Title : Navy UBO Breakout Session: T-2- 0850

1. Title: Navy UBO Breakout Session: T-2-0850

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. 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 Session2011 MHS Revenue Cycle Educational ConferenceBUMED 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

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 UBO SOPs are required for execution starting April 1st and can be downloaded from the Navy Medicine FIP NKO site: https://wwwa.nko.navy.mil/portal/navymedicine/fip/home/sop

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 M84/10UM841822 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 M84/10UM841821 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 08-007, 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 08-027, 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 08-007, 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?