Northwest Portland Area Indian Health Board: Indian Leadership for Indian Health

Medicare - Like Rates

The Department of Health and Human Services published regulations effective July 5, 2007, to implement Section 506 of the Medicare Modernization Act (MMA), which will require hospitals that participate in the Medicare program to accept Medicare-like rates as payment in full when providing services to Indian patients.  The rules place a cap on the amount hospitals may charge for patients referred by the IHS, tribal and urban Indian organization Contract Health Service (CHS) programs.  The new law will provide IHS and Tribally-operated CHS programs with similar benefits to those enjoyed by of other Federal purchasers of health care. 

Additional Information

Documents from the September 12th Portland Area Training

  • Medicare Like Rates Overview - Kris Locke, American Indian Health Commission

Presentation
Payment Chart

  • Medicare Claims Forms - Igna Zamora, Blue Cross/Blue Shield

UB 04 Example
Overview of UB04 Form

PPS Examples

  • IHS Fiscal Intermediary Contract

FI Support for Claims Processing
FI Overview for Tribes