Payment

Learn how to navigate potential payment hurdles when dealing with Medicaid, Medicare and private payer insurance companies.

Telehealth Payment Update

As of September 30, 2025, several flexibilities introduced during the COVID-19 pandemic have expired. Key services that have been impacted include originating and distant site restrictions, Hospital at Home programs, and billing and reimbursement for many telehealth services. For more details about these expiring flexibilities and how your practice can adapt to the rapidly changing environment, please see the best practices document.

Hospital at Home (HaH) programs, which enabled hospitals to deliver inpatient-level care in patients’ homes under special CMS waivers, are now particularly vulnerable. Without renewed federal authority, hospitals may experience delays in waiver renewals, claims processing, and oversight. While patients currently enrolled may continue receiving care at home, program growth and reimbursement stability could be disrupted. For more details on the impact on the HaH program, please see the best practices document.  

Medicare

Resources to ensure you are paid appropriately, including web-based educational tools and how to bill for an annual wellness visit. Also find information pertaining to the Quality Payment Program, including deadlines.

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Medicaid

Learn more about the Medicaid and CHIP programs, both at the federal level and in your own state.

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Private Payers Insurance

Materials to help you navigate a variety of issues specific to private payer insurance plans, including details in a standard payer contract and advice on how to retain lab testing when your payer is refusing coverage.

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Alternative Delivery and Payment Models

A broad array of resources covering Patient-Centered Medical Home, Accountable Care Organizations, other care models,the CMS Innovation Grant process, and how to evaluate payment contracts.  

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