1. “Medically Ready Force…Ready Medical Force”
DHA Business Support Directorate: Business Tools – An Enterprise View AMSUS 2015 Annual Continuing Education Meeting 2 December Mr. Darrell Landreaux Acting Director, DHA Business Support Directorate
“Medically Ready Force…Ready Medical Force”

2. “Medically Ready Force…Ready Medical Force”
MHS Reform Goals:
Creating a more globally integrated health system – built on our battlefield successes
Driving enterprise-wide shared services; standardized clinical and business processes that produce better health and better health care
Implementing future-oriented strategies to create a better, stronger, more relevant medical force
“Medically Ready Force…Ready Medical Force”

3. “Medically Ready Force…Ready Medical Force”
DHA Vision and Mission
Vision
A joint, integrated, premier system of health, supporting those
who serve in the defense of our country.
Key Mission Aspects
A Combat Support Agency supporting the military services
Supports the delivery of integrated, affordable, and high quality health services to beneficiaries of the Military Health System (MHS)
Executes responsibility for shared services, functions, and activities of the MHS
Serves as the program manager for the TRICARE Health Plan, medical resources, and as the market manager for the National Capital Region (NCR) enhanced Multi-Service Market
Manages the execution of policy as issued by the Assistant Secretary of Defense for Health Affairs
Exercises authority, direction and control over the inpatient facilities and the subordinate clinics assigned to the DHA in the NCR Directorate.
“Medically Ready Force…Ready Medical Force”

4. Defense Health Agency Secretary of Defense
USD(P&R)
ASD(HA)
CJCS
Policy Development & Oversight
Policy Execution
Combat Support Agency Responsibilities
Defense Health Agency Director
Deputy Director Sr. Enlisted Advisor
Defense Health Agency
Director
Deputy Director Sr. Enlisted Advisor
DHA OGC
IPO
PEO DHMS
EHR Functional Champion
Chief of Staff
Special Staff
HA / DHA Liaison
Component Acquisition Executive
Communications
Innovation
Admin & Mgt
EEOO
Manpower
Comptroller
Strategic Mgt
Def Health Board
DoD/ VA PCO
Procurement
Prog Integration
Analytics
Small Business
Healthcare Operations Directorate (CMO)
Research Development & Acquisition Directorate
Health IT
Directorate (CIO)
Education & Training Directorate
Business Support Directorate
NCR Medical Directorate
TRICARE Health Plan
Advanced Development
Innovation and Advanced Technology Dev (CTO)
METC HQ
Facility Planning
Walter Reed National Military Med Center
Pharmacy
Medical Logistics
Science & Technology
Portfolio Mgmt and Customer Relations
DMRTI
Ft. Belvoir Community Hospital
Program, Budget & Execution
Clinical Support
Clinical Infrastructure Program
Infrastructure & Operations
JMESI
Joint Pathology Center
Programming
Public Health
Veterans Affairs R&D Liaison
Solution Delivery
Academic Review
& Oversight
Financial Integrity
Readiness
Information Delivery
Prof Development , Sustainment, & Prog Mgmt
Contract Resource Management
Warrior Care Program
Cyber Security
Program Integrity
Financial Management Division
Defense Health Service System (DHSS)
Business Information Management
Defense Health Clinical Systems (DHCS)

5. DHA Budget & Resource Management Shared Service
DHA Shared Services
1. Facility Planning
2. Medical Logistics
3. Health Information Technology
4. TRICARE Health Plan
5. Pharmacy
DHA Shared Services
6. Public Health
7. Contracting
8. Budget & Resource Management (B&RM)
9. Medical Education & Training
10. Medical Research, Development & Acquisition
MHS Quadruple Aim
The B&RM Shared Service promotes cost-effective use of program and budgeted funds, increased reimbursements, and improved financial transparency and utilization.
Initiatives:
Common Cost Accounting Structure (CCAS) / NCR-MD Transition to GFEBS
(2) Armed Forces Billing and Collections Utilization Solution (ABACUS)
Remote Coding
DHP Financial Audit
ICD-10 Implementation
“Medically Ready Force…Ready Medical Force”

6. Common Cost Accounting Vision
One Accounting System
One Database
The DHA requires consistent and comparable financial data across the DHP
Provides an effective approach for data collection, analysis, consolidation, mapping and storage of financial data
CCAS
Vision Dr. Woodson, ASD(HA), envisions having the MHS on one financial accounting system and database utilizing uniform accounting practices with consistent and reliable reporting.
“What is the timeline?”
Uniform Accounting
Consistent Reporting
Provides a comprehensive approach to reduce variability in cost accounting across the MHS by standardizing cost data critical to the operations across the DHP and providing additional transparency through extensions of current accounting guidance
Improved data quality and standardized reporting for leadership, audit readiness efforts, and oversight bodies
“Medically Ready Force Ready Medical Force”

7. Common Cost Accounting Framework
The CCAS Framework provides a systematic feedback loop to continually improve financial & data integrity across all relevant financial systems
Governance & Data Stewardship
MDAG
MBOG
Policy and Guidance
Standard Data
Data Quality Analysis
Financial and Performance Reporting System
(Sub-Work Group)
Data Quality Assessment
(Sub-Work Group)
Implementation Support
(Sub-Work Group)
CCAS
Working Group
Recommended System Changes & Data Mapping
Budget Structure: Budget Activity, Budget Sub Activity, and Budget Line Item
Functional Area
Budgetary Accounting
Agency Initiatives: Agency Initiative Code, Agency Program Code, Cost Breakdown Structure
DMIS Codes
Program Management
Object and Sub Object Class Codes
Product Service Codes
Cost Accounting
Data Quality Analysis
MEPRS & PB&E Reporting
Key Performance Indicators
Compliance
Validation Tables
Reduction of Manual Adjustments
“Medically Ready Force…Ready Medical Force”

8. Armed Forces Billing and Collection Utilization Solution (ABACUS)
History
Legacy Military Health System (MHS) billing systems are 18+ years old
Third Party Outpatient Collection System (TPOCS) (since mid 1990s)
Specific modules of Composite Health Care System (CHCS) (since early 1990s)
Cost recovery processes varied among the Services
In 2009 DASD (HB&FP) directed TMA (now DHA) to provide robust billing data to enable the Services to conduct billing and collections using billing solution/system of choice
Armed Forces Billing and Collection Utilization Solution (ABACUS)
Single source of financial information for the accounting of Uniform Business Office (UBO) receivables and will contain the subsidiary records that will replace the medical billing, collections and accounting functionality provided in the current Third Party Outpatient Collection System (TPOCS), Composite Health Care System (CHCS) Third Party Collection Program (TPCP) Inpatient and Medical Service Account (MSA) modules
Will provide all incidental support for the Services’ medical billing, collections, reporting and utilization services at world-wide locations
Will generate claims for all 3 MHS cost recovery programs (MSA, TPCP and Medical Affirmative Claims (MAC))
Supports billing and collections functions including denial management and interfacing with Service Systems
Initial Operating Capability expected May 2015; Full Operating Capability expected October 2015
“Medically Ready Force…Ready Medical Force”

9. Remote Coding Goals and Objectives Reduce cost-to-collect
Minimize current operational footprint
Aggregate disparate processes into core standard operating procedures
Optimize enterprise-wide performance via procedural standards
Routinely assess operational risk
Design/Deploy stringent internal controls program
Limit future negative audit findings
Improve centralized oversight into tactical operations
Enhance forecasting (both workload and demand)
Recent DoD IG Audits have resulted in numerous discrepancies with denials management and overall management of Aged A/R
Improve efficiencies across the delivery system
Explore economies of scale and strategic partnerships across industry

10. Remote Coding Alternative End-State Options
The below table describes the alternative remote coding end state options across access, technology, and management considerations. Both options are currently being evaluated for feasibility within the DHA.
Option A
Enterprise Model
(3 Phased Approach)
Initially standardizes and ultimately centralizes the remote access process through electronic workflow
Creates an SOP for the “Access” process to be followed at each MTF
Creates a single-sign on for all applications and locations through the Joint Active Directory (JAD)
Creates a queuing system used to distribute and share workload
Primary (Day to Day) Remote Coding
Develops and refines an operating model for distributing workload and sharing workload where needed across the regions and eventually the services
Develops and refines a structure for accountability and performance management across the enterprise
Backlog (Contingency) Remote Coding
DHA offers a surge support capability to augment the Services with coding resources that can remotely assist in decreasing backlog
Option B
Dedicated Model
(Single phase)
Development of standardized form with continued service specific remote access process
Creates a single-sign on for all applications and locations through the Joint Active Directory (JAD)
Primary (Day to Day) Remote Coding
Services maintain existing operating model
Backlog (Contingency) Remote Coding
DHA offers a surge support capability to augment the Services with coding resources that can remotely assist in decreasing backlog
Access
Technology
Management
“Medically Ready Force...Ready Medical Force”

11. ICD-10 Implementation Key Process Performance Areas
Services/NCR
Coding Backlog
Coding errors
Coding Accuracy
Provider Queries
Coding Hotline Tickets/Issues
Coding Staff Vacancies
TPC Backlog
TPC Rejections
Global Services Center
Trouble Tickets
Private Sector Care/TRICARE
EDI Claim Submissions:
Claim receipts (totals and by submitter)
Batch receipts (totals and by submitter)
Claim return volumes (totals and by submitter)
Batch return volumes (totals and by submitter)
Line of Business Edits (totals and by submitter)
Paper Claim Submissions:
Claim receipt volumes
Claim return volumes
Returned edits*
Claims Adjudication:
Deferral claim reports (totals and by provider)*
Denial/Rejected Report (totals and by provider)*
Point of Service (POS) paid codes increase may show an Referral matching issue
Penalties Volumes - increase may show an Authorization/Referral matching issue
 Authorizations/Referrals:
Authorization/Referral denial reports
Interface error reports HGB MSR to PGBA TNAV system
TRICARE Encounter Data (TED) Records:
TED Edit Reports (Internal and DHA)

12. Asst. Secretary of Defense
Level 0: Monitor, Assess, Mitigate and Escalate
Level 1: Analyze, Control, and Escalate
Level 2: Executive Awareness and Decision Making
Deputy Director
Defense Health Agency
Director
PDASD
Health Affairs
Asst. Secretary of Defense
MDAG
MOG/MBOG
Legend
Status Reporting
Issue Notification / Escalation
Issue Response
Chief of Staff
TRICARE Health Plan
Healthcare Operations
POC
Billing SME
Coding SME
Virtual ICD-10 Transition Ready Room
Purchased Care SME
Global Svc Center
SDD EHR Core
Purchased Care
Direct Care
Theater (JOMIS) SME
MTFs
Func.
Analytics SME
SDD Clinical Support
TRO-N
COR
TRO-S
TRO-W
TDEFIC
TOP
MCSCs
TPharm
NCR POC
Army
Navy AF
DHA
Services/Central Help Desk
HIPAA TCS&I Team:
Receive Status and Issue Notifications
Analyze and Determine Appropriate POC for Notification and/or Mitigation
Business Support
Healthcare
Operations
HIT
Ready Room Leader
Org chart of the Ready Room will be useful
Purchased Care -         Dan Davis (HCO)
SDD Clinical Support- Naomi Escoffery/Jim Marsden (HIT)
SDD EHR Core -           Annette Jurkonie/Ratan Tadiparthi (HIT)
Billing -                         DeLisa Prater (HCO)
Analytics -                     Dr. Steve Toney (HCO)
Theater -                       Sharon Moser/CDR Joe Zagame (HIT)
Coding -                       Michele Gowen/Jeanne Yoder/Ellie Omidpanah (BSD)
Global Svc Center LCDR Thomas Carter/Isaias Carillo/Stacey McFarlin (HIT)
Direct Care
NCR -                           LCDR Adam Rae/Suzanne Leach
Army -                          MAJ Michael Ace/Minerva Leal
Navy -                          David Lott/Vickie Brennan
Air Force -                    Cindy Pierson/Col Pham
DHA -                           TBD
Purchased Care
COR’s:
Steve Hellmann North COR
Jeff Trowbridge South COR
David McCloy West COR
Michael Talisnik Overseas COR
Laura Johnson TDEFIC COR
Beth Spearman Pharmacy Operations COR
Dean (Fakhrudin) Valibhai Pharmacy Clinical COR
SME’s/Analysts/Technical Reps:
Jennifer Dietz North Claims SME
Bill (William) Brush South Claims SME
Elizabeth Gibson West Technical Representative
Patsy Capra Overseas Senior Program Analyst and Technical Representative
Cheryl Griffing TDEFIC Technical Representative
Vickie Laperle TDEFIC Senior Program Analyst
Natalie Jones Pharmacy Program Analyst

13. DHP Audit Reporting Entities*
DHP
MERHCF
DHA Consolidated
SMA Consolidated *
Comptroller
CRM
USUHS
SMA Army
SMA Navy
SMA Air Force
NCR MD
O&M
PROC
RDT&E
O&M
O&M
PROC
RDT&E
Operations & Maintenance (O&M)
Procurement (PROC)
Research Dvlpmt Test & Eval. (RDT&E) (except NCR-MD)
MILCON (except NCR-MD)
Recovery Act – MILCON (except SMA-AF, NCR-MD)
Recovery Act – FSRM (except SMA-AF, NCR-MD)
The Defense Health Program (DHP) full financial statement audit excludes MERHCF and CRM
The audit is of all remaining reporting entities consolidated (aggregate) financial statements
The consolidated DHP reporting entities subject to this full financial statement audit are considered a single reporting entity to the auditor
DHP: Defense Health Agency – SMA: Service Medical Activity
SMA: Service Medical Activities
MERHCF: Medicare-Eligible Retiree Health Care Fund
CRM: Contract Resource Management
USUHS: Uniformed Services University of the Health Sciences
NCR-MD: National Capital Region-Medical Directorate : Defense Health Program Appropriation
*MERHCF and CRM are currently under a standalone full financial statement audit.

14. DHP FY15 Schedule of Budgetary Activity (SBA) Examination Overview
SBA Overview
Responsibilities
SBA Scope
What is the SBA?
OUSD(C)
Key Supporting Documents for:
Appropriated Receipts
Reimbursable Work Orders –RWO
Medical Revenue (Only SMAs)
Civilian Payroll
Contract Vendor Pay
Consumables (Only SMAs)
Internal Controls for:
RWO
Contract Vendor Pay (except NCR)
Prior Year Activity
Adjustments
Miscellaneous Transactions
Internal Controls for Appropriated Receipts
Internal Controls for Medical Revenue
Internal Controls for Contract Vendor Pay and Consumables for NCR
RWO-Performer for DHA-C and NCR
The SBA is a quarterly financial schedule that provides a cumulative view of budgetary activity. The SBA shows total budgetary resources and status of budgetary resources for the current fiscal year 2015 appropriated activity and does not include activity funded with prior year appropriations
In Scope – DHP Enterprise
Responsible for managing audit contracts and performing main liaison function with the auditors. Responsible for managing audit response tool and providing official responses to the auditors.
DHA
Responsible for providing quality assurance and guidance related to audit response utilizing subject matter experts across the business segment(s) to assist the DHP Components in responding to audit requests and to assist the auditors in understanding the business, data, and financial processes
SBA FY15 Examination
The objective of the FY15 SBA Examination is to determine additional corrective actions that can be implemented prior to the official audit of the DHP full financial statements (SBR, BS, SNC, and SNP) in FY16
The FY15 SBA Examination contract was awarded to the Independent Public Accounting (IPA) firm, Kearney & Company. They are reviewing the budget accounts, transactions, and documentation of all DHP Components for the period ending October 2014 to 31 March 2015
DHP Components
Responsible for demonstrating business processes and responding to auditor requests for interviews, source data, documentation, and reports.
Out of Scope
Lessons Learned So Far
Preparation is Key
Complete the following before testing begins:
Implement audit response process and train personnel
Validate that processes and controls are operating effectively, including corrective action plans
Organize and retain files for quick audit response
The “pilot” SBA examination has a limited scope, as identified in slide
The auditor procedures being performed during the SBA examination are slightly different than those that will be performed during the full financial statement audit.
The alternate procedures evaluate compliance with the OUSD(C) FIAR Guidance versus a full financial statement audit will evaluate compliance with Federal Generally Accepted Accounting Standards (FedGAAP)
Auditor Training
Auditors need to be educated on:
Key Processes
Internal Controls
DHP Intricacies
Well trained auditors minimize follow up questions
Audit Timeline
SBA CY 15 Audit Timeline
Full Financial
Statement Audit (SBR, BS, SNC, SNP)
Planning
Testing
Increase Communications
Internal Control
Reporting
Communication improves audit response quality and timeliness
Attend update meetings and working groups
Read and share newsletters and meeting minutes
APR
MAY
JUN
JUL
SEP
AUG
01 Oct 2015

15. DHP Audit Timeline Defense Health Program Audit Milestones:
Full Financial Statement
Audit
(On-going Annual Requirement)
SBA
Examination
FY 2015
FY 2016
FY 2017
FY 2018
Jun
Sep
Dec
Mar
Jun
Sep
Dec
Mar
Line Service / Service Provider Audit Milestones:
DFAS:
SBR Reconciliation Tool
Line Army:
Real Property
Internal Use Software
Line Army, Navy, Air Force:
Remaining Balance Sheet
Line Items
Federal agency financial statements are comprised of the following:
Management’s Discussion and Analysis [Not audited]
Basic statements and related notes [Subjected to Audit]
Required supplementary stewardship information (RSSI) [Not applicable to DHP]
Required supplementary information (RSI) [Not applicable to DHP]
The basic statements and related notes (“DHP Full Financial Statements”) that are subjected to the audit breakdown into the following:
Statement of Budgetary Resources (SBR)
Balance Sheet (BS)
Statement of Net Cost (SNC)
Statement of Changes in Net Position (SNP)
Footnotes
The DoD Financial Improvement and Audit Readiness (FIAR) strategy (a) disaggregated the basic statements and related notes into incremental audit readiness milestones, (b) established the budget focused SBR statement as the first priority, (c) created a new schedule, Schedule of Budgetary Activity (SBA), to capture and report FY 2015 transactions separately from the SBR going forward to address in the known challenges with DoD’s ability to support priory year transactions.
The success of the DHP full financial statement audit is dependent on external organizations (e.g., Line-Services and DFAS) and the timing of DHP audit success is directly related to the timing of external organization delivery on DHP audit dependencies.
Undetermined Milestones
DFAS:
Balance Sheet Reconciliations (e.g., FBWT)
Statement of Net Cost Reconciliation
U.S. SGL posting logic validation
Line Army, Navy, Air Force:
Full Financial Statement Audit

16. QUESTIONS