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Payer Policies

Implementing federal health payer policies across state and local health plans.

ACOG recognizes that the daily practice of obstetrician-gynecologists is impacted by coverage, payment, and administrative policies imposed by public and private payers. Several policies are set by federal or state governments and implemented across all payers.

The three broad categories for payer type include Medicare, Medicaid, and commercial (private) plans. Within those categories there are hundreds of public and private companies; in fact, according to the National Association of Insurances Commissioners, over 1,000 health insurance companies in 2020 brought in a net earnings of about $31 billion for the year.

The information in these pages includes federal health payer policies that may be implemented differently by state and local health plans. To find state plan information, look up your state insurance commissioner website.

 

 

Medicare

Medicare sets the standards for health insurance, and often Medicare policies are adopted by Medicaid programs and private insurers.

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Medicaid

Medicaid covers more than 16 million women of reproductive age and is also the largest single payer of maternity care.

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Health Policies

Administrative Burden and Surprise Billing

The ACOG Health Economics and Practice Management team advocates on behalf of ACOG members with public and private payers to ensure their policies minimize administrative burden.

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Information Blocking

Information blocking is the practice of interfering with the access, exchange, or use of electronic health information.

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Hospitals: Perinatal Quality Initiative Collaboratives

The Hospital Inpatient Quality Reporting (IQR) Program is a pay-for-reporting program for acute care hospitals. Learn more about the program's Maternal Morbidity Structural Measure and what it means for publicly reported data.

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Have Questions?

For questions or issues, contact us through ACOG’s Payment Advocacy and Policy Portal.

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