CHS Support

MEDICARE like RATE IMPACT on TRIBAL PARTNERS' CHS PROGRAMS
JULY 2007 - DECEMBER 2011


*Inpatient – Outpatient hospital-based claims

Claim Type
Critical Access
Professional Claims
MLR Repriced Claims
Billed Charges
MLR Allowable
Savings Amount
% of Savings
Inpat
Outpat
CMS - CAH
(MLR-ineligible)
(Hospital-based)
3,765
30,618
2,421
869
36,804
$161,520,583
$51,087,558
$110,433,025
68%
The intent of the Medicare like Rate legislation is to extend a Tribe's finite Contract Health Services' dollars. Hence, AIHS charges fixed transaction fees for MLR re-pricing services. Compared to other MLR re-pricing service providers which charge a % of savings, we ensure that a Tribe's resources remain with its people. AIHS has repriced nearly 37,000 claims, totaling more than $110 Million in savings. Under a 3% of savings model which other providers might have charged, our partner Tribes would have paid $3.3 Million to achieve these savings. These vast savings in service fees make all the difference in our Tribal partners' ability to improve their respective CHS status from Priority 1 to Priority 2 and, with some CHS Programs, even Priority 3.
1 Note: Savings Amount does not account for potential coordination of benefits. Hence, actual savings may reflect a modest reduction.

 

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