Briefing: Charge Master Based Billing Date: Thursday, March 22, 2007 Time: 9:00 am

1. Briefing: Charge Master Based Billing Date: Thursday, March 22, 2007 Time: 9:00 am

2. Objectives • Provide you with an overview of the Charge Master Based Billing (CMBB) project

3. Summary • CMBB is the replacement system for the Third Party Outpatient Collections System (TPOCS) and the billing functions in CHCS • Provides one system for all patient inpatient and outpatient billing within the MHS including Third Party Collections (TPC), Medical Services Accounts (MSA) and Medical Affirmative Claims (MAC) • CMBB is a web-based, commercial off-the-shelf (COTS) software product • CMBB is currently being configured to meet Department of Defense (DoD) requirements

4. What is Charge Master Based Billing? • The Patient Accounting System incorporates two COTS products • Coding and Compliance Editor (CCE) • Charge Master Based Billing (CMBB) • CMBB is a patient billing and accounting system that incorporates the use of a Charge Description Master

5. What is a Charge Master? • A Charge Description Master, or charge master, is a comprehensive listing of items that could be billed to a patient, payer or healthcare provider • Charge Master Based Billing incorporates a charge master as part of the system used for patient accounting • A Charge Master is not intended to be used as a mechanism to measure performance (workload)

6. What is the COTS product for CMBB? • RITPO, in conjunction with the Services and the UBO, held a best value panel to select a COTS product during the spring and summer of 2006 • GE Centricity Business was selected as the CMBB solution

7. I have never heard of GE Centricity Business? • GE Centricity Business was formerly known as IDX/Flowcast • IDX/Flowcast was purchased by GE in January 2006 and re-branded as GE Centricity Business • IDX/Flowcast, as GE Centricity Business, remains a market leader in patient accounting systems

8. CMBB provides a Single Financial Solution • GE Centricity Business provides a suite of applications built toward automation and focuses on preventing errors and delays to assure prompt payment • The DoD purchase includes the following products • Transaction Editing System (TES) • Combined Business Office (CBO), including credit card processing • Revenue Cycle Management plays a major role in driving business success and ensuring patient satisfaction through a streamlined revenue cycle

9. What are the benefits? • Built-in payer rules ensure that patient information is collected correctly and completely • Automatic charge capture reduces the need to process data manually; claims rejections, re-work and lost charges are reduced, maximizing reimbursement • Electronic claims, claims status checks and remittance posting drive more efficient overall processing and decrease time to payment • Charges are automatically checked for accuracy prior to submission for cleaner claims, fewer rejections and less effort to correct and re-bill denials • Workflow tools automate and streamline claims management and production to accelerate reimbursement and maximize staff productivity • Simplified, patient-friendly statements reduce patient calls and improves patient satisfaction

10. What is TES? • TES is a front-end transaction editing and suspense system designed to capture, evaluate, correct, and extract charge and claim transactions into the CBO program • TES helps streamline workflow and prevent incomplete or incorrect information on claim forms • Allows information to be entered as it is available • Tests for missing or incorrect information • Filters transactions into work lists for efficient editing • Allows transactions to be edited for completeness and requested before the transactions are transferred to the CBO

11. What is CBO? • CBO provides consolidated operations to improve performance and compress the revenue cycle • CBO streamlines workflow by presenting a consolidated view of all hospital and professional financial data for a patient, guarantor or a clinical encounter • CBO increases patient satisfaction by combining all charges for both hospital and professional services on a single statement, decreases calls, paper and postage costs

12. What electronic transactions are included? • CMBB will incorporate the following electronic transactions: • 270/271 – Eligibility inquiry and response • 837/835 – Claims submission and remittances • 276/277 – Claims status and response • When the rules are finalized, GE will incorporate the 275, claims attachment, transaction – CMBB will incorporate this change as part of a COTS upgrade

13. Will I get reports? • GE Centricity Business provides many standard reports • Current TPOCS reports and CHCS reports will be matched against the standard reports to ensure that the current reporting functionality is met • Ad hoc reporting is available in GE Centricity Business • New functionality will be provided through Business Analyzer for Service-wide and UBO-wide advanced ad hoc reporting (version 1.0.1.0)

14. What Claim Forms will be supported? • UB-04 • CMS 1500 • Universal Claim Form • Dental • DoD-specific forms, including • DD7 • DD7A • DD139 • Invoice and Receipt (I&R) • SF 1080

15. Will training be provided? • Training will be provided during deployment • Follow-on training will be provided in a manner similar to what TPOCS does today

16. When is CMBB coming? • GE Centricity Business is currently being configured to meet DoD requirements • Testing is expected to start in early in 2008, including Service supported System Qualification Testing (SQT) in late spring 2008 • Milestone C is expected to be awarded by mid-summer of 2008 • Limited Deployment to two (2) Service-selected sites will begin shortly after Milestone C is awarded • Operational Test and Evaluation (OT&E) will be conducted during Limited Deployment • If OT&E is successful, full deployment will begin in late 2009

17. Quiz • What is the COTS product for CMBB? • What is a Charge Description Master? • What modules will be incorporated into CMBB? • What EDI transactions will be supported?