Presentation on theme: "Title: Navy UBO Breakout Session: T"— Presentation transcript:
1 Title: Navy UBO Breakout Session: T-2-0850 Track x – xxx day –Title: Navy UBO BreakoutSession: T
2 WelcomeIntroductionsBest business practice – 2569/AHLTA interface at NH BremertonNavy Medicine Allowance Calculation Tool (NMACT) Performance MetricsPublished SOPsBUMED topicsQuestions
3 Introductions Slide Redacted Many MTFs represented. Please say hello to our new people.
4 FY11 DD2569 FOCUSAnnual Area for Leadership EngagementDeputy Surgeon General FY11 Focus AreaCollecting other health insurance data!FY11 Data Quality Mgmt Control ProgramImprove DD Form 2569 collection!
5 IssuesForm Collections <100% per DQ AuditFY10 82%System IssuesSystems not programmed to track formDone waiting for the E-DD2569Process to quantify weak areasNeed to Increase Billing and Collections
6 Front Desk Verifies at Check-In Selects Clinical Notes ProposalDD2569 Scanned into AHLTAUnder Clinical Notes“DD2569 1Mar2011 NHB”Front Desk Verifies at Check-InSelects Clinical NotesVerifies date is within 1 yearVerification by Clinic for Valid FormPrint a daily appointment listingVerify a valid form is in Clinical Notes
9 SummaryDoubled Form Collections2K average to 4K average or moreClinic Verification Improvement45% to 80% with Valid FormNew OHIJan-Feb 90 New OHI PoliciesMarch *7 Work-Days* 25 New OHI Policies
10 Navy UBO Break Out Session 2011 MHS Revenue Cycle Educational Conference BUMED SOPs for UBO and TPC/AR UpdatesMarch 15th, 2011
11 Purpose and Objectives Third Party Outpatient Corrective ActionExecution Performance MetricsNavy Medicine SOPs for UBOIABOutpatient TPC Billing
12 Third Party Outpatient Corrective Action Third Party Outpatient AR Corrective Action deployed for Q4 FY1020 MTFs have used the Navy Medicine Allowance Calculation Tools to predict NRV on monthly TPOCS billingsResolves longstanding material weakness for Navy MedicineNavy Medicine reported AR, Public for Q4 FY10 Financial Statements
13 Measuring Execution Performance FY11 Sustainment Performance MetricsAR entered in STARS-FL prior to COB 4th calendar day of month (A)Accounting entered value on timeAR amount entered accurately per the Tool Monthly Report and backdated (B)Accounting entered AR correctly: date and valueMTF Package submitted to BUMED and DFAS by COB 4th calendar day of month (C)Documents forwarded to requested partiesPackage contains all required documentation and all Tool report values are within reason (D)Monthly Package Complete- Tool ReportsMonthly Package Complete- Collection ReconciliationMonthly Report SignedMonthly Process completed without BUMED support (E)IOP used to operate Tool successfullyMTF works with Region to resolve issues
17 Outpatient TPC Billing SOP: Contents and Roles Roles Included:MTF UBO StaffMTF UBO ManagerProcesses Included:Insurance VerificationOutpatient Medical Bill Set-upPharmacy Bill Set-upePREMIS BillingClaim CloseoutRunning Aging ReportsRunning Write-Off Reports
18 UBO SOP Deployment Information TitleDescriptionIAB Interim ProceduresRequired in preparation for executing the IAB for Medical Services SOP due to importance of finalizing the DD7A on a monthly basis.Note: Completion of Interim Procedures is due NLT April 1st, 2011IAB for Medical Services SOPImproves the efficiency and quality of the process through decreased hand-offs, decentralization, and standardization to avoid missed billings; creates greater transparency of local execution by BUMED HQ.Outpatient TPC Billing SOPImproves efficiency, accuracy, and transparency of the process through standardization, including audit check-points to ensure that no bills are lost due to system errors and collections are maximized; decreases the billing/collection timeline and aims to increase the amount of payments received over claim denialsUBO SOPs are required for execution starting April 1st and can be downloaded from the Navy Medicine FIP NKO site:
20 BUMED UBO topic – MSA/MAC/TPC(in) NRV Reporting Tools In preparation for an audit of the Navy’s ‘Balance Sheet’, BUMED/MTFs have been levied with a requirement to produce a Net Realizable Value (NRV) for its accounts receivableIn July 2010, BUMED rolled out an NRV-reporting tool that works by determining an allowance factor for TPC (outpatient) accountsBUMED is researching the development of NRV-reporting tools for TPC (inpatient), MSA and MAC claims/invoicesImplementation date: TBD (audit occurs in FY-13)
21 BUMED UBO Topic – USCG IAB Proposal Discussion of ending IABs for USCGDetails unclear, but could include:USCG makes one payment to DoD each 1 OctPayment based on total healthcare bill for USCG previous yearDoD splits the funds amongst Services; Services split funds amongst Regions/MTFsAt mid-year point, MTFs produce a 12-month wrap-up IAB; wrap-up IAB is used to prepare following year USCG paymentPossible application for other IABs as well (however, no active discussions of other IABs yet)Possible date to implement: FY-12
22 BUMED UBO topic – FY for MSA Funds As per BUMED ltr 7000 Ser M84/10UM of 5 Oct 2010:MSA payments will be credited to LOAs in the year of receipt, vice year of serviceImplements ASD(HA) ltr of 6 Feb 2006Implementation date: 1 Oct 2010
23 BUMED UBO Topic – Standard TPC Write-off Codes As per BUMED ltr 7000 Ser M84/10UM of 24 Sep 2010:All MTFs using TPOCS will use listed write-off codesImplementation date: 1 Oct 2010
24 BUMED UBO Topic – TPC Pharmacy e-Billing Contract has been awarded to PSI to implement the e-billing feature in TPOCSE-billing feature will produce a NCPDP (Natl Council for Prescription Drug Programs) universal claim form for all TPC pharmacy prescriptionsE-billing has been implemented at Camp Lejeune and is being tested at NMC Portsmouth and NH BremertonBUMED has funded the TPC pharmacy e-billing for FY-11 (contract payments are made on a per-claim basis to RelayHealth)For FY-12 and beyond, MTFs will need to self-fund if they wish to retain the capabilityEstimate to have all TPOCS facilities on line: Mar-May 2011
25 BUMED UBO Topic – e-2569As of 11 Jan 2011, USAF has granted an Authority to Operate (ATO) for AF MTFs to operate the e-2569 OHI collection formNAVMISSA is conducting an AoA regarding the feasibility of employing the e-2569 at Navy MTFsIf found feasible, Navy will have to accept the AF ATO exactly as is, or allow for significant delays while the system undergoes a lengthy DIACAP (Defense Information Assurance Certification and Accreditation Process) reviewBUMED intends to push for acceptance of the AF ATO exactly as writtenBUMED will mandate that MTFs purchase hardware and employ the e-2569 at all patient points of serviceEstimated date for e-2569: Spring/Summer 2011
26 BUMED UBO Topic – MSA Write-off Actions MTF UBO offices process unpaid invoices/claims as follows:For MSA, invoices can only be zeroed out by:Paying the invoice in full (invoice is considered as ‘paid’ when the funds have been deposited into the U.S. Treasury)Excluding invalidly-produced charges (e.g. unbundled labs, wrong PatCat registration that isn’t support by DEERS, etc) (justification must be supported!)
27 BUMED UBO Topic – MSA Write-off Actions MTF UBO offices process unpaid invoices/claims as follows: (cont’d)Transferring the debt to DFAS (see FMR Vol 5 Ch 28) (Debt and Claims Management Office (DCMO)) (mandatory for out-of-service debts of more than $225 combined that are more than 60 days old)Note that the FMR only requires one demand letter, before referring the debtIf sponsor is a military AD/retiree, submit a DD139 (MTF must track)If sponsor is a DoD employee, submit a DD2481 (MTF must track)Way ahead: BUMED researching use of the Treasury Offset Program (TOP) by MTFs (instead of submitting packages to the DCMO)
28 BUMED UBO Topic – MSA Write-off Actions MTF UBO offices process unpaid invoices/claims as follows: (cont’d)Debts that total less than $225 may be held for one year and then written offAlthough the DCMO only wants debts larger than $225, smaller debts may be submitted via DD139/DD2481/TOPDFAS adjudicates all questions regarding unpaid invoices; neither BUMED nor the Regional Commanders have the authority to authorize MSA write-offs, or adjudicate billing disputes. Do not send debt packages to BUMED.
29 BUMED UBO Topic – TPC Write-off Actions MTF UBO offices process unpaid invoices/claims as follows:For TPC, claims can only be zeroed out by:Payer pays 100% of the claimed amount;Payer provides a valid reason for paying less than 100% of the claimed amount (write-off codes W08 thru W15 and W17 thru W50);Referring invalid claim denials (code W16) to the MTF’s Judge Advocate General.Neither BUMED nor the Regional Commanders have the authority to authorize TPC write-offs, or the resources to coordinate JAG support for claim disputes; invalid denials should be coordinated with the MTF’s JAG office. Do not send claim packages to BUMED.BUMED does not possess the staff nor the necessary level security to maintain medical records / PII / HIPAA-protected data
30 BUMED UBO Topic – Standard Sales Codes/ CHCS Posting BUMED is preparing a draft memo that will:Prescribe a standard list of Sales Codes to use by all MTFsRequire that all UBO receipts (MSA, TPC, miscellaneous) be posted into CHCSEstimated date to execute standard process: 1 Oct 2011
31 BUMED UBO Topic – TPOCS Sunset As per OSD(HA) memo of 13 Dec 2010, TPOCS will sunset 1 Oct 2013 (TMA will cease funding).TPOCS will remain as a legacy system until 1 Oct 2014TPOCS sunset coincides with ICD-10 rollout 1 Oct 2013Replacement plan:Beginning in FY-13, TMA will implement the Central Events Billing Repository (CBER). The CBER will be a warehouse that uploads billable events (MSA, TPC and MAC) from every MHS MTF’s CHCS into a single database.
32 Services have been tasked with developing a plan to replace TPOCS. The replacement system is not limited to TPC (outpatient); the replacement system may provide for allMSA (IAB and non-IAB),TPC (inpatient and outpatient) andMAC billing.The replacement system will interface with the CBER, vice individual CHCS systems
33 BUMED UBO Topic – TPOCS Sunset As per OSD(HA) memo of 13 Dec 2010, TPOCS will sunset 1 Oct 2013 (TMA will cease funding).TPOCS will remain as a legacy system until 1 Oct 2014TPOCS sunset coincides with ICD-10 rollout 1 Oct 2013Replacement plan:Beginning in FY-13, TMA will implement the Central Events Billing Repository (CBER). The CBER will be a warehouse that uploads billable events (MSA, TPC and MAC) from every MHS MTF’s CHCS into a single database.
34 BUMED UBO Topic – TPOCS Sunset Replacement plan: (cont’d)Services have been tasked with developing a plan to replace TPOCS.The replacement system is not limited to TPC (outpatient); the replacement system may provide for allMSA (IAB and non-IAB),TPC (inpatient and outpatient) andMAC billing.The replacement system will interface with the CBER, vice individual CHCS systems
35 BUMED UBO Topic – TPOCS Sunset NAVMISSA is currently conducting an Analysis of Alternatives (AoA)AoA is looking at a broad range of options for systems, locations and workforcesSystems: options include Government-procurement or Government-leasing; the system could either be an existing off-the-shelf system, or one specially produced to meet the Navy’s needsLocations: The CBER does not reside on an MTF server, but rather off-site. With CBER access, UBO functions can be moved, as necessaryWorkforce: options include a Government workforce, contract workers and/or a combination workforce structure
36 BUMED UBO Topic – TPOCS Sunset NAVMISSA is currently conducting an Analysis of Alternatives (AoA) (cont’d)BUMED/NAVMISSA will work collaboratively with Regions/MTFs to build the post-TPOCS requirements documentThe goal is to develop a system that maximizes all-sources funding for the MTFs, while minimizing system/personnel costsEstimate to have replacement: NLT 1 Oct 2013 (preferably FY-12, or early FY-13)
37 BUMED UBO Topic – CHCS/TPOCS Alternatives As per OSD(HA) policy memo , MTFs may conduct billing/collection activities as per the following:Sites are not mandated to using CHCS and/or TPOCSSites may use Govt workers, contract workers or a combination thereofBilling/collection activities may occur at the MTF, contract location or a combination thereofMTFs wishing to use non-CHCS/TPOCS should review -- OASD (Networks and Information Integration) DTM , FMR Vol 4 Ch 3 (allowance methodology), and the TMA UBO metrics reporting requirementsNote: The AR NRV Reporting Tool only works with TPOCS. MTFs that depart from the use of the TPOCS will need to compile their own NRV (methodology is subject to review/approval by BUMED)
38 BUMED UBO Topic – CHCS/TPOCS Alternatives As per OSD(HA) policy memo , MTFs may conduct billing/collection activitiesBUMED is drafting guidance to the Regional Commanders/MTFs to implement the above policy memo (cont’d)MTFs should coordinate with their Regional Commanders / BUMED before contracting / purchasing any billing support products.
39 BUMED UBO Topic – Treasury Deposit Products BUMED is preparing a draft memo that will require all MTFs to use, and accept (to receive payments), the following U.S. Treasury products:Credit/Debit cards (thru pay.gov)Electronic checks (thru pay.gov)Remote payment (via a pay.gov-hosted MTF payment page)Payment via Electronic Funds Transfer (EFT) (using a Remittance Express (REX) / Credit Gateway acct)Preparation of SF215s via Over-the-counter Net (OTCNet) (formerly Treasury General Accounting Net (TGANet))
40 BUMED UBO Topic – Treasury Deposit Products BUMED is preparing a draft memo that will require all MTFs to use, and accept (to receive payments), the following U.S. Treasury products: (cont’d)Depositing of all checks with a check scanner thru OTCNet (formerly Paper Check Conversion-Over the Counter (PCC OTC))Download of SF215 data from the Treasury Reporting System (TRS) (formerly CA$HLINK II)Draft memo will include methods / procedures for submitting associated DD1131sAll of the above products are supported by the FMR Vol 5 Ch 28Estimated date to implement standard deposit products: 1 Oct 2011
41 BUMED UBO Topic – Other Items Lab unbundling – BUMED UBO will re-engage on the BUMED (Lab Specialty Leader) mandated practice of unbundling labs for productivity count reasonsKnown/possible CHCS/TPOCS systems issues:Rates do not appear for APV anesthesia chargesOther?