1. For entry into the webinar, log into: http://altarum.adobeconnect.com/ubo. Enter as a guest with your full name and Service or NCR MD affiliation for attendance verification. Instructions for CEU credit are at the end of this presentation. View and listen to the webinar through your computer or web–enabled mobile device. Note: The DHA UBO Program Office is not responsible for and does not reimburse any airtime, data, roaming, or other charges for mobile, wireless, or any other internet connections and use. If you need technical assistance with this webinar, contact us at webmeeting@altarum.org. You may submit a question or request technical assistance at any during a live broadcast time by entering it into the “Question” field of Adobe Connect. Tuesday, 23 February 2016; 0800-0900 Thursday, 25 February 2016; 1400-1500 Patient Category (PATCAT) Coding Assignment, Usage, and Common Errors

2. 2 PATCAT Basics Assigning PATCATs The PATCAT Table – Recent Changes and Updates PATCAT Finder Guide PATCAT Scenarios Resources Summary Agenda

3. PATCAT Basics

4. 4 A11 A = USA ACTIVE DUTY OFFICERK53 A = TREASURY DEPARTMENT A11 B = USA ACTIVE DUTY ENLISTED K53 B = HEALTH AND HUMAN SERVICES A11 = USA ACTIVE DUTYK53 = OTHER FED AGENCY/DEPT EMPLOYEE What is a Patient Category (PATCAT) code? –A PATCAT code is used to determine whether a patient is billable, and what type of billing is appropriate for each episode of care Basic code covers a category of interest Sub-categories segment the group Four is the maximum number of positions in a PATCAT code Correct placement of all four positions is critical for billing PATCAT Basics: What is a PATCAT?

5. 5 4 th Position Specific information about the patient Location of the patient (CONUS vs OCONUS) Condition of the patient ( K61 5 = Catastrophically Disabled VA Beneficiary) More detailed status ( *22 A In line of Duty vs. *22 B Not In Line of Duty) 3 rd Position Further delineates the second position regarding status or the patient’s agency 2 nd Position Identifies/groups the patient according to entitlement 1x = Extended Active Duty Sponsors 2x = ROTC; Inactive Duty Guard/Reserves, TAMP/TRS, Former Members, Applicants 3x = Retirees 4x = Family Members, Former Spouses and Family Members 5x – 9x = Used to segment “K” Codes 1 st Position Sponsor Service A = Army B = NOAA C = Coast Guard F = Air Force K = “Katch-all” (“Other” and “Special” categories) M = Marine Corps N = Navy P = USPHS R = Reciprocal Agreements PATCAT Basics: Understanding PATCAT Components

6. 6 4 th Position Specific information about the patient More detailed status 2 = Enlisted 3 rd Position Further delineates the second position regarding status or the patient’s agency x2= Reserve 2 nd Position Identifies/groups the patient according to entitlement 1x = Extended Active Duty Sponsors 1 st Position Sponsor Service A = Army A 1 2 2 Example: A12 2 PATCAT Basics: PATCAT Component Example

7. PATCAT Basics: Purpose of PATCATs PATCAT Codes are closely linked to entitlements under the Uniformed Services Health Benefits Program (USHBP) They allow identification and grouping of patients by ‘types’ of interest – Sponsor Service – Beneficiary Category – Special Interest patient groups PATCATs are directly linked to Uniform Business Office (UBO) billing – Rate to charge and method of billing 7

8. PATCAT Basics: PATCAT Functions Many functions and systems rely on PATCATs – Revenue cycle activities and systems (medical services coding, billing, and collections) – Patient classification by Beneficiary Category – Admission & Disposition Reports – Patient Record Extracts (CAPER and SIDR) – Workload reports (MEPRS, WWR) PATCATs can also affect functional areas outside of billing – Categorizing enrolled population – Workload accountability – Outpatient records, retirement procedures, and multiple other areas 8

9. Assigning PATCATs

10. PATCATs may be assigned by: – Auto registration – CHCS automatically assigns a PATCAT to a patient if it can successfully translate the DEERS data – Mini or Full registration – MTF personnel registering a patient may manually assign PATCAT(s) in CHCS – Mail-In registration – Not applicable for initial registration as CHCS does not require a PATCAT Lab personnel should use mini or full registration to register a patient and then use mail-in registration to set the lab referral location – Lab interoperability registration – Receiving MTFs utilize mail-in registration as part of their specimen processing Lab personnel accept the PATCAT from the MTF (CHCS host) sending the specimen Caution! If CHCS cannot translate DEERS data during an auto registration, a PATCAT cannot be assigned, leaving the field null or resulting in PCM Information Transfer (PIT) Error 10 – The first user to access the patient data with a null PATCAT will be prompted to assign a PATCAT CHCS will allow “non-logical” sponsor/dependent Service and eligibility mismatches (example F41/N43) – Review and edit a patient’s file for accuracy during each encounter An incomplete registration could result in a null PATCAT Assigning PATCATs: How to Assign PATCATs 10

11. 11 Incorrect PATCAT Assignment Poor report quality Poor data quality Incorrect MTF workload Inaccurate categorization of beneficiaries and service members Improper Billing Billing to wrong source Billing at wrong rate Billing using wrong forms Not billing when you should Potential Loss of Revenue Assigning PATCATs: Consequences of Incorrect PATCAT Assignment

12. Assigning PATCATs: Updating and Changing PATCATs Mission requirements and changes in benefits lead to delays in updating DEERS and CHCS – Activation/Deactivation of Reserve/Guard personnel – Entry into Transition Assistance Management Program (TAMP) – Entry into TRICARE Reserve Select (TRS) – Move from Active Duty (AD) to Retiree status Certain types of care require a specific PATCAT – Occupational Health Services – Workers Compensation related care – Line of Duty = “No” for Reserve/Guard DEERS eligibility has changed *When you change a PATCAT Code to track specific care for a patient, (e.g., a Worker's Compensation visit), be sure to restore the patient's prior PATCAT Code in CHCS 12

13. 13 AD Retired Change in billing for the Sponsor Inactive Reserve AD Change in billing for family members AD TAMP Change in billing for Sponsor TAMP TRS Change in billing for Sponsor Retired VA Beneficiary Change in billing for Agency Assigning PATCATs: Common PATCAT Changes

14. Assigning PATCATs: Dual Eligible Beneficiaries MHS Beneficiaries – Retirees, Family Members of AD or Retirees, who are also: Civil Service Employees Contractors DoD Dependent School System Employees Multiple Entitlements – Assignment is based on the MHS Beneficiary’s current reason for care PATCATs entered should always reflect a person’s DEERS eligibility PATCATs cannot be changed for associated episodes of care – Ex: *41(Fam Mbr AD)/K57(Occ Health) VA Beneficiaries – VA Beneficiaries receiving a VA authorized benefit at a MTF – Required PATCAT change prior to VA episode of care PATCAT should be changed from *31 (Retiree) to K61 (Veterans Admin Beneficiary) – Once VA services are rendered, the PATCAT should be changed back to the previous eligible PATCAT 14

15. Assigning PATCATs: Dual Eligibility MTFs should avoid creating duplicate patients – Register patients under the highest level of eligibility – Move patient between sponsors if possible – Manually address billing data if it is not possible to change sponsorship to apply correct PATCAT in episode of care Double-check the PATCAT data in the billing system, CHCS, and against all gathered data Perform a DEERS eligibility check for the patient’s Dates of Service – DEERS may have been updated since the last time the patient was seen for care 15 Resolving Problems with Dual Eligibility

16. The PATCAT Table

17. The PATCAT Table: Data Components 17 PATCAT Code Descriptions PATCAT Code and Sub-Category

18. The PATCAT Table: Data Components 18 Form of Payment Beneficiary Category Descriptions

19. The PATCAT Table: Data Components 19 IP Rate Info: Individual or Agency and Type of Rate OP Rate Info: Individual or Agency and Type of Rate Sponsor or Family Categorization

20. The PATCAT Table: Data Components 20 Special Interest Reporting Categories Can you skip a DEERS check? OCONUS Group Meal Sales These are the permissible values for a change of Patient Category Code during an inpatient stay.

21. Recent PATCAT Table Updates

22. Recent PATCAT Table Updates: New PATCATS Newborns 28 1 – Newborn of Former Service Member 28 2 – Newborn of Former Service Member - Sec Des 29 1 – Newborn of Sponsor’s Daughter 29 2 – Newborn of Sponsor’s Daughter - Sec Des 30 1 – Newborn of Spouse of Former Service Member 30 2 – Newborn of Spouse of Former Service Member - Sec Des 22

23. Recent PATCAT Table Updates: New PATCATs SHAPE Health Clinics K72 C - NATO Military-OCONUS (CC-SHP) – FLEX/FLXO K73 E - NATO Fam Mbr-OCONUS (CC-SHP) – FLEX/FLXO K74 3 - Other Non-NATO Military (CC-SHP) – FLEX/FLXO K75 D - Other Non-NATO Fam Mbr of Other Military (CC-SHP) – FLEX/FLXO K76 B - Foreign Civilian (CC-SHP) – FLEX/FLXO K76 D - Foreign Civilian Family Member (CC-SHP) – FLEX/FLXO K79 A - US Civilian Employee (CC-SHP) – FLEX/FLXO K79 B - US Civilian Family Member (CC-SHP) – FLEX/FLXO Maternity Care* 27 1 - Former Service Member - Maternity Care 27 2 – Spouse of Former Service Member - Maternity Care *These PATCATs are not new, but are included here because new sub-categories were added. 23

24. Recent PATCAT Table Updates: Rate Changes Newborns – Secretarial Designees Rate changed to charge for Inpatient services Other Changes 24 Newborns 28 2Newborn of Former Service Member - Sec Des Charge the 29 2Newborn of Sponsor’s Daughter - Sec Des patient 30 2Newborn of Spouse of Former Service Member - Sec Des the FMR Other Changes K92 BUSFHP Enrollee Charge the K93Medicare Civilian Emergency patient K94Medicaid Civilian EmergencyFRR (Inpatient) or K95State Children’s Health Insurance ProgramFOR (Outpatient)

25. Recent PATCAT Table Updates: Other Changes NATO Recipient Agreement Flexible payment option added Navy Specific Changes - NAF Occupational Health 25 Flexible Payment R72 1NATO Recipient Agreement – SR R72 2NATO Recipient Agreement –FLEX/FLXO R73 1NATO Recipient Agreement – Family Member - SR R73 2NATO Recipient Agreement – Family Member – FLEX/FLXO NAF OCC Health K57 9 NAF Occ Hlth CONUS - Navy Specific NC Pay K57 ANAF Occ Hlth OCONUS - Navy specific Mode

26. Recent PATCAT Table Updates: Other Changes Bill Generation – Pay mode change 26 Bill Generation K62 3WC-DoD Beneficiary, Federal Employee Added Pay mode – DD7/DD7A for bill generation

27. Recent PATCAT Table Updates: Billing Rates Rate Type Description FAAFederal Aviation Administration Rate FLEXFlexible Benefit Rate (Inpatient) FLXOFlexible Benefit Rate (Outpatient) FMRFamily Member Rate FORFull Outpatient Rate FRRFull Reimbursement Rate (Inpatient) FSRFull Subsistence Rate GBIGuantanamo Bay Rate (Inpatient) GBOGuantanamo Bay Rate (Outpatient) IARInter-Agency Rate (Inpatient) IMETInternational Military Education and Training (Inpatient) IMOInternational Military Education and Training (Outpatient) IORInter-Agency Rate (Outpatient) NCNo Charge SRSubsistence Rate 27

28. Recent PATCAT Table Updates: Process for PATCAT Updates MTF or staff recommend changes to appropriate Service or NCR MD Program Manager Program Manager forwards approved recommended changes to DHA UBO PO DHA UBO PO coordinates review with all Services/ NCR MD Program Managers – Services/ NCR MD Program Managers, in coordination with the DHA UBO PO, determine and agree on UBO position – Table is updated accordingly DHA UBO PO recommends and coordinates table update with DHA Analytics DHA UBO PO submits new table to Defense Health Clinical Systems (DHCS) for deployment DHCS releases table to MTF sites for loading and use – Estimated load time is approximately 3 weeks – Revised table is available once MTF billing system administrators load the file pending corresponding effective date 28

29. PATCAT Finder Guide

30. PATCAT Finder Guide: Overview 30 Select a category of interest on the Major PATCAT Groupings screen Follow instructions for the grouping of interest in order to move through the PATCAT categories and hierarchy As you make selections, the categories will become more focused and you will be guided to a specific PATCAT for the patient The appropriate PATCAT is shown in a box as the last step in each PATCAT logic flow To search for a new PATCAT, select “Return to the Beginning” to start the process over General Directions for using the Finder Guide An interactive tool that will assist you in choosing the correct PATCAT code for a patient.

31. PATCAT Finder Guide: Demonstration 31

32. PATCAT Scenarios

33. PATCAT Scenarios: Billing for Care Issued Under Wrong PATCAT Question: Several dual-eligible (AD AF family members) individuals came to a MTF for NAF pre-employment physicals. The patient admin was unable to change the PATCAT to NAF CONUS or NAF OCC Health. What is the proper way to bill NAF for the services after the appointment has been closed? Should a one-time charge be created in CHCS at the IOR? If so, under what PATCAT should the charge be made? In CHCS, what status do I carry the account receivable in? Or is there another way to properly bill? Answer: A one-time charge should be created using PATCAT K57 3 (NAF EEMPLOYEE OCC HEALTH CONUS) at the interagency rate. As CHCS sees this encounter as completed under a non-billable PATCAT, the claim will have to be generated manually. Please contact your Service or NCR/MD UBO Program Manager for the procedure of recording the account receivable (AR). – The preferred process is to record the AR at the time the claim is created, and carry it in an open/unpaid status until payment is received at which point it is closed. However, not all Services have been able to implement this process and in some cases, the AR is not established until payment is received when the AR is opened and closed at the same point. 33

34. PATCAT Scenarios: Dual Eligible Beneficiaries Question: If you have a DoD Civ (K57) who is also a VA Beneficiary (K61), is it correct to assume that this patient's PATCAT should always be K57, since this is what shows up in DEERS? Answer: No, it is not correct to assume the PATCAT should always be a K57. The patient may be authorized to be seen at a MTF that has a VA Sharing Agreement. If the patient has an authorized appointment under VA status for a specific episode of care, the PATCAT should be K61. Once VA services are rendered, the PATCAT should be changed back to the previous eligible PATCAT. 34

35. Question: How do you tell the difference between care provided to VA beneficiaries subject to normal inter-agency billing rules and care provided to VA beneficiaries under DoD/VA sharing agreement billing rules? Answer: The difference between care for VA beneficiaries under normal inter-agency billing and care for VA beneficiaries provided under a Sharing Agreement is determined by the sub-category assigned to the relevant PATCAT: K61. The sub- category must be assigned for appropriate billing. K61 1 denotes Veterans Admin Beneficiary when the care is not covered under a sharing agreement while K61 2 denotes care provided under a DoD/VA sharing agreement. Note some MTFs do not have sharing agreements at all while others have agreements covering certain types of care but not others, and some agreements provide for a comprehensive set of services to VA beneficiaries. PATCAT Scenarios: Dual Eligible Beneficiaries 35

36. PATCAT Scenarios: Dual Eligible Beneficiaries Question: Assume a dependent spouse is a DoD employee, but is being seen as dependent. Should the PATCAT for this beneficiary always remain as a dependent? Answer: The patient should be registered only once under their highest level of eligibility. In this scenario, the highest level of eligibility is the dependent. 36

37. Question: Are foreign military eligible for TRICARE? If so, what PATCAT would you use? Answer: The DHA UBO Program Office does not determine TRICARE eligibility. That being said, the PATCAT depends on the patient. There may be applicable International Military Education and Training Program Agreements, Reciprocal Health Care Agreements, or NATO or SOFA Agreements that could apply to the patient. The DHA Program Office can answer questions regarding reimbursement rates or billing and the PATCAT Table and Finder Guide provide the patient category codes used to identify a patient’s eligibility for care in an MTF. PATCAT Scenarios: Foreign Military Beneficiaries 37

38. PATCAT Scenarios: Medical Exams for Reservists Question: How do you determine if a reserve member is on reserve status and that their unit was not available to do an exam on them? Do inactive reserve members have orders showing their reserve status? DEERS shows him as USA RES INACTIVE DUTY TRNG ENLISTED. Answer: In order for the care to be covered, the individual should have orders of some sort to report for reserve duty or to have lab tests performed. If the billing office is uncertain of the existence of orders, a bill should be prepared for the patient. In turn the patient should be given an opportunity to return and show that he/she was on training status (under orders) or under other orders to report for lab testing. If the patient can show such orders, the bill should be canceled. 38

39. PATCAT Scenarios: PATCAT Assignment Question: If a DoD employee is being seen at an MTF for minor problems, and they do not have an assigned eligibility, should they be billed as a Civilian emergency? Answer: If the employee is being seen for an occupational health visit or workman’s compensation visit, they would have eligibility K57. Minor problems (routine appointments) do not constitute a civilian emergency. If the employee is not eligible for care and the care provided is not work related, more than likely the DoD employee would not be seen at the MTF. If the DoD employee has a true emergency, then the PATCAT should be entered as a civilian emergency to ensure the appropriate rates are charged. 39

40. Question: What is the policy for billing for workers from other agencies who are completing work on base? For example, Department of Transportation (DOT) workers who will be working on base for snow removal. Is there a processes at bases for occupational exams? Answer: Three PATCATs could be appropriate for billing for health services for DOT workers. There is K53 8 (TRANS DEPT EMPLOYEE) that calls for the billing on the DD7/DD7A to the agency (Department of Transportation) at the interagency. However, if the care was for occupational health, the correct PATCAT would be K57 2 (OTHER FEDERAL AGENCY OCC HEALTH) which also calls for billing on the DD7/DD7A to the agency (DOT) at the interagency rate. If the DOT employee is injured while on base, the PATCAT would be K62 2 (WC-CIV, FED EMPL) also billed to the agency (DOT) using the DD7/DD7A. In all three cases, you are billing the same amount, on the same form, to the same payer, but the actual patient category assignment is different. PATCAT Scenarios: PATCAT Assignment 40

41. PATCAT Scenarios: Updating PATCATs Question: Public Health personnel presented a Pre-Deployment Medical Clearance Instruction for Civilian Personnel checklist. This checklist required him to “Report to the TOPA/UBO Office” to register and stated that his “patient category code must be updated” to ensure he would not be billed for his deployment medical care. We were advised to call TriWest about this issue. They advised us to call DEERS. DEERS advised us they have nothing to do with any of this. I decided to look up TOPA/UBO on Google and both websites have phone numbers that have been disconnected or no longer in services. Answer: Unfortunately, the Helpdesk doesn’t have an exact answer for this situation. From our understanding, the local DEERS office should be the responsible party for changing PATCATs. However, a recent site visit made us aware that MTFs have limited capabilities to change PATCATs for encounters on site. Our recommendation would be for the MTF to try and change the PATCAT status during the registration process. The civilian should specifically mention a PATCAT change during the process to ensure the clerk is aware that the PATCAT needs to be updated for this encounter. 41

42. Resources

43. General PATCAT Questions – MTF Colleagues – Service and NCR MD UBO Points of Contact – DHA UBO Helpdesk 202-776-1532 or UBO.Helpdesk@altarum.org – DHA UBO Web Site http://www.health.mil/Military-Health-Topics/Business-Support/Uniform-Business- Office/Patient-Categories Questions regarding registration, PIT errors, merging duplicate records, and patient identity questions can be addressed to: – Air Force: Data Quality Patient File/NED Error/TOPA SMEs Afmoa.dq.patientfilesmes@us.af.mil – Army: MTFs should contact their PAD & local CHCS offices – Navy: MTFs should contact their PAD Officer – NCR MD: MTFs should contact their PAD Officer 43

44. Resources: DHA UBO Website The DHA UBO Website has several resources designed to help you assign the correct PATCAT to patient records: – Current PATCAT Table (2015 version) – PATCAT Training Module Provides detailed information for understanding the purpose of PATCAT codes and about how PATCATs are structured and assigned. Signed Certificate of Completion – PATCAT Finder Guide Interactive tool to help user choose the correct PATCAT To access these resources, please visit: http://health.mil/Military-Health-Topics/Business-Support/Uniform-Business- Office/Patient-Categories 44

46. Summary

47. PATCAT selection dictates billable or non-billable encounters and supports tracking, reporting and billing. – Closely linked to entitlements – Allow identification and grouping of patients by ‘types’ of interest PATCATs should always be assigned at the highest level eligibility – Changed according to episodic level of care INCORRECT ASSIGNMENT – Can lead to improper billing, rework, poor data quality, loss of revenue, etc. RESOURCES AND TOOLS – Download the Current PATCAT Table for use – Use Finder Guide and Training Module – Rely of Service/NCR MD specific resources 47

48. Thank You 48

49. Instructions for CEU Credit This in-service webinar has been approved by the American Academy of Professional Coders (AAPC) for 1.0 Continuing Education Unit (CEU) credit for DoD personnel (.mil address required). Granting of this approval in no way constitutes endorsement by the AAPC of the program, content or the program sponsor. There is no charge for this credit. Live broadcast webinar (post-test not required) – Login prior to the broadcast with your: 1) full name; 2) Service affiliation; and 3) e-mail address – View the entire broadcast – After completion of both of the live broadcasts and after attendance records have been verified, a Certificate of Approval including an AAPC Index Number will be sent via e-mail to participants who logged in or e-mailed as required. This may take several business days. Archived webinar (post-test required) – View the entire archived webinar (free and available on demand at: UBO Health.mil Learning Center Archives – Complete a post-test available within the archived webinar – E-mail answers to UBO.LearningCenter@altarum.orgUBO.LearningCenter@altarum.org – If you receive a passing score of at least 70%, we will e-mail MHS personnel with a.mil email address a Certificate of Approval including an AAPC Index Number The original Certificate of Approval may not be altered except to add the participant’s name and webinar date or the date the archived Webinar was viewed. Certificates should be maintained on file for at least six months beyond your renewal date in the event you are selected for CEU verification by AAPC For additional information or questions regarding AAPC CEUs, please contact the AAPC. Other organizations, such as American Health Information Management Association (AHIMA), American College of health care Executives (ACHE), and American Association of health care Administrative Managers (AAHAM), may also grant credit for DHA UBO Webinars. Check with the organization directly for qualification and reporting guidance. 49