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Medicare Coverage and Reimbursement

Issue Summary

Medicare is a program for those age 65 and over, the disabled and end-stage renal disease patients.  Consequently, Medicare beneficiaries make up a fairly small part of the typical midwife's patient population.  For example, total Medicare payments to CNMs in 2011 amounted to just over $3 million.

Medicare's real importance to midwifery lies in its position as the steward of various payment methodologies and policy structures that are often adopted by state Medicaid programs and private insurers. Consequently, understanding Medicare is often key to understanding how other coverage and reimbursement systems operate.

Available Literature and Resources


  • Letter to CMS on requirement that physicians review all inpatient records for CNM patients in critical access hospitals (August 5, 2016)
  • Letter to CMS on proposed changes to Medicare's Hospital Conditions of Participation (June 27, 2016)
  • Letter to CMS on proposed CY 2016 Medicare Physician Fee Schedule (September 8, 2015)
  • Letter to CMS on physician review of CNM inpatients of critical access hospitals (March 19, 2015)
  • Comments on the CY 2015 Medicare Physician Fee Schedule (September 2, 2014)
  • Comments on Physician Certification Issue in CY 2015 Medicare Hospital Outpatient Prospective Payment System Proposed Regulation (September 2, 2014)
  • Letter to CMS regarding the proposed FY 2015 Medicare Inpatient Prospective Payment System (IPPS) regulation (June 30, 2014)
  • H.R. 4663, the "Protect Patient Access and Promote Hospital Efficiency Act" - An issue brief on physician certification of inpatient admissions. 
  • Letter to CMS regarding physician certification policy. (January 30, 2014)


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