Briefing: Foreign Military Billing

1. Briefing: Foreign Military Billing Date: 23 March 2010 Time: 1400 – 1450

2. Objectives Help UBO MSA staff better understand how to bill foreign military members and their dependents – UBO MSA perspective Identify and discuss some important issues Provide ideas for improved performance Share helpful references for future use

3. Overview • Presentation limited to the billing of care provided to foreign military and their dependents at DoD Military Treatment Facilities (MTFs) • Excludes the issue of access to care at MTFs • Does not include the issue of care provided at civilian treatment facilities

4. Foreign Military Programs/Agreements • Programs Include: • International Military Education and Training (IMET) • Foreign Military Sales (FMS) • NATO Status of Forces Agreements (NATO SOFA) • Partnership for Peace (PFP) with a Status Of Forces Agreement (PFP SOFA) • Reciprocal Health Care Agreements (RHCA) • Acquisition & Cross Servicing Agreements (ACSA)

5. Getting Started • In the not so distant past, foreign military were not enrolled in DEERS • Now…Foreign Military Members and dependents automatically enrolled in DEERS upon application and/or receipt of New ID Card • DEERS assigns Foreign Identification Number (FIN) in lieu of a Social Security Number • FIN used for foreign military, foreign nationals, and their eligible family members

6. Administrative Practices • Coordinating with TRICARE Office or assigned office at your facility • Foreign Military Registration Card • Verifying country of foreign military member • Notation of Country in CHCS • Collecting Invitational Travel Orders (ITO) • Tells you where they’re from, what they’re authorized, & financial responsibility for health care of dependents • Communicating with Schools

7. Foreign Military Registration Card

8. Challenges • Perceived inconsistency of training in Foreign Military Billing throughout the Military Healthcare System • No guidance on reading ITOs • Billing for reimbursement of care provided difficult due to lack of appropriate PATCAT information • Often difficult in getting appropriate personnel to make appropriate PATCAT corrections • Some 60 counties currently covered by healthcare agreements with DoD • Agreements expiring and being renegotiated

9. Points to Acknowledge on ITO Country Program type Demographic Information Beginning/End date of reporting time Conditions: IMS, FMS, IMET Family Member Information and Amendments

10. Billing Form Options • I&R: Invoice and Receipt • IMET Students • FMS • Dependents • Embassies • UB-04: • Prepared for whomever requests billing on this form

11. References Reciprocal Health Care Agreements

12. References

13. Lessons Learned Along the Way • DOD Reference sheet and CHCS PATCATs not in alignment • CHCS does not always generate FRR bills and Ins co. does not accept DD7 billings • More foreign military now carry health insurance • CHCS does not allow the input of insurance for this category of patient • Collect a DD2569 on patient regardless of duty status • Subsistence rate has not been updated for active duty since Congress stopped charges for U.S. Active Duty • Traveler’s Insurance • Patients do not understand medical billing in the U.S. • Embassies are moving away from paper checks

14. Daily Challenges – Make CHCS Work for You DEERS TRICARE Standard issues

15. Country Code, Case ID, and Case Line • When using sales code 73 address cannot be built without country, case & line. Reference DFAS--DE 7077.2-M 13.6 & 13.8 • Country Code Criteria: Main country code (i.e., for Italy, use IT for the Country Code criteria) • Case ID and Case Line: The Case ID and Case Line is a programmed number for the training • Example: • Italy, Country Code: IT • Pseudo Country Code: S4 • Case ID: TEY • Case Line: 001 • The ITO number will have the 2 character main country code at the beginning of the ITO Number and the 2 character country code at the end of the ITO Number. (i.e. ITO#: ITPTEY0012000S4)

16. Example of Address Line Request Country/Case/Line code is available on the ITO or is obtained from the Foreign Liaison Officer

17. Helpful Hints • Know who gets the bill and how you get your money • Air Force Security Assistance Center (AFSAC) (pays the MTF directly) • Air Force Security Training (AFSAT) (pays Air Staff…but does not notify MTF when they have processed the bill for payment) • Embassy (pays by check or electronic method) • Herschel Hughes (Indianapolis DFAS) at DSN 699-8821. Herschel.hughes@dfas.mil(establishing electronic account) • Insurance company (how to get the bills to the Hub since encounters do not flow to TPOCS) • Work with GSUs to obtain listing of their foreign military • Keep track of when member is leaving the country • Establish working relationship with FLO-Coordinators

18. Helpful Hints (Cont’d) • Recommendation: Pull M2 query and perform 100% audit on foreign military being seen in your facility • Validate billing requirements • Work with Beneficiary Services to clarify PATCATS and billable services (they are human too and mistakes can easily happen) • Identify billing issues to your service representative • Audit at least quarterly! • Work MSA accounts monthly to stay on top of open foreign military accounts

19. Web Sites/References • http://www.armymedicine.army.mil/hc/ip/medical-eligibility.htm • https://private.fhp.osd.mil/portal/rhas.jsp • http://www.armymedicine.army.mil/hc/ip/reciprocal.htm • http://www.embassiesabroad.com/ • International Military Students & Medical Care Desk Top Guide

20. Questions & Answers Thank you for attending our presentation today. Are there any Questions?