Managing Contract Health Services for Tribal Organizations
Social Services
December 9-10, 2008 |
Las Vegas, NV |
$720 |
Every year, tribal health service providers lose thousands
of dollars and possibly endanger their members’ health
by entering into poorly negotiated and managed
contracts with outside health service providers.
Don’t jeopardize your limited health care
resources or, more importantly, your patients’
health.
If you’re currently managing a Contract Health
Service (CHS) program or thinking about taking over a
program from the Indian Health Service (IHS), you must
have a complete understanding of the complex issues that
apply to the administration
of a medical referral
system. Using our sample
documents and management
tools, you’ll learn
how to maximize your CHS dollars and reduce managed
care costs.
Topics that will be covered include:
IHS Manual
- Responsibilities of CHS administrators
- Persons to whom CHS will be provided
- Funding availability
- Contract to support direct services
- Authorization for CHS
- Appeals records
CHS Regulations/Federal Register Guidelines
- Understanding federal regulations
- Eligibility and CHS delivery areas
- CHS denial and appeals
- IHS Circular No. 93-03
Title 42, Part 36 & 36 (A)
- Review and purpose
- Services available
- Who is eligible?
Catastrophic Health Emergency Fund (CHEF)
- IHS administrative guidelines for CHEF
- Monitoring and reporting catastrophic cases
- Accounting procedures
- Allowable services and costs
- Responsibilities of CHEF administrators
Reducing Costs in Managed Care
- Eight strategic steps and appropriate actions to take
Overview of the Centers for Medicare and Medicaid Services (CMS)
- History and background
- Creating a culture of responsiveness
- Key legislative milestones
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Overview of Medicare
- History and background
- Medicare milestones
- Services covered under Medicare
- Medicare enrollment — trends
- Medicare Modernization Act of 2003
Overview of Medicaid
- History and background
- Medicaid services
- Medicaid milestones
- Requirements for getting Medicaid
Overview of HIPAA
- History and background
- Purpose and benefits
- Compliance issues
- Review of CFR 45
Sample Documents and Management Tools
- Sample forms:
- Patient satisfaction survey
- Alternate resource application
- Authorization to release information
- Utilization management tools for tribal CHS programs
- CHS quality indicators
- Sample tribal CHS policies and procedures
Fraud
- Medicare fraud
- Medicaid fraud
- Detecting fraud — the top indicators
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