Medicare-like Rate Training Agenda
September 12, 2007
9:00 a.m. – 3:30 p.m.
Medicare-like Rate Training
DoubleTree Hotel Seattle Airport
18740 International Boulevard
Seattle,WA 98188
September 12, 2007
8:45 a.m. – 3:30 p.m.
Time / Presenter(s)8:45 a.m. / Welcome & Introductions / Jim Roberts, NPAIHB Policy Analyst; TTAG Member
9:15 a.m. / Medicare-like Rates Overview
· Review of the regulation
· What types of hospitals?
· What types of services? / Kris Locke, American Indian Health Commission, TTAG Technical Advisor
9:30 a.m. / Medicare Claim Forms
· Overview of UB-04
· When is form complete for processing? / Inga Zamora, Blue Cross/Blue Shield of New Mexico
10:00 a.m. / Medicare Payment Methodologies
· Critical Access and TEFRA Hospitals
Per Diems and Cost to Charges ratio
· Inpatient Acute, Rehabilitation, Psychiatric, LTC, SNF / Will Fox, Consulting Actuary, Milliman Consultants & Actuaries, Seattle, WA
10:45 a.m. / Break
11:00 a.m. / Medicare Payment Methodologies (cont’d)
· Outpatient Prospective Payment System
How services are grouped
How services are paid
· Outpatient services included in regulation but not included in prospective payment
· Questions & Answers / Will Fox, Consulting Actuary, Milliman Consultants & Actuaries, Seattle, WA
12:30 noon / Lunch on your own
1:30 p.m. / Piggybacking on IHS Fiscal Intermediary Contract
· IHS Criteria for “buy back”
· Overview of services performed by BCBSNM for IHS
· Questions & Answers / IHS FI Contracting Representative (Brenda Jeanotte Smith, IHS/HQ CHS Program – by teleconference)
Blue Cross/Blue Shield of New Mexico Representative (Sarah Soule, Inga Zamora)
2:30 p.m. / Other Options for MLR Claims Processing
· Buying into Regional Medicare Fiscal Intermediary
· Other contractors
· Commercial Medicare pricing software / IHS FI Contracting Representative (Brenda Jeanotte Smith, IHS/HQ CHS Program – by teleconference)
Kim Zillyet Harris, Shoalwater Bay
Kris Locke, AIHC
3:15 p.m. / Question and Answer Session / Jim Roberts, NPAIHB Policy Analyst
3:30 p.m. / Adjourn