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TMA UBO CY 2007 OIB Rate Package Release Presented by UBO Project Support Team June 19 th : 0800, 1400 & 2100 EDT June 21 st : 0800 & 1400 EDT Dial in: (866) 866-2244 Participant code: 7486926. Agenda. CMAC CMAC Component Rates Associated Rate Tables (MEPRS Based Rates)

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TMA UBO CY 2007 OIB Rate Package ReleasePresented by UBO Project Support TeamJune 19th: 0800, 1400 & 2100 EDTJune 21st: 0800 & 1400 EDTDial in: (866) 866-2244 Participant code: 7486926

1

agenda
Agenda
  • CMAC
  • CMAC Component Rates
  • Associated Rate Tables (MEPRS Based Rates)
  • Mapping Table Updates
  • Pharmacy Rates
  • Questions

2

cmac rates overview
CMAC Rates - Overview
  • CMAC 391 locality is new – for OCONUS
  • Added rate for CPT code 90649 “HPV” ($100.00)
  • Added 171 Govt “no-pay” codes to the file
  • Added 90 lab/pathology codes/rates
  • Removed PET Scan codes (moved them to the CMAC Component file)
  • Removed Telephone Consult codes and rates (99371, 99372, 99373)
  • Set 40 codes to $0.00 (not available for separate reimbursement – considered part of the “global procedure”)

3

cmac emergency dept ed rates
CMAC Emergency Dept (ED) rates
  • 99281-99285 will only be used for the institutional portion of an ED encounter
    • Mapped to the UB 04
    • Rates are based on 2007 CMS APC rates
      • Rather than the rates provided in the TMA CMAC files
    • Because of electronic billing requirements (e.g., 837i and 837p), the professional portion of the ED encounter will not be billed
      • Previously we combined the TMA CMAC file rate with the APC rate to obtain a single combined institutional and professional rate

4

cmac ed rates compare
CMAC ED Rates Compare
  • CPT Code’06 rate’07 rate% change
  • 99281 $ 89.25 $ 50.01 (44)%
  • 99282 $ 99.77 $ 82.96 (17)%
  • 99283 $ 188.67 $ 130.00 (31)%
  • 99284 $ 317.74 $ 209.99 (34)%
  • 99285 $ 370.39 $ 325.25 (12)%

5

cmac component rate file
CMAC Component Rate File
  • Added PET Scan for professional, technical and global rates
  • CPT codeProfessionalTechnicalGlobal
  • 78608 $ 213.66 $ 641.57 $ 855.43
  • 78609 $ 213.66 $ 641.57 $ 855.43
  • 78459 $ 219.27 $ 511.97 $ 731.24
  • 78491 $ 219.27 $ 511.97 $ 731.24
  • 78492 $ 219.27 $ 511.97 $ 731.24
  • 78811 $ 85.54 $ 769.89 $ 855.43
  • 78812 $ 85.54 $ 769.89 $ 855.43
  • 78813 $ 85.54 $ 769.89 $ 855.43
  • 78814 $ 95.00 $ 855.00 $ 950.00
  • 78815 $ 95.00 $ 855.00 $ 950.00
  • 78816 $ 95.00 $ 855.00 $ 950.00

6

associated rate tables
Associated Rate Tables
  • Ambulance
  • Anesthesia
  • APV (Ambulatory Procedure Visit)
  • Dental
  • Durable Medical Equipment/Supplies (DME/DMS)
  • IOR/IMET (Government Discount %)
  • Immunization
  • Observation
  • Pharmacy Dispensing Fee

7

ambulance rate price compare
Ambulance Rate –Price Compare

CPT code’06 rate’07 rate% change

A0999

FOR: $ 154.00 $ 170.00 10%

IOR: $ 146.00 $ 161.00 10%

IMET: $ 87.00 $ 99.00 14%

8

anesthesia rate price compare
Anesthesia Rate –Price Compare

’06 rate’07 rate% change

FOR: $ 795.00 $ 886.00 11%

IOR: $ 752.00 $ 837.00 11%

IMET: $ 476.00 $ 533.00 12%

9

apv rate price compare
APV Rate – Price Compare

CPT code’06 rate’07 rate% change

99199

FOR: $ 1,299.00 $ 1,443.00 11%

IOR: $ 1,231.00 $ 1,363.00 11%

IMET: $ 729.00 $ 840.00 15%

10

dental rate price compare
Dental Rate – Price Compare

CDT codes’06 rate’07 rate% change

FOR: $ 100.00 $ 96.00 (4)%

IOR: $ 95.00 $ 91.00 (4)%

IMET: $ 40.00 $ 43.00 8%

11

dme dms rates
DME/DMS Rates
  • Continue to use CMS DME “floor rate”
    • No major price variances from 2006 to 2007
  • Used January 2007 Rate file (most recent posted on CMS)
  • Removed “duplicate” codes and secondary modifiers to adhere to CHCS and TPOCS file specs

12

ior imet discount compare
IOR/IMET Discount % Compare

Govt Discount’06’07% change

IOR: 95% 95% 0%

IMET: 56% 58% 4%

Note: The government billing discount is applied to the Full Outpatient Rate (FOR)

13

immunization rate price compare
Immunization Rate –Price Compare

’06 rate’07 rate% change

FOR: $ 47.00 $ 48.00 2%

IOR: $ 44.00 $ 45.00 2%

IMET: $ 26.00 $ 28.00 8%

14

observation rate price compare
Observation Rate –Price Compare

CPT code’06 rate’07 rate% change

99218: $ 520.33 $ 689.44* 33%

99219: $ 643.04 $ 819.94* 28%

99220: $ 790.32 $ 923.00* 17%

* Institutional component only

15

pharmacy dispensing fee
Pharmacy Dispensing Fee
  • 2007 Pharmacy Dispensing Fee calculated from MEPRS data at $9.00
  • However, the move to Average Wholesale Price (AWP) includes pharmacy operations costs
  • Therefore, 2007 Pharmacy Dispensing Fee is set to $ 0.00
    • More information on this will be covered in “Pharmacy” slides

16

mapping table updates
Mapping Table Updates
  • TPOCS Mapping Table
  • CPT Revenue Mapping Table
  • Modifier Mapping Table
  • DMIS ID Mapping Table

17

tpocs mapping table
TPOCS Mapping Table
  • Added all G codes, Q codes, and P codes
    • G codes mapped to CMAC rates and 1500
    • Q codes mapped to CMAC rates and 1500
    • P codes mapped to CMAC rates and UB-04
  • Added the following modifiers:
    • 1P, 2P, 3P, 8P: Category II codes, G codes, P codes, and Q codes
    • 50 through 59: S codes
    • Approximately 108 ambulance Modifiers
  • Removed telephone consult codes 99371, 99372 & 99373

18

cpt revenue mapping table
CPT Revenue Mapping Table
  • Added 280 new CPT codes
  • Deleted 112 CPT codes
  • Added 387 new HCPCS codes
  • Deleted 124 HCPCS codes

19

modifier mapping table
Modifier Mapping Table
  • Added 1P, 2P, 3P, 8P
  • Added Ambulance modifiers: (DE, DG, DH, DI, DJ, DP, DR, DS, DX, ED, EG, EH, EI, EJ, EN, EP, ER, ES, EX, GD, GE, GH, GI, GJ, GN, GP, GR, GS, GX, HD, HE, HG, HI, HJ, HN, HP, HR, HS, HX, ID, IE, IG, IH, IJ, IN, IP, IR, IS, IX, JD, JE, JH, JI, JN, JP, JR, JS, JX, ND, NE, NG, NH, NI, NJ, NP, NR, NS, NX, PD, PE, PG, PH, PI, PJ, PN, PR, PS, PX, RD, RE, RG, RH, RI, RJ, RN, RP, RD, RX, SD, SE, SG, SH, SI, SJ, SN, SP, SR, SX, XD, XE, XG, XH, XI, XJ, XN, XP, XR, XS)

20

dmis id mapping table
DMIS ID Mapping Table
  • Mapped all OCONUS sites to “391”
  • Mapped all 5400 sites to locality “000”

21

next steps
Next Steps
  • CY 07 OIB Rate Package is in testing CITPO/RITPO
  • Dr. Casscells Letter is in “coordination”
  • Anticipate a 30 June 2007 effective date
  • Questions???

22

tma ubo pharmacy rates update

TMA UBO Pharmacy Rates Update

Presented by the

UBO Support Team

June 2007

23

pharmacy rates update
Pharmacy Rates Update
  • Pharmacy rate file submitted to CITPO and RITPO (66,654 drugs)
  • Effective June 30, 2007

24

pharmacy rates update1
Pharmacy Rates Update
  • Changes to pricing method for the July 2007 rate update
  • Use Median Average Wholesale Price (AWP)
  • No dispensing fee
  • Delete OTC drugs from rate file
  • Delete Miscellaneous supplies from rate file

25

coordination activities
Coordination Activities
  • February 2007 Quarterly UBO Advisory Working Group
  • RADM McGinnis and Pharmacy Board of Governors - March 30, 2007
  • Resource Management Steering Committee - April 19, 2007
  • Deputy SGs - Chief Financial Officer Integration Council - April 25, 2007
  • UBO Newsletter Articles

28

coordination activities continued
Coordination Activities (Continued)
  • Continued Coordination
  • Rate briefing teleconferences
  • Pharmacy Pricing Estimator Tool (P-PET)
  • Brief Department of Defense Education Activity (DoDEA)
  • Reminder: It is the responsibility of local MTFs to communicate rate changes to their pay patients

29

questions
Questions
  • Questions?

30

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