Presentation Transcript

1. MSA Daily Duties How to Run Reports / Notify Roster 17 April 2012 0800-0900 EDT 19 April 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 Describe Medical Services Account (MSA) daily duties Describe when and how a bill is created Describe the process for preparing and running reports
3. Duties Billing Collections Financial accounting collections control accounts receivable deposits Change Fund Patient Trust Fund
4. Who and What We Bill Other Pharmacy Dental Services Ambulance Services Anesthesia Elective Cosmetic Surgery MSA Bills Patients Insurance Companies Other Federal Agencies Services Inside MTF Inpatient DRG-based (all Inclusive) Per Diem Outpatient Clinic Visits Ambulatory Procedures Ancillary Services DME/DMS Immunizations
5. How an MSA Bill Is Created Inpatient billing triggers Patient is DISCHARGED (Per Diem) Record is CODED (DRG) Outpatient billing triggers Outpatient Visit status of KEPT, WALK-IN, SICK-CALL Pharmacy Label is PRINTED Laboratory Test is CERTIFIED Radiology Exam is PERFORMED Radiology Film is INTERPRETED/READ
6. How an MSA Bill Is Created (cont.)  Other Factors Patient Category (PATCAT) Family Member vs. Civilian Emergency vs. Intergovernmental (Coast Guard, VA, etc.) TRICARE Prime Enrollee No charge for inpatient stay Rate Tables CMAC, Immunization, Dental, Pharmacy, etc. Location Service in New York may cost more than same service in Kansas MEPRS Codes/Clinics or CPT-4 Codes Visits to certain clinics may not be charged Some CPT-4 codes have no rate
7. Inpatient Charge Calculation Medical coding produces a Medical Severity-Diagnosis Related Group (MS-DRG) Every MS-DRG has an assigned Relative Weighted Product (RWP) DoD develops annually a Direct Care Inpatient Adjusted Standardized Amount (ASA) rate for each inpatient facility (includes costs of both inpatient professional and institutional services) Charge = MTF ASA Rate x RWP (See TMA UBO Website for ASA Rates and DRG weights http://tricare.mil/ocfo/mcfs/ubo/mhs_rates/inpatient.cfm) Rate discounts may apply per interagency agreements VA-DoD Resource Sharing Inpatient Institutional Billing Modified TRICARE DRG Payment Calculator available at http://tricare.mil/ocfo/mcfs/ubo/billing.cfm#Inpatient
8. Inpatient Charge Calculation, example Woman delivers a single, term, live viable infant at SAMMC. Discharged after 2 days. DRG: 775 Vaginal Delivery w/o Complicating Diagnoses RWP: 0.4056 FY12 ASA Rate for SAMMC: $16,299.84 Charge for care = $16,299.84 x 0.4056 = $6,611.22 Per Diem family member rates (FMR) developed by DoD; charge calculated based on length of stay PATCAT determines if charge is Per Diem Scenario: AD family member = A41 Current Family Member Per Diem rate for FY12: $17.05 Per Diem Charge = $17.05 x 2 = $34.10
9. Outpatient Charge Calculation Medical coding assigns CPT-4 or HCPCS code(s) for all health care services provided and documented Evaluation and Management (E/M) codes Laboratory Services Radiology Services Procedures Immunizations Durable Medical Equipment (DME) Dental (CDT) Anesthesia TMA UBO develops annual Outpatient Itemized Billing (OIB) rates for these codes; discounts may apply (e.g., 10% or other agreed amount in DoD-VA Sharing Agreement) Charge = sum of all rates for all coded services, less discount if applicable
10. Outpatient Charge Calculation (cont.) Prescriptions have rates assigned to the National Drug Code (NDC) TMA UBO biannually develops pharmacy rates and dispensing fee (generally effective February and July) Prescription charge = TMA UBO rate per NDC x quantity dispensed + dispensing fee Rates, dispensing fee and pharmaceutical price estimator tool available on the TMA UBO Website at http://tricare.mil/ocfo/mcfs/ubo/mhs_rates/pharmacy.cfm
11. Outpatient Charge Calculation (cont.) TMA UBO annually develops Elective Cosmetic Surgery (ECS) rates included in the Outpatient Itemized Billing rates ECS rates are available on the TMA UBO Website at http://tricare.mil/ocfo/mcfs/ubo/mhs_rates/cs.cfm Contact your UBO Service Program Manager for authorization and assistance to obtain a copy of the TMA UBO Cosmetic Surgery Estimator Tool
12. Billing Checklist Each line item must match medical coding data Discuss any discrepancies/questions with coders Only coding personnel may change coding and should be performed prior to manually altering a bill Create manual bills for “missed opportunities” such as: Incorrect PATCAT, expired benefits, etc. Visit data must be compiled from the various modules Ambulatory Data Module (ADM) for office visits Lab Inquiry for Laboratory Tests Exam Inquiry for Radiology Exams Prescription History for Filled Prescriptions
13. Additional Resources Refer to Service-specific guidelines DoD TMA UBO User Guide http://www.tricare.mil/ocfo/mcfs/ubo/policy_guidance/userguide.cfm TMA UBO Website http://tricare.mil/ocfo/mcfs/ubo/billing.cfm http://tricare.mil/ocfo/mcfs/ubo/mhs_rates.cfm TMA UBO Helpdesk UBO.Helpdesk@altarum.org (703) 575-5385
14. Daily Billing Routines To Print Outpatient Itemized Billing Preview List MSA  OIB  IBP Lists outpatient accounts in “pending” & “billed” status (3- + 14-day hold) Validate/verify each pending account To Exclude any non-chargeable outpatient services MSA  CFM  CLK Change status to “billed” Avoids looking at same bill the next day To Print current inpatient and outpatient bills from Nightly Processing Menu MSA  NPM  PRT
15. Daily Billing Routines (cont.) To Write Off any non-chargeable inpatient services MSA  CFM  CLK To Clear Print queue MSA  NPM  CLQ To Print, Review, or Clear Notify Roster MSA  MSR  NRR Identifies accounts with issues that need correction such as bad/missing addresses, expired NDCs, etc. Reprint corrected bills Mail invoices
16. Collecting Payments Attempt to collect payment from the patient at time of discharge Verify demographic data to avoid “undeliverable” mail Make every effort to collect accounts receivable before they become delinquent Coordinate for “payment plan” if the patient cannot pay the full amount ($50 Minimum, not to exceed 3 years) Write-off debt according to policy and regulation Conduct proper “due-process” before transferring debt to DFAS
17. Change Fund The MSA officer shall ensure change funds and other funds are not used to cash personal checks, postal money orders, or other negotiable instruments for the convenience of individuals. Change funds may not be recorded in the cash and sales journal, nor included as a part of daily receipts Personal checks shall only be accepted for the amount due
18. Patient Valuables Be specific in listing cash and money orders by amounts, check numbers, and articles of jewelry. Jewelry shall be referred to as “gold in color” instead of “gold ring,” and include any identifying marks or inscriptions Valuables shall be tagged, and a receipt shall be given to the patient The MSA office may not accept personal firearms, knives with blades above the length permitted by law and regulation, or any other item or object that may be considered a menace to safety or health
19. Accounting Maintain an accounting record of all applicable medical and dental service charges and collections Establish an accounts receivable for any health-related services or supplies requiring payment from an outside activity Ensure deposits agree with the automated system Ensure postings to patient accounts equal amounts received and deposited Prepare and submit financial reports according to Service guidelines
20. Summary Billing Validate the PATCAT to generate the proper amount due Ensure that a bill is generated “correctly” for each patient Validate demographics prior to mailing the bill, claim, or invoice Educate the MTF staff (A&D/Clinic staff) on billing procedures (SEC Army Designee, etc.) Collections Make every effort to collect accounts receivable before they become delinquent Conduct proper “due-process” before transferring debt to DFAS
21. Summary (cont.) Accounting Ensure deposits agree with the automated system Ensure postings to patient accounts equal amounts received and deposited General “Always” refer to the UBO Manual and specific Service regulations Don’t take shortcuts Keep your leadership informed and involved
22. Questions and Review
23. Instructions for CEU Credit This live Webinar broadcast has been approved by the American Academy of Professional Coders (AAPC) for 1.0 CEU credit. Granting of this approval in no way constitutes endorsement by the AAPC of the program, content or the program sponsor. There is no charge for this credit, but to receive it participants must login with their: 1) full name; 2) Service affiliation; and 3) e-mail address prior to the broadcast. If more than one participant is viewing the Webinar on one computer or mobile device, then the names and e-mail addresses of each participant who wishes to receive CEU credit must be entered into the Q&A pod below the presentation screen. If a participant cannot login and requires a dial in number to hear the Webinar, then for CEU credit he/she must e-mail the UBO.LearningCenter@altarum.org within 15 minutes of the end of the live broadcast with “request CEU credit” in the subject line. Participants must also listen to the entire Webinar broadcast. At the completion of the broadcast, the Certificate of Approval with Index Number will be sent via e-mail only to participants who logged in prior to the broadcast and provided their full name and e-mail address as required. Participants may also view and listen to the archived version of this Webinar—which will be posted to the UBO Learning Center shortly after the live broadcast--for one (1.0) AAPC approved CEU credit. To receive this credit, after viewing the archived Webinar, they must complete a ten (10) question minimum post-test that will be available on the UBO Learning Center and submit their answers via e-mail to ubohelpdesk@altarum.org. If at least 70% of the post-test is answered correctly, participants will receive via e-mail a Certificate of Approval and Index Number.
24. Instructions for CEU Credit, cont. Participants may not alter the original Certificate of Approval. CEU certificates should be maintained on file for at least six months beyond your renewal date in the event you are selected for CEU verification by AAPC. For additional information or questions, please contact the AAPC concerning CEUs and its policy.
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.