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Quarterly Claims and Operations

Understanding PPS
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Understanding PPS: Because reconciliation settlements are significantly behind, health centers that do not understand the PPS rates, their claims data, and coding for payment are in danger losing revenue. This half day training will will help health centers understand how PPS rates are constructed, and expanded. Provider types will be discussed as well as the proper way to fill out forms to ensure your CHC's reconciliation is as clean as possible.

7/11/2019
When: Thursday, July 11, 2019
9:00 AM
Where: Indiana CPA Society
900 E 96th St #250
Indianapolis, IN  46240
Presenter: Daniel S. Gaafar, CPA, Bradley and Associates
Contact: Drew Thomas
317-983-6343


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Title: Understanding PPS (Just $50 for members/ $100 non members)
Dan Gaafar, CPA, Bradley and Associates

Lunch will be served.

The State Medicaid agency and contractors are significantly behind in reconciliation settlements.  A survey completed earlier in the year shows the average year the last completed reconciliation settlement.

Line of Business

Avg. Year

RBMC

2013.1

HIP

2012.4

Dental

2014.9


Further, this delay in settlement means health centers are at significant risk of submitting errant PPS encounters without becoming aware of it for years due to the State’s tardy auditing mechanism.  IPHCA will assist health centers by providing TA on accurate PPS procedures. The impact on this will be twofold: It will help ensure health centers will not owe the State money following the completion of their reconciliations and provide accurate baseline data when the State begins to rollout an APCM.

9:00 AM

Medicaid PPS Rate Setting

            History of Medicaid FQHC Reimbursement in Indiana
                        Medicaid cost reports
                                    Preparation and Submission of Cost Reports
                                    Why the current PPS model is “value based” for the State

9:30 AM        

Billing and Wrap Payments
                        Current Billable Provider Types
                        Current “allowable” billing codes
                        Wrap billings
                        Settlements

            What about Non-billable provider types?

10:15 AM Break

10:30 AM

Increases in your PPS rate
            Change in Scope of Services
                        Current State Requirements and examples
                        Calculations

11:15 AM

Medicare PPS

            History of Medicare FQHC Reimbursement
                        Medicare cost reports
                                    Preparation and Submission of Cost Reports
            Payment Rate for Indiana
            G codes and billing examples
            Medicare Advantage wrap around payments

12 Noon

LUNCH and Questions

Health center attendees will understand the following items from Mr. Gaafar’s presentation:

  • A better understanding of PPS including:
    • Knowing the eligible provider types and medical codes
    • the wrap submission process
    • reconciliation settlements
  • Change in Scope and Community Health Workers
  • How to fill out appropriate forms:
    • a cost report
    • Change in Scope