on using Medicare payment rates as benchmark
Comparing non-Medicare payment rates to estimated Medicare fee-for-service payment rates is used as a common benchmark when evaluating healthcare reimbursement levels. These Medicare payment rate benchmarks are used for activities such as unit price analysis, provider contract negotiations, and policy development. A key statistic calculated for such comparisons is the “percent of Medicare.” This paper discusses the following topics for when using percent of Medicare comparisons for analysis:
- Percent of Medicare definition
- Scope considerations
- Actual payment calculation considerations
- Medicare payment calculation considerations
- Additional considerations for calculating and presenting percent of Medicare
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Percent of Medicare comparisons: A primer on using Medicare payment rates as benchmark
For healthcare stakeholders reporting percent-of-Medicare results, the scope and payment amounts should be clearly defined and appropriate for the comparison goals.