Hospital Overpayments – These are the facts!
In 2003, Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act. Section 506 of this law authorized Purchased Referred Care (PRC) formerly known as Contract Health Services (CHS) to pay no more than “Medicare-like” rates for eligible services provided by Medicare participating hospitals (including inpatient and outpatient services) that are authorized by Indian Health Services (IHS), Tribal or urban Indian organizations or entities.
What does Medicare-Like Rates (MLR) mean for your Tribal Health Programs?
Access to Medicare pricing for eligible medical claims enables Purchased Referred Care (PRC) to stretch its health care dollars much farther.
“Medicare-like rate” (‘MLR”) is defined as the rate that would have been paid by Medicare not reduced by any applicable deductibles, co-pays, and co-insurance.
Medicare participating facilities are required to accept MLR payments in full when the service is provided to an eligible recipient as defined by the tribe and appropriately authorized by the tribe’s Purchased Referred Care (PRC) process.
Has your Tribal Health Program overpaid hospital bills since 2007?
Forest County Potawatomi Community (FCPC) is the only tribe with an insurance department that specializes in hospital overpayment recovery with vast knowledge and expertise in Medicare-like rate repricing. Forest County Potawatomi Insurance Department (FCPID) will work to recover hospital overpayments incurred since July 5th, 2007 in accordance with Medicare Prescription Drug, Improvement, and Modernization Act. Section 506.
FCPID will audit all your hospital payments. If overpayments are identified, we will work on your behalf to recover the overpayments and provide reimbursement to the tribe. FCPID has the resources to recover overpayments that were originally paid with Purchased Referred Care (PRC) program dollars, providing tribes the opportunity to maximize health care funds to extend services to more Tribal recipients and to expand access to health care.
It’s easy to get started!