{"id":493,"date":"2017-04-24T15:54:11","date_gmt":"2017-04-24T19:54:11","guid":{"rendered":"http:\/\/blogs.duanemorris.com\/healthlaw\/?p=493"},"modified":"2017-04-24T15:54:11","modified_gmt":"2017-04-24T19:54:11","slug":"indian-health-care-payment-rates","status":"publish","type":"post","link":"https:\/\/blogs.duanemorris.com\/healthlaw\/2017\/04\/24\/indian-health-care-payment-rates\/","title":{"rendered":"INDIAN HEALTH CARE PAYMENT RATES"},"content":{"rendered":"<p><span style=\"color: #000000;font-family: Calibri\">New Purchased\/Referral Care (PRC) \u00a0regulations give the Indian Health Service (I) , Tribal\u00a0 Organizations (T) and Urban Indian Organizations (U) the ability to cap payment rates at a \u201cMedicare-like rate\u201d to physicians and other non-hospital provides and suppliers. \u00a0PRC covered services include outpatient care, physicians, laboratory, dialysis, radiology, pharmacy and transportation services.\u00a0 The effective date of the regulations was May 20, 2016, with an implementation date of no later than March 21, 2017. In the absence of a contract or agreement with I\/T\/U for a different rate, the PRC \u201cMedicare-like rate\u201d applies when a Provider accepts a referral or request for services, accepts a purchase order for services, or files a claim for payment for an I\/T\/U patient. \u00a0\u00a0Under the coordination of benefits provisions, PRC is a residual resource and pays after all other resources have considered the claim. Federal law prohibits the provider from billing the I\/T\/U \u00a0patient for authorized care. <\/span><\/p>\n<p><span style=\"color: #000000;font-family: Calibri\">\u00a0<\/span><\/p>\n<p><span style=\"color: #000000;font-family: Calibri\">\u00a0\u00a0<\/span><\/p>\n<p><span style=\"color: #000000;font-family: Calibri\">\u00a0<\/span><\/p>\n<p><span style=\"color: #000000;font-family: Calibri\">\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>New Purchased\/Referral Care (PRC) \u00a0regulations give the Indian Health Service (I) , Tribal\u00a0 Organizations (T) and Urban Indian Organizations (U) the ability to cap payment rates at a \u201cMedicare-like rate\u201d to physicians and other non-hospital provides and suppliers. \u00a0PRC covered services include outpatient care, physicians, laboratory, dialysis, radiology, pharmacy and transportation services.\u00a0 The effective date &hellip; <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/blogs.duanemorris.com\/healthlaw\/2017\/04\/24\/indian-health-care-payment-rates\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &#8220;INDIAN HEALTH CARE PAYMENT RATES&#8221;<\/span><\/a><\/p>\n","protected":false},"author":89,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[],"ppma_author":[909],"class_list":["post-493","post","type-post","status-publish","format-standard","hentry","category-health-law"],"authors":[{"term_id":909,"user_id":89,"is_guest":0,"slug":"pshofstra","display_name":"Patricia S. Hofstra","avatar_url":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-content\/uploads\/sites\/8\/2017\/11\/hofstrapatricia-125x150.jpg","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/posts\/493","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/users\/89"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/comments?post=493"}],"version-history":[{"count":0,"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/posts\/493\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/media?parent=493"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/categories?post=493"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/tags?post=493"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/ppma_author?post=493"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}