2010 UBO/UBU Conference Title: DQ Guidance DQ – UBO/UBU Data in EAS Session: W

Objectives Highlight UBO and UBU data reported in EAS IV Discuss potential data anomalies 2

What’s Available in MEPRS/EAS? All PAD and Billing operations fall under 1st level FCC “E,” which is designated for administration/overhead functions. “E” accounts are considered intermediate accounts and ultimately allocate to the final FCC (A, B, and C) accounts based on various factors (e.g., workload, FTE, etc.). In addition to workload, expenses (direct + allocated from other “E” accounts) (e.g., supplies, contracts, equipment) and FTEs (assigned, available, and non-available) used to staff these work centers is also captured. The billing and patient admin related FCC accounts are as follows: – EBH (3rd Party Collections) Workload Factor: # of claims billed – EJA (Inpatient Care Administration) Workload Factor: # of dispositions – EKA (Ambulatory Care Administration) Workload Factor: # of total visits 3

Why Is the Data Important? Used to determine the “fully loaded” costs to provide the billing and patient administrations functions at the child DMIS ID level Identifies the resources used to provide these services 4

Billing Function Falls Under EBH – 3rd Party Collections Third Party Collection Administration implements administrative procedures to maximize net recovery of healthcare delivery costs from third-party payers. It identifies DoD beneficiaries that have other health insurance, and reviews all aspects of accounts receivable management that includes the participation of many offices within the MTF, including admissions, medical records, utilization review, ancillary departments, data processing, and finance offices. Third Party Collection Administration also identifies Uniformed Services beneficiaries with third-party payer plan coverage and complies with third-party payer requirements; submits all claims to third-party payers; follows up to ensure that collections are made; and documents and reports collection activities. 5

Inpatient Care Administration Function Falls Under FCC EJA The Patient Administration Division/Department for Inpatient Care reviews and codes inpatient clinical records for completeness and accuracy, exercises administrative control of inpatients and inpatient beds, and ensures adequate clinical records are prepared and maintained for inpatients. It maintains inpatient control files, inpatient suspense files, and inpatient bed-status availability worksheet. 6

Ambulatory Care Function Falls Under FCC EKA Patient Administration Division/Department for Ambulatory Care develops and implements administrative procedures used throughout the ambulatory care function, performs a variety of clerical duties pertaining to outpatients and outpatient records, and conducts technical review of requests for procurement of equipment for components of the ambulatory care function. 7

Review of FY 10 FTE MEPRS/EAS Data EBH: 21 MTFs reported data with only 24% of those command reporting assigned FTEs. NH Camp Pendleton reported no assigned or available FTEs. EJA: 19 MTFs reported data with only 53% of those commands reporting assigned FTEs. EKA: 28 MTFs reported data with 90% of those commands reporting assigned FTEs. Available FTEs/Assigned FTEs Ratio – EBH: / = 110% – EJA: / = 113% – EKA: / = 107% *Detailed data embedded 8

Review of FY 10 Skill Types Reporting FTEs EBH – ST 3: 3.10% – ST 4: 0.90% – ST 5: 96% EJA – ST 1: 1.22% – ST 2: 1.76% – ST 3: 4.13% – ST 4: 24.29% – ST 5: 68.60% EKA – ST 1: 2.43% – ST 2: 4.42% – ST 3: 2.49% – ST 4: 33.62% – ST 5: 57.05% Question: Is it normal business practice to have a provider (skill type 1 and/or 2) reporting time to inpatient and ambulatory care administration? *Detailed data embedded 9

EBH – Cost Per Claim (Total Claims) 10

EJA – Cost Per Disposition (Total Dispositions) 11

EKA – Cost Per Visit (Total Visits) 12

Summary EAS IV data can be used to identify efficiencies between MTFs EAS IV can help identify data anomalies that may require additional investigation to support 13

Q&A Questions? 14