1. 2010 UBO/UBU Conference Health Budgets & Financial Policy 1 Briefing: Foreign Military Billing Date: 23 March 2010 Time: 1400 – 1450

2. 2010 UBO/UBU Conference Turning Knowledge Into Action Objectives Help UBO MSA staff better understand how to bill foreign military members and their dependents – UBO MSA perspective Identify and discuss some important issues Provide ideas for improved performance Share helpful references for future use 2

3. 2010 UBO/UBU Conference Turning Knowledge Into Action Overview Presentation limited to the billing of care provided to foreign military and their dependents at DoD Military Treatment Facilities (MTFs) Excludes the issue of access to care at MTFs Does not include the issue of care provided at civilian treatment facilities 3

4. 2010 UBO/UBU Conference Turning Knowledge Into Action 4 Foreign Military Programs/Agreements Programs Include: – International Military Education and Training (IMET) – Foreign Military Sales (FMS) – NATO Status of Forces Agreements (NATO SOFA) – Partnership for Peace (PFP) with a Status Of Forces Agreement (PFP SOFA) – Reciprocal Health Care Agreements (RHCA) – Acquisition & Cross Servicing Agreements (ACSA)

5. 2010 UBO/UBU Conference Turning Knowledge Into Action Getting Started In the not so distant past, foreign military were not enrolled in DEERS Now…Foreign Military Members and dependents automatically enrolled in DEERS upon application and/or receipt of New ID Card – DEERS assigns Foreign Identification Number (FIN) in lieu of a Social Security Number – FIN used for foreign military, foreign nationals, and their eligible family members 5

6. 2010 UBO/UBU Conference Turning Knowledge Into Action Administrative Practices Coordinating with TRICARE Office or assigned office at your facility – Foreign Military Registration Card Verifying country of foreign military member Notation of Country in CHCS Collecting Invitational Travel Orders (ITO) – Tells you where they’re from, what they’re authorized, & financial responsibility for health care of dependents Communicating with Schools 6

7. 2010 UBO/UBU Conference Turning Knowledge Into Action Foreign Military Registration Card 7

8. 2010 UBO/UBU Conference Turning Knowledge Into Action Challenges Perceived inconsistency of training in Foreign Military Billing throughout the Military Healthcare System – No guidance on reading ITOs Billing for reimbursement of care provided difficult due to lack of appropriate PATCAT information – Often difficult in getting appropriate personnel to make appropriate PATCAT corrections Some 60 counties currently covered by healthcare agreements with DoD – Agreements expiring and being renegotiated 8

9. 2010 UBO/UBU Conference Turning Knowledge Into Action Points to Acknowledge on ITO Country Program type Demographic Information Beginning/End date of reporting time Conditions: IMS, FMS, IMET Family Member Information and Amendments 9

10. 2010 UBO/UBU Conference Turning Knowledge Into Action 10 Billing Form Options I&R: Invoice and Receipt IMET Students FMS Dependents Embassies UB-04: Prepared for whomever requests billing on this form

11. 2010 UBO/UBU Conference Turning Knowledge Into Action Reciprocal Health Care Agreements 11 CountryTerminationStatus ArgentinaJanuary 24, 2010Current BoliviaSeptember 13, 2007Expired CanadaMay 03, 2007Expired ChileOctober 03, 2010Current ColombiaApril 08, 2005Expired Dominican RepublicJune 30, 2012Current EcuadorSeptember 18, 2009Current El SalvadorMarch 16, 2011Current GeorgiaFebruary 20, 2011Current GermanyJuly 07, 2007Expired GuatemalaMarch 20, 2010Current HondurasFebruary 10, 2012Current MexicoMarch 26, 2011Current PeruAugust 31, 2012Current RomaniaApril 25, 2007Expired TunisiaJuly 31, 2012Current UkraineJuly 08, 2012Current United KingdomOctober 31, 2014Current UruguaySeptember 18, 2012Current VenezuelaSeptember 22, 2003Expired - no renewal in progress* References DoD Dental Care for Foreign Force Members Quick Reference Guide (as of 22 July 2009) DoD Dental Care for Dependents of Foreign Force Members Quick Reference Guide (as of 22 July 2009) DoD Medical Care for Foreign Force Members Quick Reference Guide (as of 06 Jan 2009) DoD Medical Care for Dependents of Foreign Force Members Quick Reference Guide (as of 06 Jan 2009) NATO Member Countries Euro-Atlantic Partnership Council (EAPC) Member Countries References Relating to Health Care for Foreign Force Members References

12. 2010 UBO/UBU Conference Turning Knowledge Into Action 12 References

13. 2010 UBO/UBU Conference Turning Knowledge Into Action Lessons Learned Along the Way DOD Reference sheet and CHCS PATCATs not in alignment – CHCS does not always generate FRR bills and Ins co. does not accept DD7 billings More foreign military now carry health insurance – CHCS does not allow the input of insurance for this category of patient – Collect a DD2569 on patient regardless of duty status – Subsistence rate has not been updated for active duty since Congress stopped charges for U.S. Active Duty – Traveler’s Insurance – Patients do not understand medical billing in the U.S. – Embassies are moving away from paper checks 13

14. 2010 UBO/UBU Conference Turning Knowledge Into Action Daily Challenges – Make CHCS Work for You 14 DEERS TRICARE Standard issues

15. 2010 UBO/UBU Conference Turning Knowledge Into Action Country Code, Case ID, and Case Line When using sales code 73 address cannot be built without country, case & line. Reference DFAS--DE 7077.2-M 13.6 & 13.8 Country Code Criteria: Main country code (i.e., for Italy, use IT for the Country Code criteria) Case ID and Case Line: The Case ID and Case Line is a programmed number for the training – Example: Italy, Country Code: IT Pseudo Country Code: S4 Case ID: TEY Case Line: 001 The ITO number will have the 2 character main country code at the beginning of the ITO Number and the 2 character country code at the end of the ITO Number. (i.e. ITO#: ITPTEY0012000S4) 15

16. 2010 UBO/UBU Conference Turning Knowledge Into Action Example of Address Line Request 16 Country/Case/Line code is available on the ITO or is obtained from the Foreign Liaison Officer

17. 2010 UBO/UBU Conference Turning Knowledge Into Action Helpful Hints Know who gets the bill and how you get your money – Air Force Security Assistance Center (AFSAC) (pays the MTF directly) – Air Force Security Training (AFSAT) (pays Air Staff…but does not notify MTF when they have processed the bill for payment) – Embassy (pays by check or electronic method) Herschel Hughes (Indianapolis DFAS) at DSN 699-8821. Herschel.hughes@dfas.mil (establishing electronic account) Herschel.hughes@dfas.mil – Insurance company (how to get the bills to the Hub since encounters do not flow to TPOCS) Work with GSUs to obtain listing of their foreign military Keep track of when member is leaving the country Establish working relationship with FLO-Coordinators 17

18. 2010 UBO/UBU Conference Turning Knowledge Into Action Helpful Hints (Cont’d) Recommendation: Pull M2 query and perform 100% audit on foreign military being seen in your facility – Validate billing requirements Work with Beneficiary Services to clarify PATCATS and billable services (they are human too and mistakes can easily happen) Identify billing issues to your service representative Audit at least quarterly! Work MSA accounts monthly to stay on top of open foreign military accounts 18

19. 2010 UBO/UBU Conference Turning Knowledge Into Action Web Sites/References 19 http://www.armymedicine.army.mil/hc/ip/medical- eligibility.htm http://www.armymedicine.army.mil/hc/ip/medical- eligibility.htm https://private.fhp.osd.mil/portal/rhas.jsp http://www.armymedicine.army.mil/hc/ip/reciprocal.htm http://www.embassiesabroad.com/ International Military Students & Medical Care Desk Top Guide

20. 2010 UBO/UBU Conference Turning Knowledge Into Action 20 Questions & Answers Thank you for attending our presentation today. Are there any Questions?