From Registration to Accounts Receivable – The Whole Can of Worms 2007 UBO/UBU Conference 1 Briefing: The Rest of the Worms (CMBB, CDML, GFEBS, SFIS…THISISCRAZY) Date:22 March 2007 Time:

2007 UBO/UBU Conference From Registration to Accounts Receivable 2 Objectives Provide a brief overview of various UBO-related acronyms, programs, projects, and buzzwords Answer questions raised by attendees regarding other UBO-related acronyms, programs, projects, and buzzwords Solicit feedback from attendees regarding other topics/items that TMA UBO should address in future TMA UBO educational programs and/or or newsletters

2007 UBO/UBU Conference From Registration to Accounts Receivable 3 COTS & GOTS Is not what you slept on at summer camp as a child Commercial Off-The-Shelf (COTS) system – CMBB – GE Centricity/IDX Flowcast – Lab COTS – Cerner Government Off-The-Shelf (GOTS) system – CHCS is a GOTS MHS moving to using existing COTS systems rather than spending money for developing a MHS GOTS – Adopt the use of commercial best practices in healthcare when we use COTS products

2007 UBO/UBU Conference From Registration to Accounts Receivable 4 GFEBS General Fund Enterprise Business System (GFEBS) – An Enterprise Resource Planning (ERP) system designed to replace the Standard Army Finance System (STANFINS), the Defense Joint Accounting System, and the Standard Operation and Maintenance Army Research & Development System (SOMARDS) – Uses a COTS ERP package from SAP – Requirements validation and integration is currently underway – GFEBS Release 1.3 will begin being deployed to Army MTFs in August 2008 – Deployment of GFEBS Release 1.3 to Army MTFs is currently scheduled to be completed by June 2010

2007 UBO/UBU Conference From Registration to Accounts Receivable 5 CMBB Charge Master Based Billing (CMBB) Uses Commercial Off-the-Shelf (COTS) system Systems configuration currently underway Milestone C Decision currently scheduled for July 2008 – Authorizes deployment of CMBB to 3 to 6 MTFs for “real world” operational testing – Scheduled to take 12 months Full deployment of CMBB – Begins 4 th Qtr of FY 2009 – Ends 1 st Qtr of FY 2011 – Scheduled to take 18 months

2007 UBO/UBU Conference From Registration to Accounts Receivable 6 IDX Flowcast & GE Centricity IDX is the company that developed the COTS application that was purchased for use by CMBB Flowcast is the brand name of the IDX patient accounting product that CMBB bought for use by the MHS GE Healthcare purchased IDX in 2005 and rebranded IDX Flowcast as part of their GE Centricity suite of healthcare software applications

2007 UBO/UBU Conference From Registration to Accounts Receivable 7 CDML Charge Description Master List (CDML) List of all items for which CMBB has a charge/price Usually called a Charge Description Master (CDM) in the civilian healthcare world – We call it CDML since the CDM acronym is already used for the Clinical Data Mart (CDM)

2007 UBO/UBU Conference From Registration to Accounts Receivable 8 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 – SFIS

2007 UBO/UBU Conference From Registration to Accounts Receivable 9 CSET Version 3.0 Cosmetic Surgery Estimator Tool (CSET) Version 3.0 – TMA UBO developed software 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 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 10 PPET Pharmacy Pricing Estimator Tool (PPET) Microsoft Access-based software 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 compare prices 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 Envisioned that the PPET will be located in the MTF UBO for use by pay patients

2007 UBO/UBU Conference From Registration to Accounts Receivable 11 HIPAA Health Insurance Portability and Accountability Act (HIPAA) – P.L Also known as Kennedy-Kassebaum Bill (K2) or Kassebaum-Kennedy, depending on your party affiliation – House of Representatives passed it – Senate passed it unanimously Signed into law on August 21, 1996, by President Clinton

2007 UBO/UBU Conference From Registration to Accounts Receivable 12 HIPAA Components Insurance Portability Accountability (Fraud & Abuse) Administrative Simplification

2007 UBO/UBU Conference From Registration to Accounts Receivable 13 Intents of HIPAA Administrative Simplification Reduce Paperwork Improve Efficiency of Health Systems Protect Security and Confidentiality of Electronic Health Information

2007 UBO/UBU Conference From Registration to Accounts Receivable 14 Timetable for Adoption of Standards 04/14/2003 (2004<$5M) 12/28/200011/03/1999Privacy 04/20/2005 (2006<$5M) 02/20/200308/12/1998Security 07/30/2004 (2005<$5M) 05/31/200206/16/1998National Employer Identifier 05/23/2007 (2008<$5M) 01/23/200405/07/1998National Provider Identifier 10/16/ with extension 08/17/200005/07/1998Transactions & Codes Sets Compliance Required Final Rule Publication Notice of Proposed Rule Making (NPRM) Standard

2007 UBO/UBU Conference From Registration to Accounts Receivable 15 HIPAA-Covered Transaction Sets 837 – Health Care Claim (3 types) – Institutional – Professional – Dental Retail Pharmacy Drug Claim – National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard Implementation Guide, Version 5.1, September 1999 – NCPDP Batch Standard Batch Implementation Guide, Version 1.1, January 2000 —Continued—

2007 UBO/UBU Conference From Registration to Accounts Receivable 16 HIPAA-Covered Transactions Sets 270/271 – Health Care Eligibility Benefit Inquiry and Response 276/277 – Health Care Claim Status Request and Response 278 – Health Care Services Review 820 – Payroll Deducted and Other Group Premium Payment for Insurance Products 834 – Benefit Enrollment and Maintenance 835 – Health Care Claim Payment/Advice 837 – Coordination of Benefits

2007 UBO/UBU Conference From Registration to Accounts Receivable – Electronic Claim Attachment New proposed HIPAA Transaction Set in development Will simultaneously use both ANSI X12 and HL7 EDI standards Six different attachment types proposed – Clinical Reports – Laboratory Results – Medications – Rehabilitation Services – Ambulance Service – Emergency Department

2007 UBO/UBU Conference From Registration to Accounts Receivable 18 NCPDP National Council for Prescription Drug Programs (NCPDP) Develops and maintains the EDI standard used by retail pharmacies to bill prescription claims Version 5.1 is the approved HIPAA standard currently used by retail pharmacies

2007 UBO/UBU Conference From Registration to Accounts Receivable 19 ANSI ASC X12N & IGs ANSI – American National Standards Institute ASC X12 – Accredited Standards Committee (ASC) chartered by ANSI to develop standards for inter- industry electronic business transactions (EDI) X12N – is the Subcommittee for Insurance who developed the HIPAA EDI standards IGs – Implementation Guides that provide detailed formats for implementing the HIPAA EDI standards Version 4010A of the HIPAA IGs is the standard National Council for Prescription Drug Programs (NCPDP) developed standards for retail pharmacy drug claims

2007 UBO/UBU Conference From Registration to Accounts Receivable 20 ICD-9-CM ICD-9-CM – International Classification of Diseases – Clinical Modification for Diagnoses, 9 th Edition (Volumes 1 and 2) – Modified U.S. version of ICD-9 developed by the World Health Organization ICD-9-CM – International Classification of Diseases – Clinical Modification for Inpatient Procedures, 9 th Edition (Volume 3) Implemented in the U.S. in 1978

2007 UBO/UBU Conference From Registration to Accounts Receivable 21 ICD-10-CM & ICD-10-PCS International Classification of Diseases and Related Health Problems, 10 th Revision, Clinical Modification (ICD-10-CM) – U.S. version of ICD-10 developed by the World Health Organization (WHO) for reporting morbidity data in all healthcare setting – Maintained by National Center for Health Statistics (NCHS) and the Centers for Disease Control (CDC) International Classification of Diseases and Related Health Problems, 10 th Revision, Procedural Coding System (ICD-10-PCS) – Developed by CMS – Replaces the current inpatient procedural coding system included in ICD-9-CM Earliest U.S. implementation might be 1 October 2009

2007 UBO/UBU Conference From Registration to Accounts Receivable 22 National Provider Identifier (NPI) – Health care providers began applying for NPIs beginning May 23, 2005 – Health care providers, health plans, and health care clearinghouses must begin using the NPI in standard transactions NLT May 23, 2007 – Small health plans have until NLT May 23, 2008 – Is a 10-position numeric identifier (last digit is a check figure) – Is an 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 23 Use of the 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 prior to 23 May 2007 – Services SGs have issued Memoranda of Instruction detailing Service-specific instructions 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 24 Use of the 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 prior to 23 May 2007 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 25 UB-04 New paper claim form that replaces the UB-92 Health Plans and Clearinghouses need to be ready to receive the UB-04 form by 1 March Providers can begin to use the UB-04 beginning 1 March 2007 Transitional period between 1 March 2007 and 22 May 2007 where either form (UB-92 or UB-04) can be used Use of new UB-04 paper claim form required beginning 23 May 2007 UB-04 paper claim form must be used for rebilling of discharges that occurred prior to 23 May 2007 even if originally billed on a UB-92

2007 UBO/UBU Conference From Registration to Accounts Receivable 26 UB-04 (con’t) Require use of NPIs on the UB-04 beginning 23 May 2007 MHS System Change Request (SCR) has been submitted for making changes to CHCS MSA module to support the new UB-04 paper claim format CHCS software change package to support the UB-04 will be available for MTFs to load onto CHCS beginning in early May 2007 MTFs need to start ordering the new UB-04 and CMS 1500 forms now

2007 UBO/UBU Conference From Registration to Accounts Receivable 27 Revised CMS 1500 Use of new revised CMS 1500 Form required beginning 1 April 2007 Prior version of CMS 1500 Form should be discontinued after 31 March 2007 Beginning 1 April 2007, the revised CMS 1500 Form should be used for rebilling encounters with dates of service before 1 April 2007 even if originally billed on the old CMS 1500 Form New form requires use of NPIs beginning 23 May 2007 MHS System Change Request (SCR) has been submitted for making changes to TPOCS to support the new paper claim format MTFs need to start ordering the new revised CMS 1500 forms as well as the new UB-04 forms now

2007 UBO/UBU Conference From Registration to Accounts Receivable 28 Other Topics That Need Addressing What other UBO-related acronyms, programs, projects, and buzzwords would you like addressed during today’s session? What other topics/items should TMA UBO address in future TMA UBO educational programs and/or or newsletters?

2007 UBO/UBU Conference From Registration to Accounts Receivable 29 Objectives Overview of various UBO-related acronyms, programs, projects, and buzzwords Questions from attendees regarding other UBO-related acronyms, programs, projects, and buzzwords Feedback from attendees regarding other topics/items that TMA UBO should address in future TMA UBO educational programs and/or or newsletters

2007 UBO/UBU Conference From Registration to Accounts Receivable 30 Quiz When does GFEBS arrive at my Army MTF? Just what is IDX Flowcast? What is the current CMBB timeline? What is SFIS? So what is CSET and PPET? Do I need to buy my new ICD-10 coding books tomorrow? Why do I care about NPIs? What new form replaces the UB-92?