Danjie Zhou

We review the key pricing factors for the latest guidance issued by CMS for Medicare inpatient and outpatient prospective payment systems, for fiscal year 2025.

We estimate the national commercial reimbursement payment rates increasing in 2024 to 190% of Medicare fee-for-service rates, up from 188% last year.

Healthcare provider reimbursement as a percentage of Medicare fee-for-service rates provides a consistent and well-understood basis for comparing reimbursement rates.

Provider reimbursement as a percentage of Medicare fee-for-service rates provides a consistent and well-understood basis for comparing reimbursement rates.

We analyze nationwide professional commercial, Medicaid and Medicare claims from 2020 to gauge the average cost and utilization for audiology services.

We estimate 2021 commercial reimbursement for medical services to be about 190% of fully-loaded Medicare, with a big difference between facility and professional.