How to Assign and Use Patient Categories (PATCATs)

1. How to Assign and Use Patient Categories (PATCATs) 20 March 2012 0800-0900 EDT 22 March 2012 1400-1500 EDT From your computeror Web-enabledmobile devicelog into: http://altarum.adobeconnect.com/ubo.  Enter as a guest, then enter your name plusyour Service affiliation (e.g., Army, Navy, Air Force) for your Service to receive credit. 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-enabledmobile 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.orgso 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.”

2. Objectives Understanding Patient Categories (PATCATs) Importance of a Correct PATCAT Dissecting PATCATs PATCAT Positioning PATCAT Assignment PATCAT Assignment Issues PATCATs and Dual Eligible Patients VA PATCATs PATCAT and Updated Eligibility TRICARE Updates Regarding PATCATs AHLTA and PATCATs AF ePatient Data Integrity Management & Support Team

3. Understanding Patient Categories • What is a Patient Category (PATCAT)? • Assigning the PATCAT in CHCS will determine whether a patient is billable and what type of billing is appropriate for each episode of care • PATCATs can affect additional functional areas outside of billing in CHCS: • Categorizing the enrolled population • Workload accountability • Outpatient records, retirement procedures, and multiple other areas

4. Importance of a Correct PATCAT • What are the consequences of an incorrect PATCAT? • Incorrect billing (wrong rates, forms, sources, and patients) • Possible loss of revenue • Incorrect MTF workload • Inaccurate categorization of enrolled population • Poor data quality • Multiple systems receiving incorrect data • We’ve heard it time and time again, BAD DATA IN = BAD DATA OUT

5. Dissecting PATCATs • Currently there are 368 PATCAT codes identifying the patient population • Basic code covers a “category” of interest F11 = USAF ACTIVE DUTY K53 = OTHER FED AGENCY/DEPT EMPLOYEE • Sub-categories segment the group F11 A = USAF ACTIVE DUTY OFFICER F11 B = USAF ACTIVE DUTY ENLISTED K53 S = DOD SCHOOL TEACHER OUTSIDE THE US K53 T = OTHER DOD EMPLOYEE OUTSIDE THE US

6. PATCAT Codes – First Position • Sponsor’s Service • A = Army • B = National Oceanic and Atmospheric Administration • C = Coast Guard • F = Air Force • K = Other and Special categories • M = Marines • N = Navy • P = Public Health Service • R = Reciprocal Agreements (US with other nations)

7. PATCAT Codes – Second Position • Beneficiary Category • 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

8. DEERS • Information • Service • Component • Status • Special • Program CHCS Registration Function • MTF Research • Findings • ID Card • Birth Info • Orders • Contract Info • Etc, etc, etc. PATCAT (For Current Episode of Care) PATCAT Assignment Slide reprinted with permission from a previous UBO presentation

9. PATCAT Assignment • PATCAT assignments may be impacted depending on the type of registration used to register a patient: • Auto registration – CHCS automatically assigns a patient’s PATCAT if it can successfully translate the DEERS data • Mini or Full registration – MTF personnel registering a patient will manually assign the PATCAT in CHCS

10. PATCAT Assignment • Types of registration, cont. • Mail-In registration – Do not use for initial registration,since 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

11. PATCAT Assignment Issues • If CHCS cannot translate DEERS data during an auto registration, a PATCAT cannot be assigned, leaving the field null or resulting in a 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) • Screen for and edit during registration and patient file maintenance • An incomplete registration could result in a null PATCAT

12. PATCATs and Dual-Eligible Patients • By design, CHCS utilizes defined business rules between rank, Service, and Family Member Prefix (FMP) to determine valid PATCATs • PATCATs entered into CHCS should always reflect a person’s DEERS eligibility • Some dual-eligible patients may pose problems; the PATCAT cannot be changed for associated episodes of care (example: patient is dual eligible F41/K57)

13. Dual-Eligible Patients, cont. • Highly recommend MTFs avoid creating duplicate patients to resolve problems associated with dual eligibility • AF MTFs refer to NOTAM dated Oct 2010 • Register patients one time under the highest level of eligibility • Army/Navy procedures and instructions match Air Force • 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

14. VA PATCATs • K61 1 – Veterans Admin Beneficiary • K61 2 – DOD/VA Sharing Agreement • Enrolled beneficiaries utilizing VA services in a MTF require a PATCAT change prior to VA episode of care • PATCAT should be changed from *31 (Retired) to K61 • Once VA services are rendered the PATCAT should be edited to previous eligible PATCAT • Leaving the PATCAT at a K61 will affect: • Billing • Workload • Enrolled Capacities

15. PATCAT and Updated Eligibility DEERS ELIGIBILITY DATA Name: PATIENT,EXAMPLE M FMP/SSN: 20/1XX-XX-XXXX Patient Category: USAF ACTIVE DUTY SEX/DOB/AGE: M/27Oct1961/45Y ───────────────────────────────────────────────────────────────────────── Eligibility Date: 22 Jan 2007 Name First: EXAMPLE Sponsor SSN: 1XX-XX-XXXX Middle: M Branch of Service: AIR FORCE Last: PATIENT Pay Grade: 07 Cadency: Sponsor Cat Code: Retired DOB: 27 Oct 1961 Sponsor Rank: SERGEANT Sex: MALE Sponsor UIC: Relationship: Self UIC Zip Code: HCDP Code: 117 Type: MEDICAL Enr DMIS ID: 1XXX TRICARE PRIME FAMILY COVERAGE FOR RETIRED AND MEDAL OF HONOR SPONSORS AND FAMILY MEMBERS HCDP Start Date: 22 Jan 2007 Region Code: 1X HCDP End Date: 22 Jan 2007 Network Provider: Direct Care Net WII HCDP Code: HCDP Start Date: HCDP End Date: ECHO Code: Sponsor DNA On File: Yes ECHO Start Date: ECHO End Date: ───────────────────────────────────────────────────────────────────────── PCM HCDP Demographics prInthElpeXit A patient’s PATCAT does not automatically update in CHCS when his/her DEERS eligibility has changed

16. TRICARE Updates Regarding PATCATs • TRICARE Reserve Select • New PATCATs associated with Health Care Delivery Program (HCDP) codes (418,419,420, and 421) • *36 – Retired Reservist • *37 – Retired Reservist Family Member • Once beneficiary turns 65 yrs of age, the PATCAT changes to normal retiree codes • TRICARE Young Adult Program • New HCDP codes associated with standard dependent PATCATs • HCDP codes from 422 to 432

17. AHLTA and PATCATs • Do not use AHLTA to verify or reference a patient’s PATCAT • AHLTA could display an incorrect PATCAT assigned to a patient from another CHCS host (“last in wins”) • If the PATCAT is incorrect in AHLTA, correct it in the CHCS host • The local CHCS host PATCAT is the relevant PATCAT, since billing is initiated via the CHCS data

18. ePatient Data Integrity Management & Support Team • Performs the following functions for Air Force MTFs: • Resolves patient demographic errors • PIT errors (compliments MTF efforts) • Merges CHCS duplicate patient records (compliments MTF efforts) • The effort includes resolving several PATCAT problems: • Null, incorrect, mismatched PATCATs • Army and Navy do not have similar centralized office • Army MTFs should go to their PAD & local CHCS offices • Navy MTFs should contact their PAD Officer(s). They follow BUMEDINST 6320.3B for eligibility/registration procedures.

19. ePatient Data Integrity Management & Support Team • MTF personnel still need to be diligent in correcting PATCATs • Combining our efforts with the MTF’s due diligence will enhance data quality and ensure proper billing • MTF Colleagues – PAD staff are your friends • Understanding who has what entitlement • Investigating and resolving possible PATCAT errors

20. Where to Get Help • 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 and Navy have no centralized office that handles this function • Army MTFs should contact their PAD & local CHCS offices • Navy MTFs should contact their PAD Officer. MTF PAD Officers may contact Mr. Skip Katon for add’l advice (floyd.katon@med.navy.mil)

21. TMA UBO Website Resources • The following resources and training materials are available at http://www.tricare.mil/ocfo/mcfs/ubo/patcat.cfm • Current PATCAT table • PATCAT on-line training module • PATCAT finder tool (Use this ‘logic flow’ tool to help identify a specific PATCAT code for a patient) • UBU Web Site: http://www.tricare.mil/ocfo/bea/ubu/index.cfm

22. Questions?

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25. Other Organizations Accepting AAPC CEUs 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.