Laserfiche WebLink
Docusign Envelope lD: CEBC6B3C-DFA1-4BOC-AFE8-6A4A634400B0 <br />ExHrnIr B-2-A <br />MrnrcaRr Aov.s,Nracn <br />RrrvmuRsrMENT Rarps <br />1. Rates. Subject to the terms of the Agreement, reimbursement rates for Covered Services <br />billed under Facility's tax ID number for the Medicare Advantage benefit plans listed <br />below shall be the lesser of billed charges or the following and will be less any applicable <br />Cost Sharing Amounts: <br />A. CHPW Medicare Advantage and Medicare Advantage Prescription Drug Plans <br />Network Name: CHPW MA Network <br />Inpatient Services: N/A% of Medicare Fee Schedule. <br />Outpatient Services: N/A% of Medicare Fee Schedule. <br />Professional Services: N/A% of Medicare Fee Schedule. <br />B. CHPW Medicare Advantage Special Needs Plan <br />Network Name: CHPW SNP Network <br />Inpatient Services: N/A% of Medicare Fee Schedule. <br />Outpatient Services: N/A% of Medicare Fee Schedule. <br />Professional Services: N/A% of Medicare Fee Schedule. <br />2. Pavment. This ExhibitB-2-Areflects the CMS "Medicare Advantage" rates. l CFPW <br />will adjust payments to Facility consistent with any adjustment that CMS applies to <br />CHPW as a Medicare Advantage Organization. All payments under this Agreement shall <br />be made in accordance with the terms of this Agreement,the Provider Manual and the <br />applicable billing instructions and policy guidelines published and periodically updated <br />by applicable state and federal agencies as set forth in Section 4 of the Agreement. <br />Effective Date: 7 1112025 <br />(CHPW TO COMPLETE) <br />I Medicare Managed Care GME, IME, and Allied Health payments are paid through the Medicare cost reporting process, and are <br />therefore excluded from these referred payment rates. In addition, Sole Community Hospitals (SC[D and Medicare Dependent <br />Hospitals (MDII) receive a supplemental payment if their inflated and case mix adjusted base-year cos! referred to as their <br />Hospital Specific Rate (HSR) exceed the Medicare Operating MSDRG and Outlier payments under traditional Medicare Part A <br />fee for service. SCH and MDH special payment adjustments are excluded from these referred payment rates. <br />2020 Facility Exh B2A - MARates Page 42 ofSl Contract #5908-662684