Medicare Payment Policy · Healthcare Innovation
Medicare payment systems are complicated. I can help you make sense of them.
NK Fleming Consulting helps healthcare organizations, technology companies, and government contractors find practical solutions to complex Medicare policy, payment, and operations challenges. With 25 years of hands-on experience at CMS across fee-for-service payment systems, rulemaking, and the CMS Innovation Center, I bring real insider knowledge to the problems your team is trying to solve.
About NK Fleming Consulting
Nora K. Fleming is the founder of NK Fleming Consulting. She spent over 25 years at the Centers for Medicare & Medicaid Services, rising from IT specialist to GS-15 Senior Advisor and Acting Director. Her career spanned Medicare fee-for-service payment policy, data systems, and the CMS Innovation Center, giving her a rare combination of deep policy knowledge and operational fluency.
Nora has written proposed and final rules for Medicare acute and post-acute payment systems, designed and operationalized alternative payment models, managed pricing software for every major Part A and Part B payment system, and led IT modernization initiatives including CMMI's Medicare Payment Modernization project. As Acting Director of the Chronic Care Policy Group, she led a team of 50 staff overseeing six separate post-acute payment systems.
Nora is curious, practical, and collaborative. She works best when she is digging into a real problem alongside your team, understanding the constraints, cutting through the complexity, and helping you find a path forward that actually works.
Nora K. Fleming, MBA
Founder, NK Fleming Consulting
Former Acting Director, Chronic Care Policy Group, CMS
Why work with Nora?
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Her expertise spans policy, payment, and operations.
Most advisors know one side of the picture. Nora has worked across Medicare payment policy, rulemaking, operational execution, data systems, and IT modernization. That breadth means she understands not just what the rules say but how they get implemented, where things break down in practice, and how to find solutions that work across organizational lines.
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She has written the rules your organization responds to.
Nora has authored proposed and final rules across Medicare acute and post-acute payment systems. That drafting experience gives her a perspective most consultants simply do not have. She can read a rulemaking the way it was written, anticipate its real-world operational implications, and help you formulate an effective response or strategy.
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She works across all sides of Medicare.
Nora's practice serves healthcare organizations, health tech companies, government contractors, and federal agencies including CMS directly. That range means she understands the pressures and priorities on all sides of the table and can help her clients engage more effectively with each of them.
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She focuses on practical, workable solutions.
Nora's approach is collaborative and grounded. She does not arrive with a predetermined framework. She listens, gets into the details of your specific situation, and works with your team to find answers that hold up in practice. If there is a simpler path through a complex policy or operational challenge, she will find it.
Nora received CMS Honor Awards in both 2022 and 2023, along with individual performance awards in each year from 2015 through 2024, recognizing sustained, high-impact contributions across Medicare payment policy and operations.
Services
Nora works with healthcare organizations, health tech companies, and government contractors and directly with federal agencies on engagements that require deep Medicare expertise and a practical eye for solving complex policy, payment, and operational problems.
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Medicare FFS payment policy and operations
Advisory on acute and post-acute payment systems including IPPS, OPPS, SNF PPS, Home Health, Hospice, IRF, IPF, LTCH, and ESRD. Support spans policy design and payment modeling through operational implementation and problem-solving.
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Rulemaking and regulatory guidance
Interpretation and analysis of proposed and final Medicare rules. Nora has written these rules, which means she can help you understand them as they were intended, assess their operational implications, and develop effective comment letters or response strategies.
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Fee schedule expertise
Physician, Ambulance, ASC, Clinical Lab, DME, and ASP drug pricing. Guidance on interpreting, modeling, and responding to annual rulemaking cycles and the operational changes that follow.
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CMMI innovation models and alternative payment models
Model design, operational execution, financial modeling, and stakeholder engagement for bundled payments, specialty episodes, ACOs, Part B drug models, and value-based care programs.
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IT modernization and data strategy
Advisory on Medicare payment system modernization, cloud migration, AI integration, and data interoperability, grounded in direct CMS project leadership experience and a focus on operational results.
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Contract and proposal support
Helping organizations develop credible proposals for CMS work, including capture strategy, technical approach development, and requirements translation grounded in how CMS evaluates and executes contracts.
Payment systems and programs NK Fleming Consulting knows well
Part A — Prospective Payment Systems
- Inpatient (IPPS)
- Outpatient (OPPS)
- Skilled Nursing (SNF PPS)
- Home Health
- Hospice
- IRF
- IPF
- LTCH
- ESRD
Part B — Fee Schedules
- Physician Fee Schedule
- Ambulance
- ASC
- Clinical Lab
- DME
- ASP Drug Pricing
CMMI Innovation Models
- Bundled Payments (CJR/BPCI)
- Specialty Episodes
- Part B Drug Models
- Accountable Care / ACOs
- Oncology Models
- Payment Modernization
Who NK Fleming Consulting works with
- CMS and federal agencies seeking experienced subject matter expertise
- Hospitals and health systems navigating Medicare payment and APM participation
- Post-acute providers including SNFs, home health agencies, hospices, and IRFs
- Health tech companies building for the Medicare FFS market
- Government contractors pursuing or executing CMS work
- Investors and startups with Medicare payment-adjacent questions
Want NK Fleming Consulting to help you?
No sales pitch, no onboarding deck. Just a direct conversation about the problem you are trying to solve and whether I can help.
Based in Ellicott City, MD · Available for remote and in-person engagements