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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



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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