Briefing: MSA Billing Date: 19 March 2007 Time: 1110 – 1200

1. Briefing: MSA Billing Date: 19 March 2007 Time: 1110 – 1200

2. Objectives • Discuss what occurs when a TPCP Inpatient Claim is denied, and how that affects MSA • Demonstrate and explain billing for : • Subsistence • Family Member Hospitalization • Coast Guard • VA • Foreign Military

3. Effect of Inpatient TPC Denial on MSA • What happens when an inpatient TPC account is closed in the CHCS MSA module? • When a 100% denial is received and the appropriate reason code for the denial is entered into the TPC account, an MSA is automatically generated for the appropriate charge based on the Patient Category • The “clock” starts for the MSA Accounts Receivable

4. Subsistence Subsistence (SR) The daily charge to all Active Duty Members and retired officers for food while hospitalized as an inpatient. Prior or Iraq war, all Active Duty and retired officers were charged. In FY06 this charge was suspended; the suspension was recently extended through FY07 Prior to the suspension of the charge, MSA automatically calculated the SR charges from the date of admission to the day prior to discharge, creating a one-day charge if the patient was admitted and discharged on the same day The Subsistence charge may still be applied to Secretary Designee patients. If designated in the Secretary Designee letter, MSA will calculate the appropriate charge based on the PATCAT assigned

5. Family Member Hospitalization Family Member Hospitalization (FMR) The daily charge to all Active Duty Family Members not enrolled in TRICARE Prime and All Family Members of Retirees. The Family Member Charge is not only a charge for food; this charge was developed to cover the cost for meals and defray the costs for contracted services associated with an inpatient hospital stay (e.g., laundry, housekeeping, local telephone calls) MSA automatically calculates the SR charges from the date of admission to the day prior to discharge. Creating a one-day charge if the patient was admitted and discharged on the same day

6. Coast Guard Coast Guard, Public Health Service, and NOAA (PATCATs beginning with C , P, and B) • DD7 and DD7A Bills are generated by CHCS • DD7 – Inpatient Bill • Once coded by PAD in the Encoder Grouper (which calculates the DRG), CHCS MSA calculates the charge for the admission at the Inter-Agency Rate (IAR). The DD7 report can be printed and submitted to the USCG, NOAA, or PHS with an SF1080 as the coversheet —Continued—

7. Coast Guard • DD7A – Outpatient Bill • Once coded by the Outpatient Clinic staff in the ADM Module of CHCS, and released from CCE by the Outpatient Coders, the coding information is passed to CHCS MSA, which calculates the charge for each CPT-4, HCPCS, or CDT code at the Inter-Agency Rate (IAR). Ancillary services are generated when the service is performed and entered into the LAB, RAD, or Pharmacy module in CHCS. At the same time, the information is passed to CHCS MSA and charges are calculated at the IAR • DD7A report can be printed and submitted to the USCG, NOAA, or PHS with an SF1080 as the coversheet

8. VA VA – PATCAT K61 The same process as the DD7 and DD7A

9. Foreign Military Foreign Military

10. Foreign Military • Inpatient Bill • Once coded by PAD in the Encoder Grouper (which calculates the DRG), CHCS MSA calculates the charge for the admission at the appropriate rate for the PATCAT. Either the DD7 or the Invoice & Receipt (I&R) DD7 report is created and can be printed and submitted • Outpatient Bill • Once coded by the Outpatient Clinic staff in the ADM Module of CHCS, the outpatient encounter is released from CCE by the outpatient coders. Ancillary services are generated when the service is performed and entered into the LAB, RAD, or Pharmacy module in CHCS. When the information is passed to CHCS, MSA charges are calculated for each CPT-4, HCPCS, CDT code, or prescription at the appropriate rate for the PATCAT