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De-Mythifying DoD/VA Billing and Reimbursement Issues. [Name Redacted] OASD, Health Budgets and Financial Policy March 2006. Authorities. Public Law 97-174 and 107-31 Title 38, Section 8111 and Title 10, Section 1104 DoD Instruction 6010.23
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De-Mythifying DoD/VA Billing and Reimbursement Issues [Name Redacted] OASD, Health Budgets and Financial Policy March 2006
Authorities • Public Law 97-174 and 107-31 • Title 38, Section 8111 and Title 10, Section 1104 • DoD Instruction 6010.23 • Department of Defense and Department of Veterans Affairs Health Care Resource Sharing Program • 1983 MOU between VA and DoD on sharing which says the rate will take into account local conditions and actual costs. • NDAA 2003 – mandated standardized reimbursement rates for DoD/VA sharing
General Principles for DOD/VA Reimbursement • Methodology will be agreed to by both Departments • Not the same as billing TPC • Does not use the Interagency Rate • Provide flexibility to take into account local conditions and actual costs (actual = incremental) • Funds will be credited to the providing facility
General Principles for DoD/VA Reimbursement • Per NDAA for FY 2003, rates will be standardized and waivers are allowed • 2003 MOA - basic agreement to use price-based methodology of discounted CMAC or TRICARE rates • 2003 MOA states no GME reimbursement for direct sharing agreements • Joint Ventures have choice to use or not use standard rates depending on local sharing arrangements • Standardized methodology does not apply to TRICARE network contracts with VA
Outpatient RatesCMAC less 10% • Began implementation in October, 2003 • Professional fee plus ancillary and pharmacy • If no CMAC available… • CMS rate • Negotiate substitute rate based on incremental cost • Guidance did not address ambulatory procedures (will be revisited soon) • Does not apply to reference lab agreements – use incremental cost instead • Should be separated from support/tenant services
Inpatient Methodology Yet to be Finalized • TRICARE rates less 10% x DRG • TRICARE methodology for outliers • Guidance will address professional services, anesthesiology, mental health, durable medical equipment, transfer patients, ambulance service, waivers, etc. • Goal is to have guidance ready for HEC approval in April/May
Why is This Important? • Increasing DoD/VA collaboration is a priority for the President and the Congress • NDAA 2003 created the Joint Incentive Program whose purpose is increased sharing opportunities • Office of Management & Budget scores our progress quarterly • Progress is reported bi-monthly to the Joint Executive Council (USD, P&R) • Joint Strategic Plan has goals and milestones for collaboration – progress reported annually to Congress
