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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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Agenda

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


Unit measure price comparison

Unit Measure Price Comparison

26


Unit measure price market comparison

Unit Measure Price: Market Comparison

27


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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