Medicare - Like Rates

Medicare-like Rates Overview

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.

Indian Health Service Medicare like Rate website: http://www.ihs.gov/NonMedicalPrograms/mlri/

Final Rule—Section 506 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003--Limitation on Charges for Services Furnished by Medicare Participating Inpatient Hospitals to Individuals Eligible for Care Purchased by Indian Health Programs

September 12th Portland Area Training

Agenda

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

Medicare Payment Methodologies - Will Fox, Milliman Consultants & Actuaries

Implementing Medicare Hospital Payment Systems
PPS Examples

IHS Fiscal Intermediary Contract

FI Support for Claims Processing
FI Overview for Tribes

Medicare-like Rate Q&A’s

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Medicare - Like Rates

Indian Health Policy