1. MSA Daily Duties How to Run Reports / Notify Roster From your computer or Web-enabled mobile device log into: http://altarum.adobeconnect.com/ubo. Enter as a guest, then enter your name plus your Service affiliation (e.g., Army, Navy, Air Force) for your Service to receive credit. http://altarum.adobeconnect.com/ubo Instructions for CEU credit are at the end of this presentation. [Note: The TMA UBO Program Office is not responsible for and does not reimburse any airtime, data, roaming or other charges for mobile, wireless and any other internet connections and use.] Listen to the Webinar by audio stream through your computer or Web-enabled mobile device. To do so, it must have a sound card and speakers. Make sure the volume is up (click “start”, “control panel”, “sounds and audio devices” and move the volume to “high”) and that the “mute” check box is not marked on your volume/horn icon. IF YOU DO NOT HAVE A SOUND CARD OR SPEAKERS OR HAVE ANY TECHNICAL PROBLEMS BEFORE OR DURING THE WEBINAR, PLEASE CONTACT US AT WEBMEETING@ALTARUM.ORG so we may assist and set you up with audio. You may submit a question or request technical assistance at anytime by typing it into the “Question” field on the left and clicking “Send.”WEBMEETING@ALTARUM.ORG 17 April 2012 0800-0900 EDT 19 April 2012 1400-1500 EDT

2.  Describe Medical Services Account (MSA) daily duties  Describe when and how a bill is created  Describe the process for preparing and running reports Objectives 2

3.  Billing  Collections  Financial accounting -collections control -accounts receivable -deposits  Change Fund  Patient Trust Fund Duties 3

4.  MSA Bills -Patients -Insurance Companies -Other Federal Agencies  Services Inside MTF -Inpatient  DRG-based (all Inclusive)  Per Diem -Outpatient  Clinic Visits  Ambulatory Procedures  Ancillary Services  DME/DMS  Immunizations Who and What We Bill  Other -Pharmacy -Dental Services -Ambulance Services -Anesthesia -Elective Cosmetic Surgery 4

5.  Inpatient billing triggers -Patient is DISCHARGED (Per Diem) -Record is CODED (DRG)  Outpatient billing triggers -Outpatient Visit status of KEPT, WALK-IN, SICK-CALL -Pharmacy Label is PRINTED -Laboratory Test is CERTIFIED -Radiology Exam is PERFORMED -Radiology Film is INTERPRETED/READ How an MSA Bill Is Created 5

6.  Other Factors -Patient Category (PATCAT)  Family Member vs. Civilian Emergency vs. Intergovernmental (Coast Guard, VA, etc.) -TRICARE Prime Enrollee  No charge for inpatient stay -Rate Tables  CMAC, Immunization, Dental, Pharmacy, etc. -Location  Service in New York may cost more than same service in Kansas -MEPRS Codes/Clinics or CPT-4 Codes  Visits to certain clinics may not be charged  Some CPT-4 codes have no rate How an MSA Bill Is Created (cont.) 6

7.  Medical coding produces a Medical Severity-Diagnosis Related Group (MS-DRG)  Every MS-DRG has an assigned Relative Weighted Product (RWP)  DoD develops annually a Direct Care Inpatient Adjusted Standardized Amount (ASA) rate for each inpatient facility (includes costs of both inpatient professional and institutional services)  Charge = MTF ASA Rate x RWP (See TMA UBO Website for ASA Rates and DRG weights http://tricare.mil/ocfo/mcfs/ubo/mhs_rates/inpatient.cfm) http://tricare.mil/ocfo/mcfs/ubo/mhs_rates/inpatient.cfm  Rate discounts may apply per interagency agreements -VA-DoD Resource Sharing Inpatient Institutional Billing Modified TRICARE DRG Payment Calculator available at http://tricare.mil/ocfo/mcfs/ubo/billing.cfm#Inpatient http://tricare.mil/ocfo/mcfs/ubo/billing.cfm#Inpatient Inpatient Charge Calculation 7

8.  Woman delivers a single, term, live viable infant at SAMMC. Discharged after 2 days. -DRG: 775 Vaginal Delivery w/o Complicating Diagnoses -RWP: 0.4056 -FY12 ASA Rate for SAMMC: $16,299.84 -Charge for care = $16,299.84 x 0.4056 = $6,611.22  Per Diem family member rates (FMR) developed by DoD; charge calculated based on length of stay -PATCAT determines if charge is Per Diem -Scenario: AD family member = A41 -Current Family Member Per Diem rate for FY12: $17.05 -Per Diem Charge = $17.05 x 2 = $34.10 8 Inpatient Charge Calculation, example

9.  Medical coding assigns CPT-4 or HCPCS code(s) for all health care services provided and documented -Evaluation and Management (E/M) codes -Laboratory Services -Radiology Services -Procedures -Immunizations -Durable Medical Equipment (DME) -Dental (CDT) -Anesthesia  TMA UBO develops annual Outpatient Itemized Billing (OIB) rates for these codes; discounts may apply (e.g., 10% or other agreed amount in DoD-VA Sharing Agreement)  Charge = sum of all rates for all coded services, less discount if applicable Outpatient Charge Calculation 9

10.  Prescriptions have rates assigned to the National Drug Code (NDC)  TMA UBO biannually develops pharmacy rates and dispensing fee (generally effective February and July)  Prescription charge = TMA UBO rate per NDC x quantity dispensed + dispensing fee  Rates, dispensing fee and pharmaceutical price estimator tool available on the TMA UBO Website at http://tricare.mil/ocfo/mcfs/ubo/mhs_rates/pharmacy.cf m http://tricare.mil/ocfo/mcfs/ubo/mhs_rates/pharmacy.cf m 10 Outpatient Charge Calculation (cont.)

11.  TMA UBO annually develops Elective Cosmetic Surgery (ECS) rates included in the Outpatient Itemized Billing rates  ECS rates are available on the TMA UBO Website at http://tricare.mil/ocfo/mcfs/ubo/mhs_rates/cs.cfm http://tricare.mil/ocfo/mcfs/ubo/mhs_rates/cs.cfm  Contact your UBO Service Program Manager for authorization and assistance to obtain a copy of the TMA UBO Cosmetic Surgery Estimator Tool 11 Outpatient Charge Calculation (cont.)

12.  Each line item must match medical coding data  Discuss any discrepancies/questions with coders -Only coding personnel may change coding and should be performed prior to manually altering a bill  Create manual bills for “missed opportunities” such as: -Incorrect PATCAT, expired benefits, etc. -Visit data must be compiled from the various modules  Ambulatory Data Module (ADM) for office visits  Lab Inquiry for Laboratory Tests  Exam Inquiry for Radiology Exams  Prescription History for Filled Prescriptions Billing Checklist 12

13.  Refer to Service-specific guidelines  DoD TMA UBO User Guide -http://www.tricare.mil/ocfo/mcfs/ubo/policy_guidance/userg uide.cfmhttp://www.tricare.mil/ocfo/mcfs/ubo/policy_guidance/userg uide.cfm  TMA UBO Website -http://tricare.mil/ocfo/mcfs/ubo/billing.cfmhttp://tricare.mil/ocfo/mcfs/ubo/billing.cfm -http://tricare.mil/ocfo/mcfs/ubo/mhs_rates.cfmhttp://tricare.mil/ocfo/mcfs/ubo/mhs_rates.cfm  TMA UBO Helpdesk -UBO.Helpdesk@altarum.orgUBO.Helpdesk@altarum.org -(703) 575-5385 13 Additional Resources

14.  To Print Outpatient Itemized Billing Preview List -MSA  OIB  IBP  Lists outpatient accounts in “pending” & “billed” status (3- + 14-day hold)  Validate/verify each pending account  To Exclude any non-chargeable outpatient services -MSA  CFM  CLK  Change status to “billed” -Avoids looking at same bill the next day  To Print current inpatient and outpatient bills from Nightly Processing Menu -MSA  NPM  PRT Daily Billing Routines 14

15.  To Write Off any non-chargeable inpatient services -MSA  CFM  CLK  To Clear Print queue -MSA  NPM  CLQ  To Print, Review, or Clear Notify Roster -MSA  MSR  NRR  Identifies accounts with issues that need correction such as bad/missing addresses, expired NDCs, etc.  Reprint corrected bills  Mail invoices Daily Billing Routines (cont.) 15

16.  Attempt to collect payment from the patient at time of discharge  Verify demographic data to avoid “undeliverable” mail  Make every effort to collect accounts receivable before they become delinquent  Coordinate for “payment plan” if the patient cannot pay the full amount ($50 Minimum, not to exceed 3 years)  Write-off debt according to policy and regulation  Conduct proper “due-process” before transferring debt to DFAS Collecting Payments 16

17.  The MSA officer shall ensure change funds and other funds are not used to cash personal checks, postal money orders, or other negotiable instruments for the convenience of individuals.  Change funds may not be recorded in the cash and sales journal, nor included as a part of daily receipts  Personal checks shall only be accepted for the amount due Change Fund 17

18.  Be specific in listing cash and money orders by amounts, check numbers, and articles of jewelry. Jewelry shall be referred to as “gold in color” instead of “gold ring,” and include any identifying marks or inscriptions  Valuables shall be tagged, and a receipt shall be given to the patient  The MSA office may not accept personal firearms, knives with blades above the length permitted by law and regulation, or any other item or object that may be considered a menace to safety or health Patient Valuables 18

19.  Maintain an accounting record of all applicable medical and dental service charges and collections  Establish an accounts receivable for any health-related services or supplies requiring payment from an outside activity  Ensure deposits agree with the automated system  Ensure postings to patient accounts equal amounts received and deposited  Prepare and submit financial reports according to Service guidelines Accounting 19

20.  Billing -Validate the PATCAT to generate the proper amount due -Ensure that a bill is generated “correctly” for each patient -Validate demographics prior to mailing the bill, claim, or invoice -Educate the MTF staff (A&D/Clinic staff) on billing procedures (SEC Army Designee, etc.)  Collections -Make every effort to collect accounts receivable before they become delinquent -Conduct proper “due-process” before transferring debt to DFAS Summary 20

21.  Accounting -Ensure deposits agree with the automated system -Ensure postings to patient accounts equal amounts received and deposited  General -“Always” refer to the UBO Manual and specific Service regulations -Don’t take shortcuts -Keep your leadership informed and involved Summary (cont.) 21

22. Questions and Review 22

23.  This live Webinar broadcast has been approved by the American Academy of Professional Coders (AAPC) for 1.0 CEU credit. 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, but to receive it participants must login with their: 1) full name; 2) Service affiliation; and 3) e-mail address prior to the broadcast. If more than one participant is viewing the Webinar on one computer or mobile device, then the names and e-mail addresses of each participant who wishes to receive CEU credit must be entered into the Q&A pod below the presentation screen. If a participant cannot login and requires a dial in number to hear the Webinar, then for CEU credit he/she must e-mail the UBO.LearningCenter@altarum.org within 15 minutes of the end of the live broadcast with “request CEU credit” in the subject line. Participants must also listen to the entire Webinar broadcast. At the completion of the broadcast, the Certificate of Approval with Index Number will be sent via e-mail only to participants who logged in prior to the broadcast and provided their full name and e-mail address as required. UBO.LearningCenter@altarum.org  Participants may also view and listen to the archived version of this Webinar—which will be posted to the UBO Learning Center shortly after the live broadcast--for one (1.0) AAPC approved CEU credit. To receive this credit, after viewing the archived Webinar, they must complete a ten (10) question minimum post-test that will be available on the UBO Learning Center and submit their answers via e-mail to ubohelpdesk@altarum.org. If at least 70% of the post-test is answered correctly, participants will receive via e-mail a Certificate of Approval and Index Number.ubohelpdesk@altarum.org 23 Instructions for CEU Credit

24.  Participants may not alter the original Certificate of Approval. CEU 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, please contact the AAPC concerning CEUs and its policy. 24 Instructions for CEU Credit, cont.

25.  Participants certified with the American Health Information Management Association (AHIMA) may self-report AAPC CEUs for credit at https://secure.ahima.org/certification/ce/cereporting/.  The American College of Healthcare Executives (ACHE) grants one (1.0) Category II ACHE educational credit hour per one (1.0) hour executive/management-level training course or seminar sponsored by other organizations toward advancement or recertification. Participants may self- report CEUs on their personal page at http://www.ache.org/APPS/recertification.cfm.  The American Association of Healthcare Administrative Managers (AAHAM) grants one (1.0) CEU unit “for each hour in attendance at an educational program or class related to the health care field” for AAHAM-credentialed participants who self-report using AAHAM’s on-line CEU tool. Participants may self-report CEUs during their recertification process at http://www.aaham.org/Certification/ReCertification/tabid/76/Default.aspx. 25 Other Organizations Accepting AAPC CEUs