Briefing: How to Bill Surrogacy

1. Briefing: How to Bill Surrogacy Date: 24 March 2010 Time:1510 – 1600

2. Objectives • TODAY, WE WILL DISCUSS: • TRICARE Policy • Policy by Services • Sample Letter for Patients to Sign • How to Manually Enter Bills

3. TRICARE Policy • The TRICARE Reimbursement Manual 6010.55-M Chapter 4, Section 4, XIV, states “Contractual arrangements between a surrogate mother and adoptive parents are considered other coverage. TRICARE will cost share on the remaining balance of otherwise covered benefits related to the surrogate mother’s medical expenses after the contractually agreed upon amount has been exhausted. This applies where contractual arrangements for payment include a requirement for the adoptive parents to pay all or part of the medical expenses of the surrogate mother as well as where contractual arrangements for payment do not specifically address reimbursement for mother’s medical care. If brought to the contractor's attention, the requirements of TRICARE Operations Manual, Chapter 11, Section 5, paragraph 2.10. would apply.”

4. TRICARE Policy • So what does this mean? • If the surrogate mother identifies that she is in a contract with the adoptive parents that are non-DoD Beneficiaries and receiving money from the parents, then you can charge for the birth of the newborn • Out of a courtesy, we will bill the OHI of the adoptive parents, but the remaining balance is due by the adoptive parents…not the surrogate

5. Policy By Services • All Services agree that Official Policy needs to be drafted • Each Service has provided a “how to” if this situation occurs and we have provided these documents at the back of this briefing • Navy Comments (Pat Marshall):

6. Policy By Services • Air Force Comments (TSgt Alicia Mowery):

7. Sample Letter/Education • We have provided a sample letter in the back of this briefing to have a mother sign if your office finds out that she is a surrogate (just a sample; please get with your UBO Program Manager or MTF Leadership on an approved letter) • Important to sit down with your OB/GYN area and see if you can get on the checklist or include a letter • Most OB/GYN clinics do have a pre-admit or 35/36 week class • Great time to get them to sign • It is also important to educate providers of this policy • They are the ones that engage with the patient at least monthly

8. How to Enter Manual Bills • If newborn was not entered as a K99-Patient Not Elsewhere Classified, at time of birth then a manual bills will have to be created for newborn’s adoptive parents • If any outpatient care is received after the inpatient stay then these will also have to be manually entered IF not put in as a K99 • To manually entered a bill use one time post (OTP) • Menu Path is: • MSA (MSA System Menu) • CFM (Cashier Function Menu) • OPE (Outpatient Accounts Edit) • Enter patients name • It will ask if you want to open a new account select “Y” Yes • OTP (One Time Post) • Status Date is “T” for today • Enter VR for Variable Rate then type in service (inpatient or outpatient) • Quantity “1” • Enter dollar amount of procedure (if inpatient DRG cost will have to be calculated) • Enter through to save account

9. Let’s Review!!! • TODAY WE HAVE DISCUSSED: • TRICARE Policy • Policy by Services • Sample Letter for Patients to Sign • How to Manually Enter Bills