Financial Statements & Accounting Data WELCOME With TMA for 6 years As a GOVERNMENT EMPLOYEE Twelve (12) years as an IT consultant supporting MHS TMA Office of the Chief Financial Officer (OCFO) Management Control & Financial Studies Division

Outline Financial Statement Reporting Requirement Legacy Accounting Systems Medical Accounts Receivable (A/R) Overview of Presentation Financial Statement – how structured for TMA and the Service Medical Departments Issue of accounting for Medical Accounts receivable – What Are They and Why We Need to Account for Them Review of an Internet-Based Tool available for MTF use in Planning

Fiscal Management Requirements CFO Act of 1990: Integrated Financial Management (FM) systems supporting DoD accounting needs are key to effective financial management Federal Financial Management Improvement Act (FFMIA) of 1996: All Federal agencies to comply Implement/maintain systems that meet Federal FM system requirements (Joint Financial Management Improvement Program (JFMIP)) Support Federal accounting standards (Federal Accounting Standards Advisory Board (FASAB)) Apply US Standard General Ledger (USSGL) at the transaction level Proposed FY 2011 Presidential Budget requested $548.9 billion plus an additional $159.3 billion for overseas contingency operations (OCO) – formerly was GWOT (Global War on Terrorism) Total of $708.2 Billion Requested – How well does DoD spend their funds and what did we get for them? Independent auditor's declaration that he or she has no reservation in certifying that the audited firm's financial statements (1) adequately disclose material information, (2) present fairly its financial position, and (3) show results of its operations in conformity with the provisions GAAP. Also called clean opinion.

MHS Financial Statement Reporting Entities (FSREs) Financial Statements MHS Financial Statement Reporting Entities (FSREs) MHS MERHCF 1 DHP 3 MILCON 3 TRICARE Mgmt. Activity (TMA) Service Medical Activity (SMA) The Services have been reporting their financial statements for several years. Needed to separate out healthcare financial and accounting numbers. Service Medical Activity (SMA) for each of the three Services were created to be able to account for healthcare financial numbers separately Potentially, JTF CapMed may become a fourth SMA FSRE Components Under Audit – Qualified Opinion for MERHCF & CRM TMA - FOD TMA – CRM 1 TMA-USUHS 2 SMA – Army (MEDCOM) 4 (USACE) 5 SMA – Navy (BUMED) 4 (NAVFAC) 5 SMA – Air Force (AFMS) 4 (USAFE) 5 MERHCF: Medicare-Eligible Retiree Health Care Fund DHP: Defense Health Program Appropriation MILCON: Military Construction Appropriation FOD: Financial Operations Division CRM: Contract Resource Management USUHS: Uniformed Services University MEDCOM: Army Medical Command BUMED: Navy Bureau of Medicine and Surgery AFMS: Air Force Medical Service USACE: U.S. Army Corps of Engineers NAVFAC: Naval Facilities Engineering Command USAFE: U.S. Air Forces in Europe (1) Under Audit (2) All Proprietary Statements Validation Through Examination In Process (3) Includes American Recovery and Reinvestment Act (ARRA) Funding (4) Executes DHP Funds (5) Executes MILCON Funds

Accounting Data FSRE Legacy Enterprise Business Rules Command Control TMA WAAS DAI USUHS CUFS Army STANFINS GFEBS Navy STARS-FL Navy ERP Air Force GAFS-R DEAMS Multitude of accounting systems Breakout with the acronyms spelled out for the accounting systems supporting us CUFS – College and University Financial System

Accounting System Acronyms CUFS – College and University Financial System DAI – Defense Agency Initiative DEAMS – Defense Enterprise Accounting and Management System FSRE – Financial Statement Reporting Entities GAFS-R – General Accounting Financial System - Revised GFEBS – General Fund Enterprise Business System STANFINS – Standard Army Finance Information System STARS-FL – Standard Accounting and Reporting System - Field Level TMA – TRICARE Management Activity USUHS – Uniformed Services University of the Health Sciences WAAS – Washington Headquarters Services (WHS) Allotment Accounting System

Fiscal Management Requirements Office of Management & Budget (OMB) Use commercial off-the-shelf (COTS) JFMIP-certified software for replacement of core FM systems (OMB Circular A-127) New Service FM COTS are JFMIP-certified Army – General Fund Enterprise Business System (GFEBS) SAP COTS Navy – Navy Enterprise Resource Planning (ERP) Oracle COTS Air Force – Defense Enterprise Accounting and Management System (DEAMS) General Fund Enterprise Business System, or GFEBS, is a web-based enterprise resource planning solution built on SAP

What is SFIS? Standard Financial Information Structure (SFIS) A comprehensive, standard “business language” that defines financial information that supports all DoD-wide budget, cost/performance management, and external reporting requirements SFIS is NOT an IT system http://www.defenselink.mil/dbt/sfis_resources.html

Financial Statements FSRE Structure Challenges TMA clear chain of command and organizational structure MERHCF actuarial and accounting information SMA components have two lines of authority (command and control, and finance business rules) vs dollar flow. Face issues related to MILDEP priorities vs fund flow priorities: financial impact, accounting system, financial business rules

Financial Statements FSRE Structure Challenges (continued) Solution: single accounting system with common business rules and chain of command simplifies, streamlines the financial statement, financial reporting, financial performance reporting

Budget Execution - O&M As of 30 June 2010

Budget Execution - O&M As of 30 June 2010

Budget Execution Performance-O&M As of 30 June 2010

Budget Execution Performance-O&M As of 30 June 2010

Budget Execution – RDT&E As of 30 June 2010

Budget Execution – RDT&E As of 30 June 2010

Budget Execution Performance-RDT&E As of 30 June 2010

Budget Execution Performance-RDT&E As of 30 June 2010

Budget Execution - Procurement As of 30 June 2010

Budget Execution – Procurement As of 30 June 2010

Budget Execution Performance – Procurement As of 30 June 2010

Budget Execution Performance – Procurement As of 30 June 2010

Financial Metrics Monthly Reporting, History and Measures Accounts Receivable (A/R) Public debt > 30 days at Sep 30, 2009 (Red Metric) SMA-Army ($22.5 million) A/R Intragovernmental Debt > 30 days at Sep 30, 2009 (Red Metric) SMA-Army ($17.7 million) SMA Navy ($17.3 million) SMA A/R increased dramatically in 1st Qtr FY 2010 when recording begins OSD Comptroller – Robert Hale gets a monthly Dashboard Report showing how DoD is doing regarding financial reporting One of the items tracked is Accounts Receivable (A/R) Public Debt – Non-Federal Government Entities who owe us money. Includes third party insurance companies and individuals (e.g., DoDDS school teachers, Civilian Emergencies) Medical Departments were NOT reporting Medical A/R until the start of this FY (i.e., FY 2010)

DoD References DoD Financial Management Regulation (FMR), Volume 4, Chapter 3, “Receivables” dated November 2009 DoD Financial Management Regulation (FMR), Volume 6B, Chapter 10, “Notes to Financial Statements” dated September 2008 Located at OSD (Comptroller) Web site: http://www.defenselink.mil/comptroller/fmr/ FMR has 20 volumes – It’s our FINANCIAL BIBLE Sections of it are continually being updated so go to the OSD (Comptroller) website to find the latest version Looking at having the Receivables section revised to treatment Medical A/R differently

Accounts Receivable (A/R) Two types of A/R in governmental accounting Intra-governmental (e.g., Coast Guard, VA) Expect to get paid 100% of Billed Amount Disputes regarding claims against other federal agencies (e.g., Coast Guard, VA) are to be resolved per Code of Federal Regulations 4 CFR 101 Public (civilian emergencies, TPC) Need to establish an allowance for bad debt MTFs may be reporting collections to higher headquarters but what data is reported regarding outstanding and aged (e.g., >30 days, >120 days) Medical A/R? Just a quick review of the two types of A/R and how they are treated differently when it comes to establishing Allowances for Bad Debt. Expect to have VA and Coast Guard to Pay us in Full – 100%

Third Party Collections Total Third Party Collections (TPC) Billings were in FY 2009 were $496.0 million Total TPC Collections in FY 2009 were $240.7 million How much is really being written off as uncollectible, and how much is still on the books as Medical A/R? What are the sources of Medical A/R? Collected almost $2.5 Billion ($2.443.2 Billion) since FY 1987

Medical Services Account (MSA) Combination of both Intra-governmental A/R (e.g., Coast Guard, VA) and Public A/R (e.g., civilian emergencies) Total MSA amount collected for medical care provided in MTFs for FY 2009 was $151 million

Medical Affirmative Claims (MAC) Medical Affirmative Claims (MAC) A/R is all Public A/R (e.g., insurance companies, liable individuals) Total amount collected for medical care provided in MTFs for FY 2009 was $15 million

Doubtful Accounts & Write-offs FMR guidance states: The accounting office shall establish an allowance for doubtful debt, which shall provide for reducing gross receivables by the amount of the estimated loss to their net realizable value A write-off occurs when an agency official determines, after using all appropriate collection tools, that is it more than 50% likely that a debt is uncollectible

Service Financial Statements A/R are reported on the annual audited financial statements Service Financial Statements located at OSD(Comptroller) Web site: http://www.dod.mil/comptroller/cfs/fy2009.html

Accounts Receivable - Policy Accounts Receivable Policy Memorandum (with attachment) Policy signed on May 8, 2008 Purpose Establish policy for the recognition (“as rendered”), classification, recording, aging, collection, disposition and reporting of accounts receivable in order to improve the accuracy of financial statements Compliance with DoD’s Financial Management Regulation (FMR) and Generally Accepted Accounting Principles (GAAP) Policy signed back in 2008. Delays encountered in implementing it due to IT system limitations. 1st quarter FY 2010 (current FY) is when this started being implemented across all three Services.

Accounts Receivable – Policy (con’t) Implementation Date 1 October 2009 (for FY 2010 reporting purposes) Title 10 United States Code, Chapter 55, Section 1095 This policy does not modify the ability of the Services to use monies collected in the fiscal year collected 10 U.S.C. 1095(g) reads as follows: "Amounts collected under this section from a third-party payer or under any other provision of law from any other payer for health care services provided at or through a facility of the uniformed services shall be credited to the appropriation supporting the maintenance and operation of the facility and shall not be taken into consideration in establishing the operating budget of the facility." Bottom Line – Money collected stays with the MTF. It is not scooped up and taken away by Higher Headquarters.

Financial Metrics - SMA Implementation of Medical A/R Policy in 1st Quarter of FY 2010 had a large impact Accounts Receivable (A/R) Public Debt > 30 days at July 31, 2010 (Red Metric) SMA-Army ($213.9 million), SMA-Navy ($5.6 million) SMA-Air Force ($ 78.0 million) Total reported Medical A/R was $527.9 million Army reported $22.5 million of Medical A/R as of 30 Sep 2009/end of FY 2009 Navy & Air Force reported ZERO DOLLARS for Medical A/R Suddenly, we found over ½ billion dollars of assets

Financial Metrics -TMA Implementation of MARR A/R in 4th Quarter of FY 2009 had a large impact Accounts Receivable (A/R) Public debt > 30 days at Mar 31, 2010 (Red Metric) TMA-CRM ($175.0 million) Army reported $22.5 million of Medical A/R as of 30 Sep 2009/end of FY 2009 Navy & Air Force reported ZERO DOLLARS for Medical A/R Suddenly, we found over ½ billion dollars of assets

Management of Accounts Receivable Revenue Recognition All Defense Health Program (DHP) funded activities will recognize and record a receivable when it establishes a claim based on goods or services provided (“as rendered”) Financial statements have two A/R classifications: Intragovernmental and Nonfederal (public) Debt Management (Debt Collection Improvement Act (DCIA) Working with OUSD(C) to potentially add language to the FMR to better clarify medical debt and when to “turn-it over” to DFAS Can’t bill for the healthcare services until the encounter/admission is coded/DRG assigned. Why does it take so long to code/assign a DRG to a healthcare encounter when we having reimbursement riding on it 3% of Non-Active Duty Admissions are Reimbursable

Management of Accounts Receivable (continued) Proprietary vs. Budgetary Recommended accounting entries are: Debit USSGL 1310 (Accounts Receivable) and credit USSGL 6790 (Other Expenses Not Requiring Budgetary Resources) This will ensure a correct financial statement entry without the potential for a appropriation violation and maintain USC 1095 flexibility

Accounts Receivable - Revenue Recognition All Defense Health Program (DHP) funded activities will recognize and record a receivable when it establishes a claim based on goods or services provided (“as rendered”) There are two classifications of accounts receivables: Intragovernmental Nonfederal

Accounts Receivable - Going Forward Accuracy in reporting Accounts receivable reports will be better than what we have now Reports will include aging data Visibility of all accounts (including TPC accounts receivable older than prior year 2) Will become more accurate as procedures, systems and data collection become more standardized Central reporting will improve as funded systems change request have been submitted to: “Push” accounts receivable data from TPOCS and CHCS/AHLTA (both MSA and inpatient TPC), and Calculate interest in both MSA and TPOCS Medical A/R is NOT LIKE WINE OR CHEESE – They do NOT get better with age

Accounts Receivable - Going Forward Do not want to impact ability for billing contractors to develop and/or use their own billing management system Possibility of accounts marked as transferred in MSA, but documentation never forwarded to the Defense Finance and Accounting Services (DFAS) Support Center Some joint ventures are generating Department of Veterans Affairs bills on Excel spread sheets Air Force has TPC being performed by Two (2) civilian companies

Accounting System – Going Forward SMA Audit Committee will work with the SMA – Army, SMA – Navy, and SMA – Air Force to establish procedures for recording AR Provide your UBO Service Manager and Service RM monthly AR data in the following categories: Intragovernmental MSA, TPOCS, Unbilled, changes to Allowance Nonfederal

Accounts Receivable Service Points of Contact Army – Navy – Air Force –

Outline Financial Statement Reporting Requirement Legacy Accounting Systems Medical Accounts Receivable (A/R)

Questions? TMA OCFO/MC&FS Served as UBO Program Manager from 1 July 2008 to 5 July 2009 New UBO Program Manager & Deputy Program Manager Let us know what your questions are?