Medicare Advantage Reimbursement Issues - …

Medicare Advantage Reimbursement IssuesPresented by:Jason JohnsonJohn Garcia1 DISCUSSION AGENDA Brief background on Medicare Advantage ( MA ) Enrollment Rates And Trends Regulatory Environment Introduction To Shadow Billing MA Reimbursement Issues IME/GME/NAH HITECH SSI/DSH DSH and Bad Debt Deeper Discussion of Shadow Billing Reasons For Slippage Best Practices2MA Enrollment Rates and Trends3 TOTAL MA ENROLLMENT, 1999-20114 CURRENT MA ENROLLMENT BY STATE5MA ENROLLMENT - SOUTHERN CALIFORNIAC ounty NameMedicare Eligible PopulationEnrolled in Medicare AdvantageMA Penetration RateLos Angeles1,126,635247, ,856111, ,90791,293 Bernardino205,71663, Diego380,760 95,159 ,61915,002 : Effective June 2009, Excluding Kaiser and Other Cost Based PlansSource: OF MA PLANSHMO/PPOP rivate Fee for Service (PFFS)Special Needs Plans (SNP s) Plans must establish networks and sign contracts with providers Prior to 2011, no network required Patients can go to whichever hospital is most convenient Deeming Process Required to establish networks by 2011 Restricted to special needs beneficiaries7MA ENROLLMENT BY PLAN TYPE2007 - 20118MA ENROLLMENT BY PLAN TYPE20119MA ENROLLMENT BY PL

DISCUSSION AGENDA • Brief background on Medicare Advantage (“MA”) ˜Enrollment Rates And Trends ˜Regulatory Environment ˜Introduction To Shadow Billing • MA Reimbursement Issues

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