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2010 UBO/UBU Conference Title: OCONUS Training: Electronic Collections, Deposits & Payments Session: T-3-1530.

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Presentation on theme: "2010 UBO/UBU Conference Title: OCONUS Training: Electronic Collections, Deposits & Payments Session: T-3-1530."— Presentation transcript:

1 2010 UBO/UBU Conference Title: OCONUS Training: Electronic Collections, Deposits & Payments Session: T

2 Background The Composite Health Care System (CHCS) provides a very reliable and dependable set of technologies for meeting the necessary requirements of the Dept of Defense to account for the production of invoices, document supporting medical information, bill patients, and provide an audit trail for funds received However … – CHCS is woefully behind many of the common 21 st century methods used in the rest of the world for moving these sets of medical information to health insurers, patients, and other payers, and employed to provide a faster, more secure, easily traced means of accounting for the bills and funds in an end-to-end fashion 2

3 Background Available now (and mostly at no cost) are multiple 21 st century tools that MTFs can use to dramatically improve the collections process and reduce the size of the accounts receivable (AR) (while probably also greatly increasing patient satisfaction with your MTF’s billing and insurance filing process) U.S. Naval Hospital Naples implemented and employed many of these new AR management methods and processes from 2007 to During this time, NavHosp Naples has realized significant improvements to the AR as follows: MetricMar 2007Feb 2010Improvement Year prior earnings$1,800,000$2,700,000up 50% Year prior accts14,00014,000steady generation Nr accts in AR8,0503,400down > 55% Value of AR$1,200,000$650,000down > 45% 3

4 Objectives This presentation will detail some of the methods / processes used by NavHosp Naples to realize this improvement (that your MTF may also wish to consider using). These methods / processes include: – Moving towards a more cash-free office by receiving funds via: Credit card Check/debit card (Automated Clearinghouse (ACH) transfer) Electronic funds transfer (EFT) – Providing better funds accountability / documentation / speed of deposit via: Direct scanning / uploading / e-storage of checks to the Dept of Treasury – Faster / more accurate processing of insurance claims via: Use of a direct entry, Web-based medical insurance claims clearinghouse – Consolidated patient billing thru use of a: Simple / command-changeable CHCS ad hoc – Collection of delinquent debtors with: Direct DFAS garnishment of pay (for DoD appropriated fund employees) Offset of funds from any Federal source (for all other persons) thru the Treasury Offset Program (TOP) 4

5 Possibilities Available now, MSA Offices can – – Allow payers (normally large payers like governments, including many foreign) and insurance companies) to directly transfer funds into a U.S. Treasury account specifically designated for your hospital’s MSA Office – Allow payers (normally small payers) to write electronic checks, versus paper checks – Allow payers to pay with a credit card (no transaction fees) – Allow payers to pay over the Internet – Scan, upload for deposit, and locally destroy all paper checks received in person or thru the mail – Involuntary collect on delinquent debtors (for almost any debtor with an SSN) – (Nearly) instantly file virtually 100% of all outpatient claims to any medical insurer thru an extremely easy-to-use commercial Web portal (possible costs to your MTF) – Conduct easy-to-understand consolidated billing for your pay patients 5

6 Cash Reduction Tools Following are tools to provide easy / cashless methods for your patients to pay their hospital debts Records are automatically kept electronically in Dept of Treasury Web-based servers for 6+ years Products are supported in the DoD Financial Management Regulation (FMR) (see FMR Vol 5 Ch 24) 6

7 Credit Cards Credit cards thru Pay.gov: – At no cost to your Hospital, the U.S. Treasury offers to accept credit card payments and then credit those funds to your designated finance office – How does it work? Patient provides credit card info; MSA personnel then post the payment with an internet-connected computer to The Treasury sends the credit card collection to a designated commercial bank (Fifth Third Bank) for processing The commercial bank processes the payment and then sends an SF 215 Deposit Ticket to DFAS (reported via CA$HLINK II) DFAS applies the deposit against an LOA using the electronic DD 1131 that you provide – Also, you may complete your own refunds with credit cards (no DFAS support required!) (Credit card refunds generate an SF 5515 Debit Voucher) – Note: CA$HLINK II sunsets in 2012; will be replaced by the Transaction Reporting System (TRS) 7

8 Credit Cards 8 Logging into pay.gov:

9 Credit Cards 9 Entering credit card info into pay.gov:

10 Credit Cards No personal info on this screen – simulated data. 10 Listing of pay.gov processed credit card payments/refunds:

11 Credit Cards 11 Logging into CA$HLINK II to obtain SF 215 reports:

12 Credit Cards 12 Credit card CA$HLINK II SF 215 report: Note: CA$HLINK II sunsets 2012; will be replaced by TRS

13 Electronic Checks e-Checks thru Pay.gov: – Similar to credit card processing, pay.gov will accept electronic check payments and then post them to your line of accounting – How does it work? Patient provides e-check info (routing and account numbers) & MSA personnel post the payment with an Internet- connected computer to pay.gov The Treasury sends the e-check collection to the patient’s bank for processing The bank processes the payment and then sends a SF 215 Deposit Ticket to your DFAS (via CA$HLINK II) DFAS applies the deposit against your LOA using the electronic DD 1131 that you provide 13

14 Electronic Checks 14 Screen to enter electronic check payments:

15 Electronic Checks No personal info on this screen – simulated data. 15 Pay.gov summary of electronic check payments:

16 Electronic Checks 16 Electronic check CA$HLINK II SF 215 report:

17 Pay Via the Internet Patients may pay directly at Pay.gov (no need for the patient to waste their time (or yours!) by making an unnecessary trip into your office): – Pay.gov will host your payment form (at no cost to you). You may advertise the Web address of your pay.gov hosted Webpage, or you may link to it thru your Hospital’s Webpage. – How does it work? The patient goes to your hosted form at pay.gov and enters information, such as CHCS account numbers, name, address, etc. (you choose what information is required). The patient then enters his/her own credit card/e-Check info and submits the payment MSA Office personnel periodically check (normally daily) at pay.gov and look for any new payments. New payments are then posted into CHCS and invoices sent to the patient 17

18 Internet Payments 18 Easy Payment letter enclosed with each invoice:

19 Internet Payments No personal info on this screen – simulated data. 19 Hospital Web site/payment form hosted by Pay.gov:

20 Internet Payments No personal info on this screen – simulated data. 20 Screen where the patient enters his/her account info:

21 Internet Payments 21 Location where the MTF finds patient payments: No personal info on this screen – simulated data.

22 Payments Directly to Your MSA ‘Bank’ Account Credit Gateway / Remittance Express (REX): – With REX, your hospital has its own depository-only bank account at the U.S. Treasury (for deposits only; no funds are available for withdrawal). You have your own 9-digit routing number and account number – How does it work? You provide your routing / account number to a payer; the payer then provides this information to his/her bank and asks the bank to make a payment. The payer notifies the MSA Office (normally via an Electronic Remittance Advice (ERA)) that a direct payment is forthcoming Funds appear at the Treasury which then sends a SF 215 Deposit Ticket to your DFAS (via CA$HLINK II) MSA personnel post the payments using the ERA info DFAS applies the deposit against your LOA using the electronic DD 1131 that you provide. 22 Large payers who will use REX include: AETNA, MailHandlers, Foreign Service Benefit Plan, UnitedHealthcare, Veterans Affairs, and the U.S. Treasury’s Treasury Offset Program (TOP). Expect this list to grow.

23 REX REX CA$HLINK II SF 215 report: 23

24 REX / Electronic Funds Transfer (EFT) payment notification via 24 REX

25 EFT / Electronic Remittance Advice (ERA) info via Internet: 25

26 REX REX / EFT via CA$HLINK II: 26

27 Speed of Deposit / Documentation Tools Following are tools to provide a safe, fast, secure method of depositing checks, while retaining Web-based electronic records for 6+ years Products are supported in the DoD Financial Management Regulation (FMR) (see FMR Vol 5 Ch 24) 27

28 Get Rid of the Paper Checks & Cash on Hand With Paper Check Conversion – Over the Counter (PCC OTC) / Over the Counter Net (OTCNet): – The MSA Office receives paper checks (thru the mail or in person) – The payment is posted in CHCS (at any point you choose) – The check is sent thru your Treasury-provided check scanner for scanning / upload / deposit. (Within 14 days, you must either return the check to the patient or shred it) – Treasury processes the check(s) (normally as a batch) and then sends a SF 215 Deposit Ticket to your DFAS (via CA$HLINK II) – DFAS applies the deposit against your LOA using the electronic DD 1131 that you provide Also, you may deposit cash by exchanging it for a cashier’s check (at your community bank), and then uploading it via PCC OTC Note: Beginning in Mar 2011, PCC OTC is being replaced by OTCNet. OTCNet is 100% Web-based and does not require software to be installed on your network (this means that, normally, you will not need an Authority to Operate (ATO) for OTCNet) Note: PCC OTC use requires purchase of a check scanner; appx cost < $1,000 28

29 PCC OTC 29 No personal info on this screen – simulated data. PCC OTC Hardware / Scanning Software:

30 PCC OTC 30 PCC OTC Batch Upload Summary: No personal info on this screen – simulated data.

31 PCC OTC 31 PCC OTC SF 215 Report: No personal info on this screen – simulated data.

32 PCC OTC 32 Copy of check / info from the U.S. Treasury’s Web site (available for 6+ years): No personal info on this screen – simulated data.

33 Faster Insurance Claims Submission Instead of paper / mail filing of your insurance claims, electronically file them (some of these services may cost to use) Records are automatically kept electronically on commercial Web-based servers for a minimum of several years Before using these services, review Service policies and Assistant Secretary of Defense (Networks and Information Integration) Directive-Type Memorandum (DTM) (Security of Unclassified DoD Information on Non-DoD Information Systems) 33

34 Medical Insurance Claims Clearinghouse Filing of insurance claims via paper is slow and provides very little ability to prove/verify delivery to a health insurer / insurance claims payer. Errors may not be discovered for weeks or months Commercial vendors have powerful Web-based systems that allow for hospitals / providers to enter medical claims data directly into the servers of medical claims clearinghouses – From there, the clearinghouse electronically delivers the claim to the payer (normally, delivery to the health insurer occurs within 24 hours of the claim data being entered by MSA personnel) Commercial clearinghouses offer the following advantages: – Direct data entry (prepare, and electronically file, your claim in less time than you used to spend in just preparing, printing and putting your paper claims into the mailbox) – Verified ‘proof’ of claims delivery – Fast delivery of claims – Instant verification of claim for correct usage of CPT/ICD-9 code / other data – Ability to quickly resubmit / modify previously submitted claims – Electronic/online storage of claims data (at least several years of data) – Powerful tools to sort claims by patient, claims status, dates of service, payer, etc. – Online download of EOB/ERA data (for some payers) Note: Most clearinghouses require a paid subscription, although some provide the service for no cost. Often, costs (if any) can be justified by postage savings alone. Briefer does not endorse any specific service 34

35 Medical Insurance Claims Clearinghouse 35

36 Medical Insurance Claims Clearinghouse 36

37 Medical Insurance Claims Clearinghouse 37

38 Consolidated Invoicing Perform more easily understood consolidated billing for your MSA pay patients As per Assistant Secretary of Defense (Health Affairs) policy , MTFs are not restricted to using the CHCS MSA module (or its standard I&Rs) for billing. As allowed by Service policy, MTFs may use alternate solutions 38

39 Consolidated Invoicing The Consolidated Invoice is a locally written ad hoc that USNH Naples uses in lieu of all follow-on individual acct invoices. The Consolidated Invoice pulls data from all accounts under the specified sponsor and produces a mail-ready report that provides/lists: – Mailing insert (for window envelopes), incl address field, statement of requirement to pay, methods of payment – Sponsor name – Patient name (repeating for all patients under the sponsor) – Type of acct (user chooses ‘All’, or just ‘O’, ‘Z’, ‘P’, etc., or a combination of acct types) – Acct number – Date of service – Total charges – Payment / charge calculation history, incl payment date, payment amount, payment type, check number – Remarks field (used primarily to indicate insurance filing/processing status) The Consolidated Invoice does not contain: – Social Security numbers – Medical information 39

40 Consolidated Invoicing USNH Naples uses the Consolidated Invoice as follows: – Original invoices are still sent to the sponsor after producing (and being verified) from the nightly run. Unless requested by the patient, this invoice will not be mailed again – patients are asked to keep the original invoice for future reference (greatly reduced chance of mis- mailing HIPAA-protected info!). For patients who have provided their insurance information to the MSA Office, invoices are stamped ‘Information Copy – Health Insurer will be billed.’ The invoice Remarks field is annotated as ‘PEND’ to indicate that this invoice is still pending processing by the health insurer – After completing insurance processing, the invoice Remarks field is annotated as ‘DUE’ to indicate that insurance patients should now pay any remaining balance For patients who have not provided insurance information to the MSA Office, the invoice is mailed to the patient for payment. The invoice Remarks field is annotated as ‘DUE’ to indicate that this invoice should be paid – Once per month, each patient with an open balance (on any acct under their sponsorship) is mailed the Consolidated Invoice Other than mailing of the original invoice, this is the only mailing to the sponsor that occurs (an average mailing reduction to patients of 60%) Since the Consolidated Invoice goes out monthly, Delinquent Letters are no longer printed/sent – On request (such as income tax filing season, Flexible Savings Account filing, or PCS checkout), MSA personnel simply print the entire Consolidated Invoice for the patient to reference (provides a single document that historically lists all (open, closed, pending, etc.) acct/payment information under a sponsor) 40

41 Consolidated Invoice – Mail Insert / Payment Methods 41

42 Consolidated Invoice – Monthly Mailing / ‘O’ Accts Simulated data only – no personal information included 42

43 Consolidated Invoice – All Accts 43 Simulated data only – no personal information included

44 Bad Debt / Involuntary Collections Pay patients are seen on a cost-reimbursable basis (using rates published for their registered PatCat). As such, all patients are expected to pay 100% of all validly produced charges Following are tools to provide methods of involuntary collecting from persons who do not pay / are considered bad debtors Following programs are supported by the DoD Financial Management Regulation (FMR) Vol 5 Ch 28 (Management and Collection of Individual Debt); coordinate use of these tools with your Service and/or DFAS policy 44

45 Involuntary Garnishment – DoD Employees From a CHCS-system generated invoice – – “Payment of this bill is due upon receipt. You may inspect and copy government records related to this debt to the United States and question its validity or accuracy. If payment is not received for this debt within 30 days of hospital discharge or outpatient date of service, your account is subject to referral to higher authority for collection action, involuntary pay checkage (if you or your spouse is a federal employee), and referral to your employer.” For persons employed by the Dept of Defense (and paid thru the Defense Civilian Pay System (DCPS) (mostly includes just DoD appropriated-fund employees), you may collect involuntarily by: – Sending the employee an invoice / demand letter If the patient disputes the invoice, follow your MTF’s dispute procedures – If the patient does not respond, after 30 days, prepare a DD2481 (Request for Salary Offset). Attach a listing of accts / amounts due for each acct (ensure to check block 4.b -- “EMPLOYEE DID NOT RESPOND (Consent assumed)”) Note: As per the FMR, the Federal Claims Collection Standard (FCCS) only requires that 1 demand letter be submitted to a debtor – Submit the DD2481 (and listing of accts) electronically to DFAS ( listed at the end of this brief) (coordinate with DFAS regarding specific format issues before submitting actual DD2481s) – For patients who have their pay garnished, those funds are directly applied to the LOA that you provide 45

46 Final Notice Prior to DD2481 / TOP 46

47 DD 2481 Attachment (either a typed list or printout of the CLK accts summary page): 47

48 U.S. Treasury’s Treasury Offset Program (TOP) Delinquent debts are transferred to DFAS for further collection actions. This works well for DoD Civil Servants, but what about: – Non-DoD Civil Servants, – Contractors, – Civilian emergency patients? Debt Collection Improvement Act (DCIA) of 1996: – The DCIA mandates that all Federal agencies refer all legally enforceable, nontax debts more than 180 days old to the U.S. Treasury for administrative offset (thru the TOP) Referral to TOP: This may / may not be occurring by DFAS (if you submit the debt to DFAS’ out-of-service debt office). In coordination with Service/DFAS policies, MTFs may refer debts on their own behalf How does it work? TOP identifies debtors who are receiving Federal payment(s) (salary, income tax refund, etc) and then levies/offsets those payment(s) Where does a TOP levy go? Collected funds are transferred to your hospital via your Credit Gateway/REX account 48

49 U.S. Treasury’s Treasury Offset Program (TOP) Adding a debt to the TOP database: No personal info on this screen – simulated data. 49

50 Finding patients who are being offset: No personal info on this screen. 50 U.S. Treasury’s Treasury Offset Program (TOP)

51 Finding TOP payment info from CA$HLINK II (REX): No personal info on this screen. 51 U.S. Treasury’s Treasury Offset Program (TOP)

52 eCollections / eDeposits / ePayments Contacts Pay.gov: or Credit Gateway/REX: or PCC OTC: TOP: CA$HLINK II: or DFAS (process DD 1131s) (Navy): DFAS (process DD 2481s): Consolidated Invoice Ad hoc: (do not contact directly – contact thru your SAIC CHCS mgr) AETNA (ERA/EFT payments): MailHandlers / Foreign Service Benefit Plan (ERA/EFT payments): 52

53 Summary You can easily transition from current methods of billing / collecting / depositing funds at your MTF These methods / processes can do for you: – Patients happier as invoices progress thru the insurance process faster – Patients happier with a single consolidated invoice – Happier patients (who more easily understand, and remember their bills) pay your MTF faster – Faster payments means fewer open accounts / smaller AR – Smaller AR means more time to work on problem accts / less need for addl staff / longer lunch hours for the MSA staff … – eCollections mean less risk for loss of funds / less cash on hand – Less mail / paper (check log, paper checks, EOBs) – Faster transfer of funds to your LOA – Greater accountability of previous transactions – Easier records searches – Less reliance on Finance Office hours of operations / deposit rules (deposit funds 24/7 as you wish) 53


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