Native Advantage

Medicare Like Rates:

  • What they are?
  • Why they are underutilized?
  • Why we have to stop the underutilization?


Many of you have heard of the “Medicare Like Rates” (MLR) and how this program can help your tribe. Medicare Like RatesWhat does this mean to you and your members? Savings. On certain claims, tribal members that qualify for MLR rates a savings on average 30% over standard “discounted” rates is realized.

What is this MLR? Medicare Like Rates is a regulation set forth by the Department of Health and Human Services. This legislation was finalized on July 5, 2007 under Section 506 of the Medicare Modernization Act (MMA). This requires hospitals that participate in the Medicare program to accept deeply discounted Medicare levels of reimbursement for certain services. The unique legislation directly affects your members, your I.H.S. provider and most importantly your tribes finances. More information on MLR and Indian Tribes

The legislation does not apply to all claims, but the ones it does apply to will normally be your biggest claims. Medicare Like RatesFor example we have seen a number of diabetic induced large claims that exceeded $1 million. With normal pricing, these claims were discounted the standard 30%. With MLR properly administered, this 30% discount was more than doubled. Instead of the tribe paying $700,000 for a claim of this type, they ended up paying $400,000, a substantial savings.

We have spoken to a number of tribes that thought they were receiving MLR discounts, but after investigation, it was found that they were not. Why? There a number of factors why. Such things are oversight, politics, incorrect billing and a lack of understanding are to blame. The legislation is there to protect your tribe, Indian Health Service and your people, let First People Insurance Services make this important legislation work on your behalf.

With First Peoples, our oversight insures that:

  • Enrollment and coverage is verified.
  • Proper approvals and authorizations are obtained.
  • Federal and Tribal dollars are maximized.
  • Claims are repriced at Medicare Like Rates (MLR) when applicable.
  • Claims from Tribal Members and non-Tribal Members are processed.
  • Appropriate claims are paid quickly and accurately to each provider.

Prescription Drug Savings and 340B

Medicare Like RatesAnother great savings to your tribe and its members brought to you by First People Insurance Services. 340 B is a federal Drug Pricing Program that provides reduced drug pricing to over 17,000 vendors nationwide. Deep discounts and savings are to be realized, yet so many are not taking advantage of this legislation. With Department of Health and Human Services (HHS) acting as the link to whether 340 B pricing is available, let us help you and your provider achieve and maintain this important cost saving measure. Maybe a 340 B provider is not available in your area? Medicare Like Rates No problem, with First People Insurance Services help we have helped other entities establish a mail order and in some cases delivery supplier that was 340 B compliant.

This brought tremendous cost savings to the tribe and once again its members. All of this is accomplished with little to no disruption to the members, little to no work on your staffs behalf and many received better, more cost effective and safer prescription service in the end.

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Health Care Reform and Tribal Members

Medicare Like Rates The landmark Health Care Reform legislation of 2010 has provided a wealth of provisions to help Native American tribal members and Tribal business’ control, maintain and improve the health of their members as well as control costs in the future. With an Indian Health Service system that is traditionally overwhelmed and understaffed, we now have a new tool that will allow Tribal members to expand their health care choices while taking pressure off of your local Indian Health Service provider. Medicare Like RatesThe exchanges are a great tool to help your enrolled staff members lower their costs, lower your plans costs while increasing their benefit offerings. Our staff is well versed in Indian Health Service and Health Care Reform integration. Let us take this workload off of your hands will helping out your people. New changes in the landscape, require new ideas and thinking, we can show you how.

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