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Briefing: The Rest of the Worms (CMBB, CDML, GFEBS, SFIS…THISISCRAZY) Date: 22 March 2007 Time: 1110 - 1200

Briefing: The Rest of the Worms (CMBB, CDML, GFEBS, SFIS…THISISCRAZY) Date: 22 March 2007 Time: 1110 - 1200. Objectives. Provide a brief overview of various UBO-related acronyms, programs, projects, and buzzwords

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Briefing: The Rest of the Worms (CMBB, CDML, GFEBS, SFIS…THISISCRAZY) Date: 22 March 2007 Time: 1110 - 1200

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  1. Briefing: The Rest of the Worms (CMBB, CDML, GFEBS, SFIS…THISISCRAZY) Date: 22 March 2007 Time: 1110 - 1200

  2. Objectives • Provide a brief overview of various UBO-related acronyms, programs, projects, and buzzwords • Answer questions raised by attendees regarding other UBO-related acronyms, programs, projects, and buzzwords • Solicit feedback from attendees regarding other topics/items that TMA UBO should address in future TMA UBO educational programs and/or or newsletters

  3. COTS & GOTS • Is not what you slept on at summer camp as a child • Commercial Off-The-Shelf (COTS) system • CMBB – GE Centricity/IDX Flowcast • Lab COTS – Cerner • Government Off-The-Shelf (GOTS) system • CHCS is a GOTS • MHS moving to using existing COTS systems rather than spending money for developing a MHS GOTS • Adopt the use of commercial best practices in healthcare when we use COTS products

  4. GFEBS • General Fund Enterprise Business System (GFEBS) • An Enterprise Resource Planning (ERP) system designed to replace the Standard Army Finance System (STANFINS), the Defense Joint Accounting System, and the Standard Operation and Maintenance Army Research & Development System (SOMARDS) • Uses a COTS ERP package from SAP • Requirements validation and integration is currently underway • GFEBS Release 1.3 will begin being deployed to Army MTFs in August 2008 • Deployment of GFEBS Release 1.3 to Army MTFs is currently scheduled to be completed by June 2010

  5. CMBB • Charge Master Based Billing (CMBB) • Uses Commercial Off-the-Shelf (COTS) system • Systems configuration currently underway • Milestone C Decision currently scheduled for July 2008 • Authorizes deployment of CMBB to 3 to 6 MTFs for “real world” operational testing • Scheduled to take 12 months • Full deployment of CMBB • Begins 4th Qtr of FY 2009 • Ends 1st Qtr of FY 2011 • Scheduled to take 18 months

  6. IDX Flowcast & GE Centricity • IDX is the company that developed the COTS application that was purchased for use by CMBB • Flowcast is the brand name of the IDX patient accounting product that CMBB bought for use by the MHS • GE Healthcare purchased IDX in 2005 and rebranded IDX Flowcast as part of their GE Centricity suite of healthcare software applications

  7. CDML • Charge Description Master List (CDML) • List of all items for which CMBB has a charge/price • Usually called a Charge Description Master (CDM) in the civilian healthcare world • We call it CDML since the CDM acronym is already used for the Clinical Data Mart (CDM)

  8. 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 • http://www.defenselink.mil/dbt/sfis_resources.html

  9. CSET Version 3.0 • Cosmetic Surgery Estimator Tool (CSET) Version 3.0 • TMA UBO developed software tool for use in estimating the cost of elective cosmetic surgery • Cosmetic surgery patient pays the estimated amount before the procedure can occur • Version 3.0 will be the most current available for use by MTFs • Replaces Version 2.0 currently in use by MTF UBOs • Version 3.0 currently in development • Will be deployed to MTF UBOs in June 2007 • Service UBO Managers determine which MTFs get the CSET

  10. PPET • Pharmacy Pricing Estimator Tool (PPET) • Microsoft Access-based software application that pay patients can use to calculate their pharmacy prescription bill prior to having their prescription filled by the MTF pharmacy • Enables pay patients to compare prices • Pay patients enter their drug prescription name, dosage strength, and quantity into the PPET • Calculated price will include the $8.00 MHS prescription dispensing fee • PPET will be deployed to MTFs by June 2007 prior to deployment of the new pharmacy pricing update • Envisioned that the PPET will be located in the MTF UBO for use by pay patients

  11. HIPAA • Health Insurance Portability and Accountability Act (HIPAA) – P.L. 104-191 • Also known as Kennedy-Kassebaum Bill (K2) or Kassebaum-Kennedy, depending on your party affiliation • House of Representatives passed it 421-2 • Senate passed it unanimously • Signed into law on August 21, 1996, by President Clinton

  12. HIPAA Components • Insurance Portability • Accountability (Fraud & Abuse) • Administrative Simplification

  13. Intents of HIPAAAdministrative Simplification • Reduce Paperwork • Improve Efficiency of Health Systems • Protect Security and Confidentiality of Electronic Health Information

  14. Standard Notice of Proposed Rule Making (NPRM) Final Rule Publication Compliance Required Transactions & Codes Sets 05/07/1998 08/17/2000 10/16/2003 - with extension National Provider Identifier 05/07/1998 01/23/2004 05/23/2007 (2008<$5M) National Employer Identifier 06/16/1998 05/31/2002 07/30/2004 (2005<$5M) Security 08/12/1998 02/20/2003 04/20/2005 (2006<$5M) Privacy 11/03/1999 12/28/2000 04/14/2003 (2004<$5M) Timetable for Adoption of Standards

  15. HIPAA-Covered Transaction Sets • 837 – Health Care Claim (3 types) • Institutional • Professional • Dental • Retail Pharmacy Drug Claim • National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard Implementation Guide, Version 5.1, September 1999 • NCPDP Batch Standard Batch Implementation Guide, Version 1.1, January 2000 —Continued—

  16. HIPAA-Covered Transactions Sets • 270/271 – Health Care Eligibility Benefit Inquiry and Response • 276/277 – Health Care Claim Status Request and Response • 278 – Health Care Services Review • 820 – Payroll Deducted and Other Group Premium Payment for Insurance Products • 834 – Benefit Enrollment and Maintenance • 835 – Health Care Claim Payment/Advice • 837 – Coordination of Benefits

  17. 275 – Electronic Claim Attachment • New proposed HIPAA Transaction Set in development • Will simultaneously use both ANSI X12 and HL7 EDI standards • Six different attachment types proposed • Clinical Reports • Laboratory Results • Medications • Rehabilitation Services • Ambulance Service • Emergency Department

  18. NCPDP • National Council for Prescription Drug Programs (NCPDP) • Develops and maintains the EDI standard used by retail pharmacies to bill prescription claims • Version 5.1 is the approved HIPAA standard currently used by retail pharmacies

  19. ANSI ASC X12N & IGs • ANSI – American National Standards Institute • ASC X12 – Accredited Standards Committee (ASC) chartered by ANSI to develop standards for inter-industry electronic business transactions (EDI) • X12N – is the Subcommittee for Insurance who developed the HIPAA EDI standards • IGs – Implementation Guides that provide detailed formats for implementing the HIPAA EDI standards • Version 4010A of the HIPAA IGs is the standard • National Council for Prescription Drug Programs (NCPDP) developed standards for retail pharmacy drug claims

  20. ICD-9-CM • ICD-9-CM – International Classification of Diseases – Clinical Modification for Diagnoses, 9th Edition (Volumes 1 and 2) • Modified U.S. version of ICD-9 developed by the World Health Organization • ICD-9-CM – International Classification of Diseases – Clinical Modification for Inpatient Procedures, 9th Edition (Volume 3) • Implemented in the U.S. in 1978

  21. ICD-10-CM & ICD-10-PCS • International Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10-CM) • U.S. version of ICD-10 developed by the World Health Organization (WHO) for reporting morbidity data in all healthcare setting • Maintained by National Center for Health Statistics (NCHS) and the Centers for Disease Control (CDC) • International Classification of Diseases and Related Health Problems, 10th Revision, Procedural Coding System (ICD-10-PCS) • Developed by CMS • Replaces the current inpatient procedural coding system included in ICD-9-CM • Earliest U.S. implementation might be 1 October 2009

  22. National Provider Identifier (NPI) • National Provider Identifier (NPI) • Health care providers began applying for NPIs beginning May 23, 2005 • Health care providers, health plans, and health care clearinghouses must begin using the NPI in standard transactions NLT May 23, 2007 • Small health plans have until NLT May 23, 2008 • Is a 10-position numeric identifier (last digit is a check figure) • Is an intelligence-free number • NPI Type 1 – for health care providers who are individual human beings • NPI Type 2 – for health care organizations

  23. Use of the NPI Type 1 in the MHS • HA Policy 05-002 issued 26 January 2005 regarding NPI Type 1 • Requires “all Health Care Providers who furnish billable health care services or who may initiate and/or receive referrals must obtain an NPI Type 1.” • Services are responsible for ensuring all privileged/credentialed providers (including Reserve Component) obtain and submit their NPI to the TMA designated data base/repository prior to 23 May 2007 • Services SGs have issued Memoranda of Instruction detailing Service-specific instructions • As of 27 February 2007, 19,711 NPI Type 1 identifiers have been entered into DMHRSi • Still need an estimated 8,711 more NPI Type 1 identifiers! • Only 64 days remaining until 23 May 2007 deadline

  24. Use of the NPI Type 2 in the MHS • HA Policy 05-012 issued 1 August 2005 regarding NPI Type 2 • Requires all organizational health care providers within the MHS to obtain an NPI Type 2. These include: • MTFs that bill third party insurers • Pharmacy dispensing Sites • The Services are responsible for ensuring all applicable organizational health care providers obtain NPI Type 2 identifiers prior to 23 May 2007 • As of 27 February 2007 • 128 NPI Type 2 identifiers for MTFs have been entered into DMHRSi • 600 NPI Type 2 identifiers for Pharmacy Dispensing Sites have been entered into DMHRSi • Only 64 days remaining until 23 May 2007 deadline

  25. UB-04 • New paper claim form that replaces the UB-92 • Health Plans and Clearinghouses need to be ready to receive the UB-04 form by 1 March 2007. Providers can begin to use the UB-04 beginning 1 March 2007 • Transitional period between 1 March 2007 and 22 May 2007 where either form (UB-92 or UB-04) can be used • Use of new UB-04 paper claim form required beginning 23 May 2007 • UB-04 paper claim form must be used for rebilling of discharges that occurred prior to 23 May 2007 even if originally billed on a UB-92

  26. UB-04 (con’t) • Require use of NPIs on the UB-04 beginning 23 May 2007 • MHS System Change Request (SCR) has been submitted for making changes to CHCS MSA module to support the new UB-04 paper claim format • CHCS software change package to support the UB-04 will be available for MTFs to load onto CHCS beginning in early May 2007 • MTFs need to start ordering the new UB-04 and CMS 1500 forms now

  27. Revised CMS 1500 • Use of new revised CMS 1500 Form required beginning 1 April 2007 • Prior version of CMS 1500 Form should be discontinued after 31 March 2007 • Beginning 1 April 2007, the revised CMS 1500 Form should be used for rebilling encounters with dates of service before 1 April 2007 even if originally billed on the old CMS 1500 Form • New form requires use of NPIs beginning 23 May 2007 • MHS System Change Request (SCR) has been submitted for making changes to TPOCS to support the new paper claim format • MTFs need to start ordering the new revised CMS 1500 forms as well as the new UB-04 forms now

  28. Other Topics That Need Addressing • What other UBO-related acronyms, programs, projects, and buzzwords would you like addressed during today’s session? • What other topics/items should TMA UBO address in future TMA UBO educational programs and/or or newsletters?

  29. Objectives • Overview of various UBO-related acronyms, programs, projects, and buzzwords • Questions from attendees regarding other UBO-related acronyms, programs, projects, and buzzwords • Feedback from attendees regarding other topics/items that TMA UBO should address in future TMA UBO educational programs and/or or newsletters

  30. Quiz • When does GFEBS arrive at my Army MTF? • Just what is IDX Flowcast? • What is the current CMBB timeline? • What is SFIS? • So what is CSET and PPET? • Do I need to buy my new ICD-10 coding books tomorrow? • Why do I care about NPIs? • What new form replaces the UB-92?

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