This live event occurred on 06/30/2016; to purchase a copy of the recording for $75, please register below.
With the recent Medi-Cal expansion and implementation of Medicare PPS, many health centers have seen dramatic swings in the size and direction of the settlement due to or from them on the Medi-Cal PPS Reconciliation. Some health centers are relatively new to Code 18 billing and have rates set on projected utilization. Others have seen a significant increase in the number of capitated patients assigned to them and need to understand how their Medi-Cal reimbursement is impacted. Gaining an understanding of all the factors that affect the Code 18 and other differential rates will enable health center management to more accurately forecast net revenue, cash flow, and PPS Reconciliation settlements.
LEARNING OBJECTIVES
- Understand the background of the Medi-Cal differential rates (Code 02, 18, and 20) and when to bill each.
- Understand the impact of dual eligible patients and visits on Code 18 rate setting.
- Understand the differences between fee-for-service and capitation contracts, and the impact of each on Code 18 rate setting.
- Learn how to analyze utilization data to determine if you should request a change to any of your Medi-Cal interim rates.
- Know how to request a rate adjustment for Code 02, 18, and 20, including which forms to file and how to submit them.
PRESENTER
Steve Rousso, MBA, MPA, Principal, HFS Consultants
FEES
- Members: $90
- Non Members: $115
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Disclaimer: The information on this session is intended only to provide a general overview of the topics addressed. This session is not intended to provide legal advice or substitute for the guidance, counsel or advice of legal counsel on any matters particular to a specific primary care clinic.