From Registration to Accounts Receivable – The Whole Can of Worms 2007 UBO/UBU Conference 1 Briefing: TMA UBO Initiatives Date:20 March 2007 Time:

2007 UBO/UBU Conference From Registration to Accounts Receivable 2 Objectives Describe the various TMA UBO initiatives currently underway that support MTF UBO staff Answer questions raised by attendees regarding other TMA UBO initiatives not included in these briefing slides Obtain MTF UBO staff feedback regarding suggested potential new TMA UBO initiatives that might be developed

2007 UBO/UBU Conference From Registration to Accounts Receivable 3 UB-04 and Revised CMS 1500 UB-04 paper claim form is replacing the existing UB-92 Revised CMS 1500 paper claim form has been developed Both forms mandate use of the National Provider Identifier (NPI) effective 23 May 2007 Updated DoD UBO User Guide Appendices B1 & B2 and C1 & C2 reflect the new form requirements – Information on TMA UBO Web site Providing UB-04 and Revised CMS 1500 training classes at the UBO/UBU Conference Conducted audio teleconferences on 6 & 8 March 2007 regarding the UB-04 and revised CMS 1500 paper claim forms

2007 UBO/UBU Conference From Registration to Accounts Receivable 4 CSET Version 3.0 Cosmetic Surgery Estimator Tool (CSET) Version 3.0 – TMA UBO developed a Microsoft ® Access tool for use in estimating the cost of elective cosmetic surgery – Cosmetic surgery patient pays the estimated amount before the procedure can occur – Version 3.0 will be the most current one available for use by MTFs – Replaces Version 2.0 currently in use by MTF UBOs – Version 3.0 currently in development – Will be deployed to MTF UBOs in June 2007 Service UBO Managers determine which MTFs get the CSET

2007 UBO/UBU Conference From Registration to Accounts Receivable 5 OHI Identification Pilot Department of Veterans Affairs (DVA) has an existing nationwide contract with Health Management Systems (HMS) for identifying patients with other health insurance (OHI) MTFs can use this existing DVA contract MTFs are billed $14.75 by HMS for each OHI patient identified – If MTF provides 50,000 patient names to HMS and they find just one person – contractor just gets $14.75 – Identified OHI excludes TRICARE and Medicare beneficiaries Case Study – VA VISN 1 provided HMS with 51,000 patient names and 6,000 of the patients were found to have billable insurance generating $2 million in collections —Continued—

2007 UBO/UBU Conference From Registration to Accounts Receivable 6 OHI Identification Pilot DVA contract limits MTF spending to no more than $30,000/year – Would be about 2,000 identified OHI patients North Carolina (NC) and Georgia (GA) selected as pilot locations because HMS has their most comprehensive OHI databases for those two states OHI Identification Pilot initially limited to checking non- active duty dispositions for OHI – About 15,000 non-active duty dispositions in FY 2006 – Start with identifying those encounters with the highest charges (i.e., inpatient disposition) – MTFs can use the OHI information to bill for outpatient encounters and prescriptions Womack AMC at Ft Bragg will be first pilot participant —Continued—

2007 UBO/UBU Conference From Registration to Accounts Receivable 7 OHI Identification Pilot Several steps need to be completed before the OHI Identification Pilot can begin operations – Develop a Data Use Agreement (DUA) for each participating MTF before providing HMS with patient data Require MTF commander, Service Medical CIO, and HMS to sign the DUA – Identify specific data elements that will be provided to HMS for identifying patients – Develop a method for exchanging protected health information (PHI) with HMS that meets DoD and HIPAA requirements – Establish a bill payment mechanism between participating MTFs and the DVA contracting office —Continued—

2007 UBO/UBU Conference From Registration to Accounts Receivable 8 OHI Identification Pilot Plan to track the return on investment (ROI) of the OHI Identification Pilot – What did the MTFs collect versus the cost of obtaining the OHI information plus their cost of collections? Once the OHI Identification Pilot is operating successfully, plans are to seek an increase in the DVA contract ceiling and expand its use to MTFs beyond North Carolina and Georgia Use of the OHI identification contract will provide an external benchmark of the prevalence of OHI by our beneficiaries

2007 UBO/UBU Conference From Registration to Accounts Receivable 9 Updated Pharmacy Rate Methodology Pharmacy rates deployed in August 2006 no longer used the lowest MHS unit drug cost within a Generic Sequence (as many prices above as below) Began use of the MHS median unit drug cost within a Generic Sequence Large backlash from Overseas Pay Patients due to increases in billed pharmacy prescription prices – Complained they were never given notice of the price changes TMA UBO will be providing DoDDS with information regarding pharmacy pricing updates so they can get the word out to their personnel Development of the Pharmacy Pricing Estimator Tool (PPET) for use by Pay Patients

2007 UBO/UBU Conference From Registration to Accounts Receivable 10 PPET Pharmacy Pricing Estimator Tool (PPET) Microsoft Access application that Pay Patients can use to calculate their pharmacy prescription bill prior to having their prescription filled by the MTF pharmacy Enables Pay Patients to do price comparison shopping Pay Patients enter their drug prescription name, dosage strength, and quantity into the PPET Calculated price will include the $8.00 MHS prescription dispensing fee PPET will be deployed to MTFs by June 2007 prior to deployment of the new pharmacy pricing update MTFs will make their own decisions as to where to locate the PPET for use by Pay Patients

2007 UBO/UBU Conference From Registration to Accounts Receivable 11 CY 2007 Outpatient Rates Expect rates to be available for use in July 2007 – Includes addition of a price for the new HPV vaccine ($100 per inoculation and an administration fee) Three inoculations required in the HPV series

2007 UBO/UBU Conference From Registration to Accounts Receivable 12 PATCAT Decision Tree MTF staff face a challenge in accurately assigning the 300+ Patient Categories (PATCATs) in use by the MHS Training sessions offered at the annual UBO Conference are not enough to meet the challenge of assigning the correct PATCAT TMA UBO has developed an online training course for correctly assigning PATCATs Available on 2 April 2007 at TMA University –

2007 UBO/UBU Conference From Registration to Accounts Receivable 13 TMA UBO Learning Center Teleconferences Increasing use of telecons for UBO training Recent telecons include: – TPC Metrics Reporting Introduction – Provider Specialty Code Table Update – August 2006 Rate Update – 2007 ICD-9-CM Updates – VA/DoD Health Care Resource Sharing Agreements – New Inpatient Billing Guidance and Tools to Support Billing If you missed any of these trainings – please visit the TMA UBO Web site for copies of the presentation and associated handouts /teleconferences.cfm /teleconferences.cfm

2007 UBO/UBU Conference From Registration to Accounts Receivable 14 TMA UBO Learning Center Teleconferences TPC Metrics Reporting System Introduction – 4 sessions Topics covered: – Overview of the UBO Third Party Collections Metrics Reporting System (MRS) – Basic instruction for MRS users

2007 UBO/UBU Conference From Registration to Accounts Receivable 15 TMA UBO Learning Center Teleconferences Provider Specialty Code Table Update – 6 sessions Topics covered: – Updated information regarding how provider specialty codes changed – Requested MTF UBO staff to get the briefing information into the hands of those who need it

2007 UBO/UBU Conference From Registration to Accounts Receivable 16 TMA UBO Learning Center Teleconferences August 2006 Rate Update – 4 sessions Topics covered: – Rate Table Updates – Change in Pharmacy Rate Methodology – CMAC Component File – new rates – Inpatient ASA Rate Update – MHS Helpdesk & TMA UBO Helpdesk

2007 UBO/UBU Conference From Registration to Accounts Receivable 17 TMA UBO Learning Center Teleconferences FY 2007 ICD-9-CM Updates for Outpatient Professional Services – 8 sessions Topics covered: – Updates on new FY 2007 ICD-9-CM diagnosis codes – Updates on new FY 2007 ICD-9-CM procedure codes – Guidance on who the teleconference listener should tell about these new codes

2007 UBO/UBU Conference From Registration to Accounts Receivable 18 TMA UBO Learning Center Teleconferences VA/DoD Health Care Resource Sharing Agreements – New Inpatient Billing Guidance and Tools to Support Billing – 4 sessions Topics covered: – Description of the new VA/DoD Inpatient Billing guidance – Guidance on how to use the new automated calculator to determine the billable amount of the institutional (hospitalization) component of inpatient care provided by military or DVA hospitals under the provisions of VA/DoD Health Care Resource Sharing Agreements

2007 UBO/UBU Conference From Registration to Accounts Receivable 19 National Provider Identifier (NPI) – Health care providers began applying for NPIs beginning 23 May 2005 – Health care providers, health plans, and health care clearinghouses must begin using the NPI in standard transactions NLT 23 May 2007 – Small health plans have until NLT 23 May 2008 – A 10-position numeric identifier (last digit is a check figure) – Intelligence-free number – NPI Type 1 – for health care providers who are individual human beings – NPI Type 2 – for health care organizations

2007 UBO/UBU Conference From Registration to Accounts Receivable 20 Use of NPI Type 1 In the MHS HA Policy issued 26 January 2005 regarding NPI Type 1 – – Requires “all Health Care Providers who furnish billable health care services or who may initiate and/or receive referrals must obtain an NPI Type 1” – Services are responsible for ensuring all privileged/credentialed providers (including Reserve Component) obtain and submit their NPI to the TMA designated data base/repository NLT 23 May 2007 – Service SGs have issued Memoranda of Instruction detailing Service-specific instructions

2007 UBO/UBU Conference From Registration to Accounts Receivable 21 NPI Type 1 in the MHS As of 27 February 2007, 19,711 NPI Type 1 identifiers have been entered into DMHRSi Still need an estimated 8,711 more NPI Type 1 identifiers! Only 64 days remaining until 23 May 2007 deadline

2007 UBO/UBU Conference From Registration to Accounts Receivable 22 Use of NPI Type 2 in the MHS HA Policy issued 1 August 2005 regarding NPI Type 2 – – Requires all organizational health care providers within the MHS to obtain an NPI Type 2. These include: MTFs that bill Third Party Insurers Pharmacy Dispensing Sites – The Services are responsible for ensuring all applicable organizational health care providers obtain NPI Type 2 identifiers NLT 23 May 2007

2007 UBO/UBU Conference From Registration to Accounts Receivable 23 NPI Type 2 In the MHS As of 27 February 2007 – 128 NPI Type 2 identifiers for MTFs have been entered into DMHRSi – 600 NPI Type 2 identifiers for Pharmacy Dispensing Sites have been entered into DMHRSi Only 64 days remaining until 23 May 2007 deadline

2007 UBO/UBU Conference From Registration to Accounts Receivable 24 VA/DoD DRG Rate Calculator Implements VA/DoD Inpatient Rate Agreement Uses a Microsoft Excel software program developed by TMA UBO Calculates just the institutional fee of the inpatient stay – Professional fees NOT included in the total

2007 UBO/UBU Conference From Registration to Accounts Receivable 25 Additional VA/DoD Calculators Additional VA/DoD Calculators will be developed – Inpatient Professional Calculator – Outpatient Institutional Calculator – Outpatient Professional Calculator Likely to use Microsoft Excel program for the new calculators

2007 UBO/UBU Conference From Registration to Accounts Receivable 26 MAC Tool Provide a standard software application for use by MTF UBO staff in handling Medical Affirmative Claims (MAC) Be able to generate “bills” for use by JAG Be available to track MAC claims/final bills submitted to JAG Services get information on MAC collections from the JAG but no idea as to total amounts submitted to them for collection – My JAG collected $X dollars in FY 2006 – Is that good or bad performance? – Depends on the value of claims forwarded to them Tool requirements are being developed Earliest deployment of the MAC Tracking Tool will be FY 2008

2007 UBO/UBU Conference From Registration to Accounts Receivable 27 What Else Should We Be Addressing? We’ve identified what initiatives that TMA UBO is currently working on But what are some of the other hot topics/issues that MTF UBO staff would like to see addressed by TMA UBO?

2007 UBO/UBU Conference From Registration to Accounts Receivable 28 Objectives Describe the various TMA UBO initiatives currently underway that support MTF UBO staff Answer questions raised by attendees regarding other TMA UBO initiatives not included in these briefing slides Obtain MTF UBO staff feedback regarding suggested potential new TMA UBO initiatives that might be developed

2007 UBO/UBU Conference From Registration to Accounts Receivable 29 Quiz When can my MTF start using the DVA OHI identification contract with HMS? How can Pay Patients find out in advance what their MTF pharmacy prescription will cost them? Where can I find online training on assigning the correct PATCAT? Where can I find the slides from previous TMA UBO telecons?