Briefing: PATCAT Assignments Date: 21 March 2007 Time: 1300 - 1350

1. Briefing: PATCAT Assignments Date: 21 March 2007 Time: 1300 - 1350

2. Objectives • Know the purpose of Patient Categories • Why are they so important? • Learn how they are structured and assigned • Identify the common and uncommon categories • Learn where to go for help

3. Purpose of PATCATs • Patient Categories are closely linked to entitlements under the Uniformed Services Health Benefits Program (USHBP) • They identify and group patients by types: • Sponsor Service • Beneficiary Category • Special Interest Patient Groups • Patient Categories are directly linked to UBO billing • PATCATs determine entitlement, priority for care, agreement, who pays, and what rate for beneficiaries or non-beneficiaries

4. Making of PATCATs • Title 10, U.S.Code • Inter-Agency Agreements • Contracts • International Agreements • Secretarial Designees • Proposed changes by the UBO Advisory Work Group (AWG) and the Unified Biostatistical Utility (UBU) All of the above have a process for determining the Patient Category

5. PATCATs • Patient Category table may be printed from CHCS: • MSR>PCT • Download from the UBO Web site: • http://www.tricare.mil/ocfo/mcfs/ubo/patcat.cfm • Keep copy of table on your computer desktop for easy access • Print updated Patient Categories tables from CHCS to distribute to Emergency Room, Admissions, Clinics, and Outpatient Records

6. Who Cares About PATCATs? • Personnel community (DEERS) 1-800-538-9552 • Know local number for Personnel Support command; usually, the office that will issue the ID card • Patient Administration • UBO/Medical Services Account (MSA) • Management at all levels • Data analysts

7. What is Affected by PATCATs? • Many CHCS functions and downstream systems rely on PATCATs: • Patient classification by beneficiary category • Admission & Disposition reports • Patient Record Extracts (SADR, SIDR, HL7) • Workload reports (MEPRS, WWR) • Bad PATCATS = Poor Data Quality = Rework, Lost Money $$, Bad Decisions

8. Impact of “Bad” PATCATs • When an incorrect PATCAT is assigned, it will impact the MSA/UBO office by: • Not billing when you should • Billing when you should not • Billing at the wrong rate • Billing to the wrong source • Billing on the wrong form • This is extra work for MSA office and takes effort to make the corrections

9. PATCAT Assignment and Process • Daily the MSA office should receive notification from ED, outpatient clinics, Admissions, and Pharmacy that a patient has presented to the clinic with an incorrect patient category assignment or a DEERS ineligibility override • MSA office should print OUTPATIENT ITEMIZED BILLING PREVIEW LIST daily • MSA>OIB>IBP>print • MSA office will research and follow-up with information provided • MSA office will do another DEERS verification either in CHCS or native DEERS • A phone call to the patient may be necessary to gather all information. Patient may need to provide copy of ID card, driver license, insurance information, birth certificate, marriage certificate, orders, etc. • Patient Categories will change when they retire, go to active duty from inactive duty, active duty to TAMP, TAMP to TRICARE Reserve Select, released from active duty, divorce, etc.

10. PATCAT Assignment and Process • Patients may have multiple relationship codes: • Retirees and dependents may be Civil Service employees • Retirees may be married to Active Duty • Contractors • DoD Dependent School system employees • NAF employees • MSA office will double check PATCAT data in CHCS against other data received. DEERS eligibility inquiry will need to cover the dates of service that the patient was seen • Example: Reserve personnel can go from inactive to active, to TAMP, to TRS all with a space of a few months

11. PATCAT Assignment and Process • If you have a question about a certain program or eligibility, www.tricare.mil is an excellent web site • TRICARE Beneficiaries>TRICARE PLANS> • TRICARE Prime • Reserve Component Programs • Continued Health Care Benefit Program • U.S. Family Health Plans These are a few that you will become familiar with

12. Patient Category Table * * * PATIENT CATEGORY BILLING TABLE * * * Inpatient Outpatient Pay Enl Allow Code Description Ind Agy Ind Agy Mode 1080 DD139 -------------------------------------------------------------------------------- N12 USN RES-30 DAYS OR LESS, FRR NC FOR NC N13 USN AD RECRUIT NC NC NC NC N14 USN ACADEMY CADET NC NC NC NC N21 USN ROTC NC NC NC NC N22 USN RES INACT DUTY TRG NC NC NC NC N22 USN RES INACT DUTY TRG - FRR NC FOR NC N24 USN FRM AD-TRANS ASSISTA FMR NC NC NC N25 USN FAM MBR FAD-TRANS AS FMR NC NC NC N26 USN APPLICANT/REGISTRANT NC NC NC NC N27 USN FRM MEMBER-MATERNITY FMR NC NC NC N28 USN NEWBORN OF FRM SERVI FMR NC NC NC

13. Patient Category Table • Know how to read your PATCAT table • The first letter would identify the agency. Example: Army = A, Air Force = F, Navy = N, Coast Guard = C, NOAA = B, PHS = P, K =all others agencies • The N22 USN RES INACT DUTY TRG – NOT LOD would have a Full Reimbursement rate for any inpatient admission that was not a result of a line of duty injury • The N24 USN FRM AD – TRANS ASSISTANCE would be charged the daily subsistence rate for any inpatient charge. There would be no charge for any outpatient visits

14. Patient Category Table * * * PATIENT CATEGORY BILLING TABLE * * * -------------------------------------------------------------------------------- Inpatient Outpatient Pay Enl Allow Code Description Ind Agy Ind Agy Mode 1080 DD139 -------------------------------------------------------------------------------- K55 DOD EMPLOYEE REMOTE AREA IAR NC IOR NC K56 DOD FAM MBR REMOTE AREA IAR NC IOR NC K57 DOD EMPL OCCUPATIONAL HE NC NC NC NC K58 DISABILITY RET EXAM-DOD NC NC NC NC K58 DISABILITY RET EXAM - NO NC IAR NC IOR DD7/DD7A K59 FED GOVT EMPLOYEE IN REM NC IAR NC IOR DD7/DD7A K59 FAM MBR FED EMPL IN REMO NC IAR NC IOR DD7/DD7A K61 VETERANS ADMIN BENEFICIA NC IAR NC IOR DD7/DD7A K61 DOD/VA SHARING AGREEMENT NC FLEX NC FLXO DD7/DD7A K62 WC-CIV, FED EMPL NC IAR NC IOR DD7/DD7A K62 WC-DOD BENE, DOD EMPL NC NC NC NC

15. Patient Category Table • The K57 DOD EMPL OCCUPATIONAL HEALTH would have no charge for occupational health visits or workman’s compensation visits • The K61 VETERANS ADMIN BENEFICIARY OR DOD/VA SHARING AGREEMENT would either have an inter-agency or flexible rate attached to their inpatient and outpatient visits. This would depend how your MTF is set up for veterans

16. Help with PATCATs • Having problems determining what the right patient category to use? • MTF colleagues – PAD staff are your friends • Other MSA colleagues • Service UBO point of contact • Web site for UBO and UBU: • http://www.tricare.mil/ocfo

17. Scenario #1 • DEERS ELIGIBILITY DATA • Name: GOOSE, MOTHER FMP/SSN: 30/123-00-1234 • Patient Category: USN FAM MBR AD SEX/DOB/AGE: F/04Jul1985/21Y • ──────────────────────────────────────────────────────────────────────────────── • Eligibility Date: 14 Dec 2006 • Name First: MOTHER Sponsor SSN: 123-00-1234 • Middle: ANN Branch of Service: NAVY • Last: GOOSE Pay Grade: 05 • Cadency: Sponsor Cat Code: Active Duty • DOB: 04 Jul 1985 Sponsor Rank: PETTY OFFICER SE • Sex: FEMALE Sponsor UIC: N68095 • Relationship: Spouse UIC Zip Code: 99283 • HCDP Code: 108 Type: MEDICAL Enr DMIS ID: 0194 • TRICARE PRIME FAMILY COVERAGE FOR ACTIVE DUTY FAMILY MEMBERS • HCDP Start Date: 12 Apr 2005 Region Code: 19 • HCDP End Date: 14 Jun 2007 Network Provider: • ECHO Code: • ECHO Start Date: ECHO End Date: • ───────── ** PATIENT ENROLLED IN DP/USFHP - NOT ELIGIBLE FOR CARE ** ────────── • eXit PCM HCDP Demographics prInt hElp • Exit this option

18. Scenario #2 Patient: KRINGLE, CHRIS Patient Information FMP/SSN: 20/122-51-2251 DOB: 25Dec62 PATCAT: N12 Patient: KRINGLE, CHRIS DOB: 25 Dec 1962 PATCAT: N12 (USN RES-30 DAYS OR LESS, NOT IN ) ─────────────────────────────────── N22 USN RES INACT DUTY TRG N22 N22 USN RES INACT DUTY TRG - NOT IN LOD • Patient showed up on IBP list • Native DEERS reflects member as drilling reservist • http://dir.navy.mil reflects member in a reserve unit • Presented to clinic for lab work for physical exam as required by U.S. Reserves • What is the correct Patient Category? • Patient Category should be N22 RES INACT DUTY TRG.

19. Scenario #3 Patient: PICASSO, PABLO Patient Information FMP/SSN: 99/222-11-3333 DOB: 1Apr79 PATCAT: K99 Sex: M Patient: PICASSO,PABLO DOB: 1 Apr 1979 PATCAT: K99 (PATIENT NOT ELSEWHERE CLASSIFIED) FMP: 99 SSN: 222-11-3333 Sex: MALE Religion: • Patient on IBP report. Patient reported to Occupational Health for appointment. Patient Category listed is K99 • DEERS inquiry reflects him as DoD Civilian Employee • What should his patient category be? • Patient Category should be K57 DOD EMPL OCCUPATIONAL HEALTH

20. Scenario #4 • Patient presented to clinic for workers’ comp injury. CHCS shows her as K65 (Contract Employee and Family Member). • DEERS reflects her as Non-Appropriated Fund DoD Employee (NAF) • What should her patient category reflect? • Patient Category should be K53 NAF EMPLOYEE CONUS

21. How to correct the PATCAT • Once the PATCAT has been identified as incorrect, it will need to be corrected • If an inpatient episode, Admissions office will correct the PATCAT. MSA will ensure all appointments are corrected that relate to correct PATCAT. This will ensure all visits that need to be billed are billed • If an outpatient visit, Naval Hospital Bremerton CHCS Data Base Administrator will make changes. Ensure outpatient visits are associated with correct PATCAT are linked for correct billing if needed • This is Naval Hospital Bremerton Business Office guidelines for changing PATCATs. MTFs will need to establish a procedure for changing PATCATs that will fit their requirements

22. PATCAT Process • Are you tired of continually having the PATCAT changed because personnel are not paying attention to detail? • I have implemented the following process at Naval Hospital Bremerton: • Patient is registered in CHCS with incomplete or missing data (address, phone number, etc.). • I will fill out what Quality Management calls a “Green Sheet” “Green Sheet” Patient Safety/RM Data Collection Worksheet • All information is gathered and reported. Action is taken to appropriate clinic for correction to their operating procedures • As a result of some “green sheet” actions, the recommendation has been made by quality management that the business office do a more intense training to front desk personnel at various clinics • I have put the process for placing the responsibility back on those who have made the error

23. PATCAT Process Patient Safety/RM Data Collection Worksheet (Green Sheet) Date of Event:*          Patient's Last name, First name:*     Person Involved:*     Prefix/Full SS#:*         Event  Location:* Select one that best fits summary of event(s) Lab/Specimen & Ancillary (LAB/ANC) Process:      Use of Medical Equipment/EOC:                    Chart Integrity (CI) /Medical Documentation: Informed Consent Process:     Sentinel Events (SE) Reportable:       RM/QM Indicators (QMI): Surgical QM Indicators (SURG):    FALL Prevention Program:     Correct Person, Surgical & Site Verification (SSV):   Medication (MED) & IV Administration:     Bld Product/Transfusion (BLD PROD) Administration:    REPORT ALL Restraint Use: Summary and Action(s) Taken: * A brief description of the event and what was not done at time of patient’s check-in. Example: Patient seen in immediate care clinic for electrical shock and atypical chest pains. Patient’s CHCS registration showed only name and SSN. This was a workmen’s compensation claim that will need to file. Please review process and correct. Request feedback by Division Officer/Department Head reviewing above event. Name/Contact#: (optional)

24. Quiz • Patient came to ER 11/22/06. Patient was listed as a P43 in CHCS under sponsor. Patient is 29 years old and not eligible for care per DEERS. Further investigation led us to find that the patient is former AF active duty with transitional assistance coverage until 3/29/2007. Patient Category was not changed, nor was address with additional and necessary information updated in CHCS at time of service. • The correct PATCAT would be: A. F11 USAF ACTIVE DUTY B. F12 USAF ACTIVE DUTY RESERVE C. F24 USAF FRM AD - TRANS ASSISTANCE ACT D. K92 CIVILIAN EMERGENCY

25. Quiz • The correct answer would be: C: F24 USAF FRM AD – TRANS ASSISTANCE ACT I also initiated a “green sheet” for this visit

26. Upcoming Changes • Patient Category (PATCAT) Codes CHCS Operational Release of FY2007 PATCAT Table – 4 December 2006 • FY2007 version of Patient Category Code table was released to support CHCS operations on 4 December 2006. CHCS Release information is MHS_CITPO_1083, CCB267, PTTFN 1.868. This operational release followed coordination and approval of the proposed changes by the UBO Advisory Work Group (AWG) and the Unified Biostatistical Utility (UBU), as well as successful testing by the CHCS software management team. The specific changes implemented by this update are shown in the table —Continued—

27. Upcoming Changes • PATCAT Code Changes Incorporated • A27, F27, M27, or N27 (Former Member – Maternity Care) • Change billable rate from ‘NC’ to ‘FMR’ • K53Z (NAF CONUS) Change Pay Mode to ‘DD7/DD7A’ • Change billing to ‘Agency’ rather than ‘Individual’ • K61-1 (VA Beneficiary) and • K61-2 (DOD/VA Sharing Agreement) • Reinstate the Pay Mode = ‘DD7/DD7A’ • K91, Sub 2 (Civilian – Disaster – FEMA) Change billable rates to ‘FLEX/FLXO’ rather than ‘IAR/IOR’

28. Upcoming Changes • COMING SOON! Patient Category Code Web-based training • Web-based training course to help MTF staff correctly designate the appropriate Patient Category code • It is in the final stages of development. Look for its release by February 2007

29. Summary • Purpose: Identify the correct PATCAT to support tracking, reporting and billing • Importance: Used by many functions and systems; linked to billing for services • Structure: Service/Civilian; Category; Subcategory • Help: Colleagues in PAD; Service POCs; MSA colleagues; UBO Web site; UBU Web site