1. 2010 UBO/UBU Conference Health Budgets & Financial Policy 1 Briefing: MSA Billing & Collections for DoD Civilians Date: 24 March 2010 Time: 0900–0950

2. 2010 UBO/UBU Conference Turning Knowledge Into Action Objectives Types of MSA Billing Billing Process Collection Process Challenges with DoD Civilians 2

3. 2010 UBO/UBU Conference Turning Knowledge Into Action MSA Billing Type of Patient Civilian Emergencies DoD Civilians DoD Contractors Medicare Visitors (Family member) Daily Subsistence (TRICARE standard) Foreign Military /NATO KATUSA (Local National Military who support U.S. Army) Inter-Agency (U.S. Embassy Workers VA, PHS) 3 Type of Billing

4. 2010 UBO/UBU Conference Turning Knowledge Into Action Billing Process 1.Print bills from CHCS using the following menu path: – Nightly Processing Menu (NPM) – Print Nightly Reports (PRT) – Select Batch Invoice and Receipts 2. Sort out bills: EEC/MEC, Sports physical, Occupational Heath exam and all other exams reviewed by patient appointment history (PRAP). ICD 9 Code are V70.5 X and V70.3 3. 40% of MSA bills are EEC/MEC and other occupational exams. 4

5. 2010 UBO/UBU Conference Turning Knowledge Into Action 5 Billing Process 4. Precaution with mixed bills (PHY exam with other treatment, medication, lab or x-ray)

6. 2010 UBO/UBU Conference Turning Knowledge Into Action 6 Billing Process 5. Precaution with duplicate bills (same day visit with two or three different bills) Same day visit / Same code/ 7 different bills

7. 2010 UBO/UBU Conference Turning Knowledge Into Action 7 Same visit day/ Same code/ 7 different bills Billing Process

8. 2010 UBO/UBU Conference Turning Knowledge Into Action 8 Billing Process 6. When a bill is large, request a coding review prior to sending a claim to the insurance carrier. Ex: wart removal bill $97.38 ( but coded as wart removal $800.00)

9. 2010 UBO/UBU Conference Turning Knowledge Into Action 9 Billing Info to CMS-1500

10. 2010 UBO/UBU Conference Turning Knowledge Into Action Collection Process 1. Payment should be posted to the appropriate patient account and specify Cash (C) or Check (K and the check number) 2. Prior to posting the check, open and review the account by; – Casher Function Menu (CFM) – Casher Action Screen (CLK) – Type account # OIB – From the bottom of Main Screen: Select OIB and review what was paid/covered and what is not covered. 10

11. 2010 UBO/UBU Conference Turning Knowledge Into Action 11 PHR Example Collection Process

12. 2010 UBO/UBU Conference Turning Knowledge Into Action 12 OPE Example Collection Process

13. 2010 UBO/UBU Conference Turning Knowledge Into Action 13 RAD Example Collection Process

14. 2010 UBO/UBU Conference Turning Knowledge Into Action 14 Collection Process

15. 2010 UBO/UBU Conference Turning Knowledge Into Action 15 There is 1 PHR, 1 OPE, 4 RAD’s, and 2 LAB’s Collection Process One Account # / Mixed-up Payment

16. 2010 UBO/UBU Conference Turning Knowledge Into Action 16 Collection Process Wrong Account # / Mixed-up Payment

17. 2010 UBO/UBU Conference Turning Knowledge Into Action 17 Collection Process Wrong Account # / Mixed-up Payment

18. 2010 UBO/UBU Conference Turning Knowledge Into Action 18 MSA Payment TPC Payment Collection Process MSA / TPC Payment on One Check

19. 2010 UBO/UBU Conference Turning Knowledge Into Action 19 3. Do not send the invoice and receipt for remaining balance until all the requested claims are covered by the insurance. (If only paid office visit, wait for the other charges like LAB test, X-ray and MEDS) 4. If the personal check bounced and was returned back from DFAS, back out from the account and request payment with cash/money order from the patient. Collection Process

20. 2010 UBO/UBU Conference Turning Knowledge Into Action 20 96% of MSA bills are outpatient (Civilian Emergency in CONUS) Takes a huge amount of time to post check (Ex: $5792.96 was collected against 60 accounts that were paid. 24 accounts were not paid ) Paid : 60 accounts Not Paid: 22 accounts

21. 2010 UBO/UBU Conference Turning Knowledge Into Action Challenges with DoD Civilian PT did not provide DD 2569 information until UBO sent several delinquent letters and they request all accounts be claimed to their insurance company. Patient’s insurance policy expires and they fail to submit new insurance information. Patient’s claim they never received I&R or 1 st delinquent letter, only the final notice. 21

22. 2010 UBO/UBU Conference Turning Knowledge Into Action 22 Challenges with DoD Civilian Large number of soldiers ETS’d and obtained contractor status, yet their PAT CAT still reflects active duty Problems with civilians parents age over 65 (MEDICARE) Reservist from CONUS who participate in the Military Exercises

23. 2010 UBO/UBU Conference Turning Knowledge Into Action 23 Challenges with DoD Civilian Insurance benefits paid directly to patient. Patient denies receiving the payment and insurance denies sending explanation of benefit without patient’s consent. Large numbers of civilians request payment agreement

24. 2010 UBO/UBU Conference Turning Knowledge Into Action 24 Challenges with DoD Civilian Invalid reasons for requesting charges be excluded: – Sports physical with other symptoms – Periodic reserve physical with meds (Ex: Levitra) – Patient denies receiving meds from the pharmacy – Pick up meds for existing condition while participating in the exercise. (Ex: Synthroid) – TRICARE standard with daily substance rate

25. 2010 UBO/UBU Conference Turning Knowledge Into Action 25 Challenges with DoD Civilian Coding /Billing problems (Need Billing help desk) – Coded as unspecified exam (Ex: ICD 692.9) – Coumadin patient – Patient with alcohol abuse treatment for 5 weeks was charged a little over $500.00 instead of $16,000.00 in the states

26. 2010 UBO/UBU Conference Turning Knowledge Into Action Today We Discussed Outline Billing Problems Overseas Identify which claims are applicable Explain the collection process Dealing with different categories of civilians in an OCONUS environment 26

27. 2010 UBO/UBU Conference Turning Knowledge Into Action 27 Questions?