1. Financial Statements & Accounting Data
WELCOME
With TMA for 6 years As a GOVERNMENT EMPLOYEE
Twelve (12) years as an IT consultant supporting MHS
TMA Office of the Chief Financial Officer (OCFO)
Management Control & Financial Studies Division

2. Outline Financial Statement Reporting Requirement
Legacy Accounting Systems
Medical Accounts Receivable (A/R)
Overview of Presentation
Financial Statement – how structured for TMA and the Service Medical Departments
Issue of accounting for Medical Accounts receivable – What Are They and Why We Need to Account for Them
Review of an Internet-Based Tool available for MTF use in Planning

3. Fiscal Management Requirements
CFO Act of 1990: Integrated Financial Management (FM) systems supporting DoD accounting needs are key to effective financial management
Federal Financial Management Improvement Act (FFMIA) of 1996: All Federal agencies to comply
Implement/maintain systems that meet Federal FM system requirements (Joint Financial Management Improvement Program (JFMIP))
Support Federal accounting standards (Federal Accounting Standards Advisory Board (FASAB))
Apply US Standard General Ledger (USSGL) at the transaction level
Proposed FY 2011 Presidential Budget requested $548.9 billion plus an additional $159.3 billion for overseas contingency operations (OCO) – formerly was GWOT (Global War on Terrorism)
Total of $708.2 Billion Requested – How well does DoD spend their funds and what did we get for them?
Independent auditor's declaration that he or she has no reservation in certifying that the audited firm's financial statements (1) adequately disclose material information, (2) present fairly its financial position, and (3) show results of its operations in conformity with the provisions GAAP. Also called clean opinion.

4. MHS Financial Statement Reporting Entities (FSREs)
Financial Statements
MHS Financial Statement Reporting Entities (FSREs)
MHS
MERHCF 1
DHP 3
MILCON 3
TRICARE Mgmt.
Activity (TMA)
Service Medical
Activity (SMA)
The Services have been reporting their financial statements for several years. Needed to separate out healthcare financial and accounting numbers.
Service Medical Activity (SMA) for each of the three Services were created to be able to account for healthcare financial numbers separately
Potentially, JTF CapMed may become a fourth SMA FSRE
Components Under Audit – Qualified Opinion for MERHCF & CRM
TMA - FOD
TMA – CRM 1
TMA-USUHS 2
SMA – Army
(MEDCOM) 4
(USACE) 5
SMA – Navy
(BUMED) 4
(NAVFAC) 5
SMA – Air Force
(AFMS) 4
(USAFE) 5
MERHCF: Medicare-Eligible Retiree Health Care Fund
DHP: Defense Health Program Appropriation
MILCON: Military Construction Appropriation
FOD: Financial Operations Division
CRM: Contract Resource Management
USUHS: Uniformed Services University
MEDCOM: Army Medical Command
BUMED: Navy Bureau of Medicine and Surgery
AFMS: Air Force Medical Service
USACE: U.S. Army Corps of Engineers
NAVFAC: Naval Facilities Engineering Command
USAFE: U.S. Air Forces in Europe
(1) Under Audit
(2) All Proprietary Statements Validation Through Examination In Process
(3) Includes American Recovery and
Reinvestment Act (ARRA) Funding
(4) Executes DHP Funds
(5) Executes MILCON Funds

5. Accounting Data FSRE Legacy Enterprise Business Rules Command Control
TMA
WAAS
DAI
USUHS
CUFS
Army
STANFINS
GFEBS
Navy
STARS-FL
Navy ERP
Air Force
GAFS-R
DEAMS
Multitude of accounting systems
Breakout with the acronyms spelled out for the accounting systems supporting us
CUFS – College and University Financial System

6. Accounting System Acronyms
CUFS – College and University Financial System
DAI – Defense Agency Initiative
DEAMS – Defense Enterprise Accounting and Management System
FSRE – Financial Statement Reporting Entities
GAFS-R – General Accounting Financial System - Revised
GFEBS – General Fund Enterprise Business System
STANFINS – Standard Army Finance Information System
STARS-FL – Standard Accounting and Reporting System - Field Level
TMA – TRICARE Management Activity
USUHS – Uniformed Services University of the Health Sciences
WAAS – Washington Headquarters Services (WHS) Allotment Accounting System

7. Fiscal Management Requirements
Office of Management & Budget (OMB)
Use commercial off-the-shelf (COTS) JFMIP-certified software for replacement of core FM systems (OMB Circular A-127)
New Service FM COTS are JFMIP-certified
Army – General Fund Enterprise Business System (GFEBS)
SAP COTS
Navy – Navy Enterprise Resource Planning (ERP)
Oracle COTS
Air Force – Defense Enterprise Accounting and Management System (DEAMS)
General Fund Enterprise Business System, or GFEBS, is a web-based enterprise resource planning solution built on SAP

8. What is SFIS? Standard Financial Information Structure (SFIS)
A comprehensive, standard “business language” that defines financial information that supports all DoD-wide budget, cost/performance management, and external reporting requirements
SFIS is NOT an IT system

9. Financial Statements FSRE Structure Challenges
TMA clear chain of command and organizational structure
MERHCF actuarial and accounting information
SMA components have two lines of authority (command and control, and finance business rules) vs dollar flow. Face issues related to MILDEP priorities vs fund flow priorities: financial impact, accounting system, financial business rules

10. Financial Statements FSRE Structure Challenges (continued)
Solution: single accounting system with common business rules and chain of command simplifies, streamlines the financial statement, financial reporting, financial performance reporting

11. Budget Execution - O&M As of 30 June 2010

12. Budget Execution - O&M As of 30 June 2010

13. Budget Execution Performance-O&M As of 30 June 2010

14. Budget Execution Performance-O&M As of 30 June 2010

15. Budget Execution – RDT&E As of 30 June 2010

16. Budget Execution – RDT&E As of 30 June 2010

17. Budget Execution Performance-RDT&E As of 30 June 2010

18. Budget Execution Performance-RDT&E As of 30 June 2010

19. Budget Execution - Procurement As of 30 June 2010

20. Budget Execution – Procurement As of 30 June 2010

21. Budget Execution Performance – Procurement As of 30 June 2010

22. Budget Execution Performance – Procurement As of 30 June 2010

23. Financial Metrics Monthly Reporting, History and Measures
Accounts Receivable (A/R) Public debt > 30 days at Sep 30, 2009 (Red Metric)
SMA-Army ($22.5 million)
A/R Intragovernmental Debt > 30 days at Sep 30, 2009 (Red Metric)
SMA-Army ($17.7 million)
SMA Navy ($17.3 million)
SMA A/R increased dramatically in 1st Qtr FY 2010 when recording begins
OSD Comptroller – Robert Hale gets a monthly Dashboard Report showing how DoD is doing regarding financial reporting
One of the items tracked is Accounts Receivable (A/R)
Public Debt – Non-Federal Government Entities who owe us money. Includes third party insurance companies and individuals (e.g., DoDDS school teachers, Civilian Emergencies)
Medical Departments were NOT reporting Medical A/R until the start of this FY (i.e., FY 2010)

24. DoD References
DoD Financial Management Regulation (FMR), Volume 4, Chapter 3, “Receivables” dated November 2009
DoD Financial Management Regulation (FMR), Volume 6B, Chapter 10, “Notes to Financial Statements” dated September 2008
Located at OSD (Comptroller) Web site:
FMR has 20 volumes – It’s our FINANCIAL BIBLE
Sections of it are continually being updated so go to the OSD (Comptroller) website to find the latest version
Looking at having the Receivables section revised to treatment Medical A/R differently

25. Accounts Receivable (A/R)
Two types of A/R in governmental accounting
Intra-governmental (e.g., Coast Guard, VA)
Expect to get paid 100% of Billed Amount
Disputes regarding claims against other federal agencies (e.g., Coast Guard, VA) are to be resolved per Code of Federal Regulations CFR 101
Public (civilian emergencies, TPC)
Need to establish an allowance for bad debt
MTFs may be reporting collections to higher headquarters but what data is reported regarding outstanding and aged (e.g., >30 days, >120 days) Medical A/R?
Just a quick review of the two types of A/R and how they are treated differently when it comes to establishing Allowances for Bad Debt.
Expect to have VA and Coast Guard to Pay us in Full – 100%

26. Third Party Collections
Total Third Party Collections (TPC) Billings were in FY 2009 were $496.0 million
Total TPC Collections in FY 2009 were $240.7 million
How much is really being written off as uncollectible, and how much is still on the books as Medical A/R?
What are the sources of Medical A/R?
Collected almost $2.5 Billion ($ Billion) since FY 1987

27. Medical Services Account (MSA)
Combination of both Intra-governmental A/R (e.g., Coast Guard, VA) and Public A/R (e.g., civilian emergencies)
Total MSA amount collected for medical care provided in MTFs for FY 2009 was $151 million

28. Medical Affirmative Claims (MAC)
Medical Affirmative Claims (MAC) A/R is all Public A/R (e.g., insurance companies, liable individuals)
Total amount collected for medical care provided in MTFs for FY 2009 was $15 million

29. Doubtful Accounts & Write-offs
FMR guidance states:
The accounting office shall establish an allowance for doubtful debt, which shall provide for reducing gross receivables by the amount of the estimated loss to their net realizable value
A write-off occurs when an agency official determines, after using all appropriate collection tools, that is it more than 50% likely that a debt is uncollectible

30. Service Financial Statements
A/R are reported on the annual audited financial statements
Service Financial Statements located at OSD(Comptroller) Web site:

31. Accounts Receivable - Policy
Accounts Receivable Policy Memorandum (with attachment)
Policy signed on May 8, 2008
Purpose
Establish policy for the recognition (“as rendered”), classification, recording, aging, collection, disposition and reporting of accounts receivable in order to improve the accuracy of financial statements
Compliance with DoD’s Financial Management Regulation (FMR) and Generally Accepted Accounting Principles (GAAP)
Policy signed back in Delays encountered in implementing it due to IT system limitations.
1st quarter FY 2010 (current FY) is when this started being implemented across all three Services.

32. Accounts Receivable – Policy (con’t)
Implementation Date
1 October 2009 (for FY 2010 reporting purposes)
Title 10 United States Code, Chapter 55, Section 1095
This policy does not modify the ability of the Services to use monies collected in the fiscal year collected 10 U.S.C. 1095(g) reads as follows: "Amounts collected under this section from a third-party payer or under any other provision of law from any other payer for health care services provided at or through a facility of the uniformed services shall be credited to the appropriation supporting the maintenance and operation of the facility and shall not be taken into consideration in establishing the operating budget of the facility."
Bottom Line – Money collected stays with the MTF. It is not scooped up and taken away by Higher Headquarters.

33. Financial Metrics - SMA
Implementation of Medical A/R Policy in 1st Quarter of FY 2010 had a large impact
Accounts Receivable (A/R) Public Debt > 30 days at July 31, 2010 (Red Metric)
SMA-Army ($213.9 million),
SMA-Navy ($5.6 million)
SMA-Air Force ($ 78.0 million)
Total reported Medical A/R was $527.9 million
Army reported $22.5 million of Medical A/R as of 30 Sep 2009/end of FY 2009
Navy & Air Force reported ZERO DOLLARS for Medical A/R
Suddenly, we found over ½ billion dollars of assets

34. Financial Metrics -TMA
Implementation of MARR A/R in 4th Quarter of FY 2009 had a large impact
Accounts Receivable (A/R) Public debt > 30 days at Mar 31, 2010 (Red Metric)
TMA-CRM ($175.0 million)
Army reported $22.5 million of Medical A/R as of 30 Sep 2009/end of FY 2009
Navy & Air Force reported ZERO DOLLARS for Medical A/R
Suddenly, we found over ½ billion dollars of assets

35. Management of Accounts Receivable
Revenue Recognition
All Defense Health Program (DHP) funded activities will recognize and record a receivable when it establishes a claim based on goods or services provided (“as rendered”)
Financial statements have two A/R classifications:
Intragovernmental and Nonfederal (public)
Debt Management (Debt Collection Improvement Act (DCIA)
Working with OUSD(C) to potentially add language to the FMR to better clarify medical debt and when to “turn-it over” to DFAS
Can’t bill for the healthcare services until the encounter/admission is coded/DRG assigned.
Why does it take so long to code/assign a DRG to a healthcare encounter when we having reimbursement riding on it
3% of Non-Active Duty Admissions are Reimbursable

36. Management of Accounts Receivable (continued)
Proprietary vs. Budgetary
Recommended accounting entries are: Debit USSGL 1310 (Accounts Receivable) and credit USSGL 6790 (Other Expenses Not Requiring Budgetary Resources)
This will ensure a correct financial statement entry without the potential for a appropriation violation and maintain USC 1095 flexibility

37. Accounts Receivable - Revenue Recognition
All Defense Health Program (DHP) funded activities will recognize and record a receivable when it establishes a claim based on goods or services provided (“as rendered”)
There are two classifications of accounts receivables:
Intragovernmental
Nonfederal

38. Accounts Receivable - Going Forward
Accuracy in reporting
Accounts receivable reports will be better than what we have now
Reports will include aging data
Visibility of all accounts (including TPC accounts receivable older than prior year 2)
Will become more accurate as procedures, systems and data collection become more standardized
Central reporting will improve as funded systems change request have been submitted to:
“Push” accounts receivable data from TPOCS and CHCS/AHLTA (both MSA and inpatient TPC), and
Calculate interest in both MSA and TPOCS
Medical A/R is NOT LIKE WINE OR CHEESE – They do NOT get better with age

39. Accounts Receivable - Going Forward
Do not want to impact ability for billing contractors to develop and/or use their own billing management system
Possibility of accounts marked as transferred in MSA, but documentation never forwarded to the Defense Finance and Accounting Services (DFAS) Support Center
Some joint ventures are generating Department of Veterans Affairs bills on Excel spread sheets
Air Force has TPC being performed by Two (2) civilian companies

40. Accounting System – Going Forward
SMA Audit Committee will work with the SMA – Army, SMA – Navy, and SMA – Air Force to establish procedures for recording AR
Provide your UBO Service Manager and Service RM monthly AR data in the following categories:
Intragovernmental
MSA, TPOCS, Unbilled, changes to Allowance
Nonfederal

41. Accounts Receivable Service Points of Contact
Army –
Navy –
Air Force –

42. Outline Financial Statement Reporting Requirement
Legacy Accounting Systems
Medical Accounts Receivable (A/R)

43. Questions? TMA OCFO/MC&FS
Served as UBO Program Manager from 1 July 2008 to 5 July 2009
New UBO Program Manager & Deputy Program Manager
Let us know what your questions are?