Presentation is loading. Please wait.

Presentation is loading. Please wait.

2010 UBO/UBU Conference Title: Navy UBO Breakout Session: T-2-0850.

Similar presentations


Presentation on theme: "2010 UBO/UBU Conference Title: Navy UBO Breakout Session: T-2-0850."— Presentation transcript:

1 2010 UBO/UBU Conference Title: Navy UBO Breakout Session: T

2 Welcome Introductions Best business practice – 2569/AHLTA interface at NH Bremerton Navy Medicine Allowance Calculation Tool (NMACT) Performance Metrics Published SOPs BUMED topics Questions 2

3 Introductions Slide Redacted Many MTFs represented. Please say hello to our new people. 3

4 FY11 DD2569 FOCUS Annual Area for Leadership Engagement Deputy Surgeon General FY11 Focus Area Collecting other health insurance data! FY11 Data Quality Mgmt Control Program Improve DD Form 2569 collection!

5 Issues Form Collections <100% per DQ Audit FY10 82% System Issues Systems not programmed to track form Done waiting for the E-DD2569 Process to quantify weak areas Need to Increase Billing and Collections

6 Proposal DD2569 Scanned into AHLTA Under Clinical Notes “DD2569 1Mar2011 NHB” Front Desk Verifies at Check-In Selects Clinical Notes Verifies date is within 1 year Verification by Clinic for Valid Form Print a daily appointment listing Verify a valid form is in Clinical Notes

7 DD2569 Count

8 DD2569 Verification

9 Summary Doubled Form Collections 2K average to 4K average or more Clinic Verification Improvement 45% to 80% with Valid Form New OHI Jan-Feb 90 New OHI Policies March *7 Work-Days* 25 New OHI Policies

10 March 15 th, 2011 Navy UBO Break Out Session 2011 MHS Revenue Cycle Educational Conference BUMED SOPs for UBO and TPC/AR Updates 10

11 Purpose and Objectives Third Party Outpatient Corrective Action Execution Performance Metrics Navy Medicine SOPs for UBO IAB Outpatient TPC Billing 11

12 Third Party Outpatient AR Corrective Action deployed for Q4 FY10 20 MTFs have used the Navy Medicine Allowance Calculation Tools to predict NRV on monthly TPOCS billings Resolves longstanding material weakness for Navy Medicine Navy Medicine reported AR, Public for Q4 FY10 Financial Statements Third Party Outpatient Corrective Action 12

13 Accounting entered value on time AR entered in STARS-FL prior to COB 4th calendar day of month (A) Accounting entered AR correctly: date and value AR amount entered accurately per the Tool Monthly Report and backdated (B) Documents forwarded to requested parties MTF Package submitted to BUMED and DFAS by COB 4th calendar day of month (C) Monthly Package Complete- Tool Reports Monthly Package Complete- Collection Reconciliation Monthly Report Signed Package contains all required documentation and all Tool report values are within reason (D) IOP used to operate Tool successfully MTF works with Region to resolve issues Monthly Process completed without BUMED support (E) Measuring Execution Performance FY11 Sustainment Performance Metrics

14 Inter-Agency Billing (IAB) SOP: Overview 14

15 IAB SOP: Contents and Roles Roles Included: MTF UBO Staff MTF UBO Manager Activity Accounting Technician Regional UBO Manager BUMED UBO Manager Processes Included: Bill Preparation Bill Review Bill Submission Reconciliation of Billings and Collections STARS-FL Entries Monitoring the IAB Program 15

16 Outpatient TPC Billing SOP: Overview

17 Outpatient TPC Billing SOP: Contents and Roles Roles Included: MTF UBO Staff MTF UBO Manager Processes Included: Insurance Verification Outpatient Medical Bill Set-up Pharmacy Bill Set-up ePREMIS Billing Claim Closeout Running Aging Reports Running Write-Off Reports 17

18 TitleDescription IAB Interim Procedures Required 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 1 st, 2011 IAB for Medical Services SOP Improves 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 SOP Improves 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 denials UBO SOP Deployment Information UBO SOPs are required for execution starting April 1 st and can be downloaded from the Navy Medicine FIP NKO site: https://wwwa.nko.navy.mil/portal/navymedicine/fip/home/sophttps://wwwa.nko.navy.mil/portal/navymedicine/fip/home/sop

19 ●SLIDE REDACTED Contact Information

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 receivable In July 2010, BUMED rolled out an NRV-reporting tool that works by determining an allowance factor for TPC (outpatient) accounts BUMED is researching the development of NRV-reporting tools for TPC (inpatient), MSA and MAC claims/invoices Implementation date: TBD (audit occurs in FY-13) 20

21 BUMED UBO Topic – USCG IAB Proposal Discussion of ending IABs for USCG Details unclear, but could include: – USCG makes one payment to DoD each 1 Oct Payment based on total healthcare bill for USCG previous year – DoD splits the funds amongst Services; Services split funds amongst Regions/MTFs – At mid-year point, MTFs produce a 12-month wrap-up IAB; wrap-up IAB is used to prepare following year USCG payment – Possible application for other IABs as well (however, no active discussions of other IABs yet) Possible date to implement: FY-12 21

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 service – Implements ASD(HA) ltr of 6 Feb 2006 Implementation date: 1 Oct

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 codes Implementation date: 1 Oct

24 BUMED UBO Topic – TPC Pharmacy e-Billing Contract has been awarded to PSI to implement the e- billing feature in TPOCS – E-billing feature will produce a NCPDP (Natl Council for Prescription Drug Programs) universal claim form for all TPC pharmacy prescriptions – E-billing has been implemented at Camp Lejeune and is being tested at NMC Portsmouth and NH Bremerton – BUMED 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 capability Estimate to have all TPOCS facilities on line: Mar-May

25 BUMED UBO Topic – e-2569 As of 11 Jan 2011, USAF has granted an Authority to Operate (ATO) for AF MTFs to operate the e-2569 OHI collection form NAVMISSA is conducting an AoA regarding the feasibility of employing the e-2569 at Navy MTFs If 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) review BUMED intends to push for acceptance of the AF ATO exactly as written – BUMED will mandate that MTFs purchase hardware and employ the e-2569 at all patient points of service Estimated date for e-2569: Spring/Summer

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!) 26

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 debt – If 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) 27

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 off – Although the DCMO only wants debts larger than $225, smaller debts may be submitted via DD139/DD2481/TOP DFAS 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. 28

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 29

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 MTFs – Require that all UBO receipts (MSA, TPC, miscellaneous) be posted into CHCS Estimated date to execute standard process: 1 Oct

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 2014 – TPOCS sunset coincides with ICD-10 rollout 1 Oct 2013 Replacement 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. 31

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 all – MSA (IAB and non-IAB), – TPC (inpatient and outpatient) and – MAC billing. The replacement system will interface with the CBER, vice individual CHCS systems 32

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 2014 – TPOCS sunset coincides with ICD-10 rollout 1 Oct 2013 Replacement 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. 33

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 all – MSA (IAB and non-IAB), – TPC (inpatient and outpatient) and – MAC billing. The replacement system will interface with the CBER, vice individual CHCS systems 34

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 workforces Systems: 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 needs Locations: The CBER does not reside on an MTF server, but rather off-site. With CBER access, UBO functions can be moved, as necessary Workforce: options include a Government workforce, contract workers and/or a combination workforce structure 35

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 document The goal is to develop a system that maximizes all-sources funding for the MTFs, while minimizing system/personnel costs Estimate to have replacement: NLT 1 Oct 2013 (preferably FY-12, or early FY-13) 36

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 TPOCS – Sites may use Govt workers, contract workers or a combination thereof – Billing/collection activities may occur at the MTF, contract location or a combination thereof – MTFs 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 requirements Note: 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) 37

38 BUMED UBO Topic – CHCS/TPOCS Alternatives As per OSD(HA) policy memo , MTFs may conduct billing/collection activities BUMED 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. 38

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)) 39

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 DD1131s All of the above products are supported by the FMR Vol 5 Ch 28 Estimated date to implement standard deposit products: 1 Oct

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 reasons Known/possible CHCS/TPOCS systems issues: – Rates do not appear for APV anesthesia charges – Other? 41

42 Questions? 42


Download ppt "2010 UBO/UBU Conference Title: Navy UBO Breakout Session: T-2-0850."

Similar presentations


Ads by Google