1. Title: Navy UBO Breakout Session: T-2-0850
Track x – xxx day –
Title: Navy UBO Breakout
Session: T

2. Welcome
Introductions
Best business practice – 2569/AHLTA interface at NH Bremerton
Navy Medicine Allowance Calculation Tool (NMACT) Performance Metrics
Published SOPs
BUMED topics
Questions

3. Introductions Slide Redacted
Many MTFs represented. Please say hello to our new people.

4. FY11 DD2569 FOCUS
Annual Area for Leadership Engagement
Deputy Surgeon General FY11 Focus Area
Collecting other health insurance data!
FY11 Data Quality Mgmt Control Program
Improve DD Form 2569 collection!

5. Issues
Form Collections <100% per DQ Audit
FY10 82%
System Issues
Systems not programmed to track form
Done waiting for the E-DD2569
Process to quantify weak areas
Need to Increase Billing and Collections

6. Front Desk Verifies at Check-In Selects Clinical Notes
Proposal
DD2569 Scanned into AHLTA
Under Clinical Notes
“DD2569 1Mar2011 NHB”
Front Desk Verifies at Check-In
Selects Clinical Notes
Verifies date is within 1 year
Verification by Clinic for Valid Form
Print a daily appointment listing
Verify a valid form is in Clinical Notes

7. DD2569 Count

8. DD2569 Verification

9. Summary
Doubled Form Collections
2K average to 4K average or more
Clinic Verification Improvement
45% to 80% with Valid Form
New OHI
Jan-Feb 90 New OHI Policies
March *7 Work-Days* 25 New OHI Policies

10. Navy UBO Break Out Session 2011 MHS Revenue Cycle Educational Conference BUMED SOPs for UBO and TPC/AR Updates
March 15th, 2011

11. Purpose and Objectives
Third Party Outpatient Corrective Action
Execution Performance Metrics
Navy Medicine SOPs for UBO
IAB
Outpatient TPC Billing

12. Third Party Outpatient Corrective Action
Third Party Outpatient AR Corrective Action deployed for Q4 FY10
20 MTFs have used the Navy Medicine Allowance Calculation Tools to predict NRV on monthly TPOCS billings
Resolves longstanding material weakness for Navy Medicine
Navy Medicine reported AR, Public for Q4 FY10 Financial Statements

13. Measuring Execution Performance
FY11 Sustainment Performance Metrics
AR entered in STARS-FL prior to COB 4th calendar day of month (A)
Accounting entered value on time
AR amount entered accurately per the Tool Monthly Report and backdated (B)
Accounting entered AR correctly: date and value
MTF Package submitted to BUMED and DFAS by COB 4th calendar day of month (C)
Documents forwarded to requested parties
Package contains all required documentation and all Tool report values are within reason (D)
Monthly Package Complete- Tool Reports
Monthly Package Complete- Collection Reconciliation
Monthly Report Signed
Monthly Process completed without BUMED support (E)
IOP used to operate Tool successfully
MTF works with Region to resolve issues

14. Inter-Agency Billing (IAB) SOP: Overview

15. IAB SOP: Contents and Roles
Roles Included:
MTF UBO Staff
MTF UBO Manager
Activity Accounting Technician
Regional UBO Manager
BUMED UBO Manager
Processes Included:
Bill Preparation
Bill Review
Bill Submission
Reconciliation of Billings
and Collections
STARS-FL Entries
Monitoring the IAB Program

16. Outpatient TPC Billing SOP: Overview

17. Outpatient TPC Billing SOP: Contents and Roles
Roles Included:
MTF UBO Staff
MTF UBO Manager
Processes Included:
Insurance Verification
Outpatient Medical Bill Set-up
Pharmacy Bill Set-up
ePREMIS Billing
Claim Closeout
Running Aging Reports
Running Write-Off Reports

18. UBO SOP Deployment Information
Title
Description
IAB Interim Procedures
Required in preparation for executing the IAB for Medical Services SOP due to importance of finalizing the DD7A on a monthly basis.
Note: Completion of Interim Procedures is due NLT April 1st, 2011
IAB for Medical Services SOP
Improves the efficiency and quality of the process through decreased hand-offs, decentralization, and standardization to avoid missed billings; creates greater transparency of local execution by BUMED HQ.
Outpatient TPC Billing SOP
Improves efficiency, accuracy, and transparency of the process through standardization, including audit check-points to ensure that no bills are lost due to system errors and collections are maximized; decreases the billing/collection timeline and aims to increase the amount of payments received over claim denials
UBO SOPs are required for execution starting April 1st and can be downloaded from the Navy Medicine FIP NKO site:

19. Contact Information
SLIDE REDACTED

20. BUMED UBO topic – MSA/MAC/TPC(in) NRV Reporting Tools
In preparation for an audit of the Navy’s ‘Balance Sheet’, BUMED/MTFs have been levied with a requirement to produce a Net Realizable Value (NRV) for its accounts receivable
In July 2010, BUMED rolled out an NRV-reporting tool that works by determining an allowance factor for TPC (outpatient) accounts
BUMED is researching the development of NRV-reporting tools for TPC (inpatient), MSA and MAC claims/invoices
Implementation date: TBD (audit occurs in FY-13)

21. BUMED UBO Topic – USCG IAB Proposal
Discussion of ending IABs for USCG
Details unclear, but could include:
USCG makes one payment to DoD each 1 Oct
Payment based on total healthcare bill for USCG previous year
DoD splits the funds amongst Services; Services split funds amongst Regions/MTFs
At mid-year point, MTFs produce a 12-month wrap-up IAB; wrap-up IAB is used to prepare following year USCG payment
Possible application for other IABs as well (however, no active discussions of other IABs yet)
Possible date to implement: FY-12

22. BUMED UBO topic – FY for MSA Funds
As per BUMED ltr 7000 Ser M84/10UM of 5 Oct 2010:
MSA payments will be credited to LOAs in the year of receipt, vice year of service
Implements ASD(HA) ltr of 6 Feb 2006
Implementation date: 1 Oct 2010

23. BUMED UBO Topic – Standard TPC Write-off Codes
As per BUMED ltr 7000 Ser M84/10UM of 24 Sep 2010:
All MTFs using TPOCS will use listed write-off codes
Implementation date: 1 Oct 2010

24. BUMED UBO Topic – TPC Pharmacy e-Billing
Contract has been awarded to PSI to implement the e-billing feature in TPOCS
E-billing feature will produce a NCPDP (Natl Council for Prescription Drug Programs) universal claim form for all TPC pharmacy prescriptions
E-billing has been implemented at Camp Lejeune and is being tested at NMC Portsmouth and NH Bremerton
BUMED has funded the TPC pharmacy e-billing for FY-11 (contract payments are made on a per-claim basis to RelayHealth)
For FY-12 and beyond, MTFs will need to self-fund if they wish to retain the capability
Estimate to have all TPOCS facilities on line: Mar-May 2011

25. BUMED UBO Topic – e-2569
As of 11 Jan 2011, USAF has granted an Authority to Operate (ATO) for AF MTFs to operate the e-2569 OHI collection form
NAVMISSA is conducting an AoA regarding the feasibility of employing the e-2569 at Navy MTFs
If found feasible, Navy will have to accept the AF ATO exactly as is, or allow for significant delays while the system undergoes a lengthy DIACAP (Defense Information Assurance Certification and Accreditation Process) review
BUMED intends to push for acceptance of the AF ATO exactly as written
BUMED will mandate that MTFs purchase hardware and employ the e-2569 at all patient points of service
Estimated date for e-2569: Spring/Summer 2011

26. BUMED UBO Topic – MSA Write-off Actions
MTF UBO offices process unpaid invoices/claims as follows:
For MSA, invoices can only be zeroed out by:
Paying the invoice in full (invoice is considered as ‘paid’ when the funds have been deposited into the U.S. Treasury)
Excluding invalidly-produced charges (e.g. unbundled labs, wrong PatCat registration that isn’t support by DEERS, etc) (justification must be supported!)

27. BUMED UBO Topic – MSA Write-off Actions
MTF UBO offices process unpaid invoices/claims as follows: (cont’d)
Transferring the debt to DFAS (see FMR Vol 5 Ch 28) (Debt and Claims Management Office (DCMO)) (mandatory for out-of-service debts of more than $225 combined that are more than 60 days old)
Note that the FMR only requires one demand letter, before referring the debt
If sponsor is a military AD/retiree, submit a DD139 (MTF must track)
If sponsor is a DoD employee, submit a DD2481 (MTF must track)
Way ahead: BUMED researching use of the Treasury Offset Program (TOP) by MTFs (instead of submitting packages to the DCMO)

28. BUMED UBO Topic – MSA Write-off Actions
MTF UBO offices process unpaid invoices/claims as follows: (cont’d)
Debts that total less than $225 may be held for one year and then written off
Although the DCMO only wants debts larger than $225, smaller debts may be submitted via DD139/DD2481/TOP
DFAS adjudicates all questions regarding unpaid invoices; neither BUMED nor the Regional Commanders have the authority to authorize MSA write-offs, or adjudicate billing disputes. Do not send debt packages to BUMED.

29. BUMED UBO Topic – TPC Write-off Actions
MTF UBO offices process unpaid invoices/claims as follows:
For TPC, claims can only be zeroed out by:
Payer pays 100% of the claimed amount;
Payer provides a valid reason for paying less than 100% of the claimed amount (write-off codes W08 thru W15 and W17 thru W50);
Referring invalid claim denials (code W16) to the MTF’s Judge Advocate General.
Neither BUMED nor the Regional Commanders have the authority to authorize TPC write-offs, or the resources to coordinate JAG support for claim disputes; invalid denials should be coordinated with the MTF’s JAG office. Do not send claim packages to BUMED.
BUMED does not possess the staff nor the necessary level security to maintain medical records / PII / HIPAA-protected data

30. BUMED UBO Topic – Standard Sales Codes/ CHCS Posting
BUMED is preparing a draft memo that will:
Prescribe a standard list of Sales Codes to use by all MTFs
Require that all UBO receipts (MSA, TPC, miscellaneous) be posted into CHCS
Estimated date to execute standard process: 1 Oct 2011

31. BUMED UBO Topic – TPOCS Sunset
As per OSD(HA) memo of 13 Dec 2010, TPOCS will sunset 1 Oct 2013 (TMA will cease funding).
TPOCS will remain as a legacy system until 1 Oct 2014
TPOCS sunset coincides with ICD-10 rollout 1 Oct 2013
Replacement plan:
Beginning in FY-13, TMA will implement the Central Events Billing Repository (CBER). The CBER will be a warehouse that uploads billable events (MSA, TPC and MAC) from every MHS MTF’s CHCS into a single database.

32. Services have been tasked with developing a plan to replace TPOCS.
The replacement system is not limited to TPC (outpatient); the replacement system may provide for all
MSA (IAB and non-IAB),
TPC (inpatient and outpatient) and
MAC billing.
The replacement system will interface with the CBER, vice individual CHCS systems

33. BUMED UBO Topic – TPOCS Sunset
As per OSD(HA) memo of 13 Dec 2010, TPOCS will sunset 1 Oct 2013 (TMA will cease funding).
TPOCS will remain as a legacy system until 1 Oct 2014
TPOCS sunset coincides with ICD-10 rollout 1 Oct 2013
Replacement plan:
Beginning in FY-13, TMA will implement the Central Events Billing Repository (CBER). The CBER will be a warehouse that uploads billable events (MSA, TPC and MAC) from every MHS MTF’s CHCS into a single database.

34. BUMED UBO Topic – TPOCS Sunset
Replacement plan: (cont’d)
Services have been tasked with developing a plan to replace TPOCS.
The replacement system is not limited to TPC (outpatient); the replacement system may provide for all
MSA (IAB and non-IAB),
TPC (inpatient and outpatient) and
MAC billing.
The replacement system will interface with the CBER, vice individual CHCS systems

35. BUMED UBO Topic – TPOCS Sunset
NAVMISSA is currently conducting an Analysis of Alternatives (AoA)
AoA is looking at a broad range of options for systems, locations and workforces
Systems: options include Government-procurement or Government-leasing; the system could either be an existing off-the-shelf system, or one specially produced to meet the Navy’s needs
Locations: The CBER does not reside on an MTF server, but rather off-site. With CBER access, UBO functions can be moved, as necessary
Workforce: options include a Government workforce, contract workers and/or a combination workforce structure

36. BUMED UBO Topic – TPOCS Sunset
NAVMISSA is currently conducting an Analysis of Alternatives (AoA) (cont’d)
BUMED/NAVMISSA will work collaboratively with Regions/MTFs to build the post-TPOCS requirements document
The goal is to develop a system that maximizes all-sources funding for the MTFs, while minimizing system/personnel costs
Estimate to have replacement: NLT 1 Oct 2013 (preferably FY-12, or early FY-13)

37. BUMED UBO Topic – CHCS/TPOCS Alternatives
As per OSD(HA) policy memo , MTFs may conduct billing/collection activities as per the following:
Sites are not mandated to using CHCS and/or TPOCS
Sites may use Govt workers, contract workers or a combination thereof
Billing/collection activities may occur at the MTF, contract location or a combination thereof
MTFs wishing to use non-CHCS/TPOCS should review -- OASD (Networks and Information Integration) DTM , FMR Vol 4 Ch 3 (allowance methodology), and the TMA UBO metrics reporting requirements
Note: The AR NRV Reporting Tool only works with TPOCS. MTFs that depart from the use of the TPOCS will need to compile their own NRV (methodology is subject to review/approval by BUMED)

38. BUMED UBO Topic – CHCS/TPOCS Alternatives
As per OSD(HA) policy memo , MTFs may conduct billing/collection activities
BUMED is drafting guidance to the Regional Commanders/MTFs to implement the above policy memo (cont’d)
MTFs should coordinate with their Regional Commanders / BUMED before contracting / purchasing any billing support products.

39. BUMED UBO Topic – Treasury Deposit Products
BUMED is preparing a draft memo that will require all MTFs to use, and accept (to receive payments), the following U.S. Treasury products:
Credit/Debit cards (thru pay.gov)
Electronic checks (thru pay.gov)
Remote payment (via a pay.gov-hosted MTF payment page)
Payment via Electronic Funds Transfer (EFT) (using a Remittance Express (REX) / Credit Gateway acct)
Preparation of SF215s via Over-the-counter Net (OTCNet) (formerly Treasury General Accounting Net (TGANet))

40. BUMED UBO Topic – Treasury Deposit Products
BUMED is preparing a draft memo that will require all MTFs to use, and accept (to receive payments), the following U.S. Treasury products: (cont’d)
Depositing of all checks with a check scanner thru OTCNet (formerly Paper Check Conversion-Over the Counter (PCC OTC))
Download of SF215 data from the Treasury Reporting System (TRS) (formerly CA$HLINK II)
Draft memo will include methods / procedures for submitting associated DD1131s
All of the above products are supported by the FMR Vol 5 Ch 28
Estimated date to implement standard deposit products: 1 Oct 2011

41. BUMED UBO Topic – Other Items
Lab unbundling – BUMED UBO will re-engage on the BUMED (Lab Specialty Leader) mandated practice of unbundling labs for productivity count reasons
Known/possible CHCS/TPOCS systems issues:
Rates do not appear for APV anesthesia charges
Other?

42. Questions?
Questions?