1. Palo Alto’s Work to Improve Tricare Billing Process
VA Palo Alto Health Care System
Business Office
Presenters
Jean Parsons
Sharlene Del Rosario
Li Cai

2. OVERVIEW
Tricare Billing Process
Changes
Future Projects

3. TRICARE BILLING PROCESS
Work closely with A&E on identifying Active Duty patients
TBI, SCI, Blind Rehab, and PTSD admission coordinators as well as Polytrauma Network Site staff notifies UR when an Active Duty patient will be transferring to facility or receiving outpatient care
Insurance Verification verify and load Tricare policy
UR obtains authorization and reviews discharge summary to determine rates for billing

4. ESTABLISHING CLAIMS Check patient insurance
Check IR for UR comments/authorizations
Check PTF to see if it is closed
Check patient bed section
Start bill
Identify rates to bill (DRG vs. Reasonable Charges vs. Pier Diem vs. CMAC)
Use of specific Revenue Codes associated with bed sections
Send claims electronically.

5. CHANGES
Implemented changes identified through Sharing Office/Tricare/CBO site visit in June 2008
Entering in all Tricare insurance policies
UR Nurses/staff use VIS and/or Tricare website to determine status of patient
Accounting Technicians obtains Auths on prosthetics for inpatient Active Duty DoD
UR reviews discharges daily and forwards to Coding
PTSD sends information to UR on pending Active Duty admissions
Used to not have the electronic billing process. Used to have to drop everything to paper.
- Contract to bill RXs to Express Scripts – Only 6 facilities are on this contract
- UR reviews discharges on a daily basis to forward to Coding – before it was done on a monthly basis
- UR Nurses uses VIS to determine status of patient – have noticed that a lot of Active Duty patients were being marked as Combat Vet

6. CHANGES Continued… Adherence to per diem rates Billing Reports
Veterans with Reimbursable Insurance and Inpatient Discharge Report
SC/NSC Report (Fileman)
Electronic Billing Process
Contract to bill RXs to Express Scripts (includes Active Duty)
One dedicated AR Follow-up Staff to communicate issues to UR and Billing

7. FUTURE PROJECTS
Obtaining per diem rate for Transitional Bed (PTRP) program
UR clerical staff will follow-up on Tricare claims
Setting up e-Pharmacy for Tricare Express Scripts claims
- UR clerical staff will follow-up on Tricare claims – with current follow-up being conducted by MCCR staff many times Tricare functions were pushed aside due to MCCR claims taking priority due to set collection goals.

8. CONCLUSION
Improvement in Billing process was accomplished by establishing processes for communication with staff in the front-end and providers and Revenue Office. This improvement in communication was key in our ability to create a clean and accurate bill.