From Registration to Accounts Receivable – The Whole Can of Worms 2007 UBO/UBU Conference 1 Briefing:Medical Affirmative Claims – How should MAC work? Date:21 March 2007 Time:

2007 UBO/UBU Conference From Registration to Accounts Receivable 2 Objectives Identify Legal Authority requiring Medical Care Recovery / Medical Affirmative Claims (MAC) Identify what is included in the MAC Program Identify how to improve the identification and collection of MAC information Identify the requirements of the MAC Billers in the MTF Identify requirements of the NLSO Claims Office – JAG Code 15 Identify reporting requirements Identify the Charge Master Based Billing system will impact MAC

2007 UBO/UBU Conference From Registration to Accounts Receivable 3 Legal Authority Federal Medical Care Recovery Act (42 U.S. Code, Chapter 32, Sections 2651 – 2653) Collections From Third Party Payers (10 U.S. Code, Chapter 55, Section 1095 Federal Claims Collections Act (31 U.S. Code, Chapter 37, Section 3711) Worker’s Compensation Statutes - Federal and State

2007 UBO/UBU Conference From Registration to Accounts Receivable 4 What is included in the MAC Program? Motor Vehicle Accidents - Automobile, Motorcycle, Boating, etc., caused by another party or the beneficiary injured Personal Injuries – Slip & Falls, Dog Bites, etc. Product Liability – Silicone Breast Implants, Phen Phen Diet Pills, etc. Medical Malpractice – suit is against a civilian hospital, or private medical practice. Treatment/care to correct/repair was provided by the MTF Worker’s Compensation – Treatment/care provided to beneficiaries for work related injuries. Does not include care/treatment provided to Federal employees or Active Duty Military Personnel who are injured on their DoD job

2007 UBO/UBU Conference From Registration to Accounts Receivable 5 Who Is Responsible? Everyone in the MTF is responsible for the success of the MAC Program, but the UBO is responsible for overseeing the MAC Program at the MTF UBO MAC staff must provide training to all of the departments/clinics/ancillary services in the MTF on how to identify “potential” MAC cases The UBO must provide the department/clinics/ ancillary services with the MAC questionnaires to be completed by the patient

2007 UBO/UBU Conference From Registration to Accounts Receivable 6 Duties of the MAC Biller Train and maintain a relationship with the front desk staff in the various clinics, ancillary services throughout the MTF, especially in the ER and Admission Office Obtain completed MAC questionnaires and determine if there is a potential MAC case Receive requests for Medical/Dental care costs from civilian attorney’s, insurance companies, and military legal offices (All requests should be coming via the NLSO) Identify all inpatient care, outpatient care, and ancillary services provided to the patient since the Date of Accident/Injury/Illness that are related to the injury / illness Obtain all medical records and other documentation supporting the care/services identified as related to the injury / illness

2007 UBO/UBU Conference From Registration to Accounts Receivable 7 Duties of the MAC Biller (con’t) Generate the appropriate claim form(s) / invoice to be provided to the NLSO, Army JAG, or Air Force JAG responsible for adjudicating the government’s claim Maintain a file (electronic or paper) of all claims/invoice submitted to the NLSO, Army JAG, or Air Force JAG, including all documentation submitted with the claim(s) / invoice Maintain a claims tracking system, identifying all claims submitted, where they were submitted, original amount of the claims submitted, and the actual amount collected, and reason for any adjustment or denial Submit reports to the BUMED Regional UBO Program Managers

2007 UBO/UBU Conference From Registration to Accounts Receivable 8 Reporting Requirements CLAIM # PATCATPATCAT PATIENT'S NAME SPONSOR'S SSNFMP DOA / DOI ADJUDICATIN G AUTHORITY (NLSO, USA, USAF) ORIGINATOR (MTF / ATTORNEY / INS CO) AMOUNT BILLED AMOUNT COLLECTEDSTATUS DATE OF STATU S EXPLANATION FOR LESS THAN 100% COLLECTION NMCP (NMC Portsmouth FY06 January 00001)

2007 UBO/UBU Conference From Registration to Accounts Receivable 9 NLSO Responsibilities Receive all incoming request for costs of Medical Care from Civilian attorneys and insurance companies Obtain a signed agreement from civilian attorney’s that state they will represent the interests of the government. Placing the attorney/insurance company on notice that the government will have a claim if any medical/dental care was provided by the MTF related to the accident/injury Forward requests and all additional documentation to the MAC Office Forwards all claims/invoices to the appropriate attorney and or insurance company in a timely manner to comply with the statute of limitations pertaining to that claim/case Collect all monies due to the government, depositing the collections to the correct Line of Accounting (LOA) for the MTF that submitted the claim/ invoice

2007 UBO/UBU Conference From Registration to Accounts Receivable 10 NLSO Responsibilities (Con’t) Provide monthly reports to BUMED Regional UBO Program Manager, identifying claims received, amount billed, amount collected, claims closed, and reason for receipt of less than 100% of what was billed or total denial Meet with the BUMED Regional UBO Program manager and Legal Officer to discuss compromised claims, claims closed without collections, and develop process improvements

2007 UBO/UBU Conference From Registration to Accounts Receivable 11 Summary Be knowledgeable of the legal authority requiring Medical Care Recovery / Medical Affirmative Claims (MAC) Know exactly what is included in the MAC Program so that you don’t waste time generating claims that will never be pursued Work with the clinics and ancillary services in your MTF to identify and collect MAC information Work with the NLSO Claims Office – don’t waste time creating and sending them claims they will never pursue Only with the information we are collecting on the MAC Tracking spreadsheet can we prove what is being sent to NLSO for processing Be patient, the Charge Master Based Billing system is coming and will include MAC. CMBB will have the same billing capabilities and reports as MSA and TPC