2010 UBO/UBU Conference

Title: Navy UBO Breakout

Session: T-2-0850

Welcome

Introductions Best business practice – 2569/AHLTA interface at NH

Bremerton Navy Medicine Allowance Calculation Tool (NMACT)

Performance Metrics Published SOPs BUMED topics Questions

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Introductions

Slide Redacted

Many MTFs represented. Please say hello to our new people.

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FY11 DD2569 FOCUS

• Annual Area for Leadership Engagement

• Deputy Surgeon General FY11 Focus Area

• Collecting other health insurance data!

• FY11 Data Quality Mgmt Control Program

• Improve DD Form 2569 collection!

Issues

• Form Collections <100% per DQ Audit

• FY10 82%

• System Issues

• Systems not programmed to track form

• Done waiting for the E-DD2569

• Process to quantify weak areas

• Need to Increase Billing and Collections

Proposal

• DD2569 Scanned into AHLTA

• Under Clinical Notes• “DD2569 1Mar2011 NHB”

• Front Desk Verifies at Check-In

• Selects Clinical Notes

• Verifies date is within 1 year

• Verification by Clinic for Valid Form

• Print a daily appointment listing

• Verify a valid form is in Clinical Notes

DD2569 Count

OCT NOV DEC JAN FEBMAR 1-9 Y-T-D

Dermatology 14 10 1 27 31 20 103Emergency Room 112 115 63 126 493 266 1,175FP / Imm - 2nd Floor 321 256 277 176 433 331 1,794FP - 3rd Floor 164 194 247 200 346 276 1,427Internal Medicine 105 74 71 109 300 68 727Mental Health 0 0 0 11 18 17 46Optometry 22 23 0 111 147 35 338Pediatrics 81 52 21 70 669 220 1,113Ambulatory Proc 128 125 112 141 136 65 707General Surgery 56 57 53 50 27 13 256OB/GYN 56 76 96 81 132 11 452Ophthalmology 36 34 45 54 98 15 282Orthopedics 34 33 37 40 10 3 157Otolaryngology 3 1 3 68 69 7 151Urology 11 12 1 22 10 5 61Pharmacy 339 263 298 288 297 189 1,674Physical Therapy 9 3 5 21 49 20 107Business Office 8 10 13 18 39 8 96Admissions 123 132 141 124 131 35 686Outpatient Records 147 132 140 139 183 64 805Bangor BMC 180 151 55 0 61 32 479Bangor PHARMACY 42 34 76Everett BMC 65 60 99 166 186 250 826Everett PHARMACY 16 30 173 180 126 23 548MONTHLY TOTAL 2,030 1,843 1,951 2,222 4,033 2,007 14,086

DD2569 Verification

VISITSYES

FORMNO

FORM% with FORM VISITS

YES FORM

NO FORM

% with FORM

CODE 03 7-Mar-11 28-Jan-11

Family Practice 2nd Floor 96 86 10 90% 191 65 126 34%Family Practice 3rd Floor 104 93 11 89% 65 12 53 18%Family Practice Immun 87 62 25 71%

Total Family Practice 287 241 46 84% 256 77 179 30%Dermatology 16 11 5 69% 6 2 4 33%Emergency Room 59 42 17 71% 53 21 32 40%Internal Medicine Ck-In 55 46 9 84% 45 24 21 53%Mental Health 13 10 3 77% 1 0 1 0%Optometry 15 14 1 93% 9 9 0 100%Pediatrics 74 59 15 80% 30 14 16 47%

CODE 03 TOTAL 519 423 96 82% 400 147 253 37%CODE 04 7-Mar-11 28-Jan-11

OB/GYN 45 33 12 73% 47 36 11 77%General Surgery 18 17 1 94% 10 8 5 80%Urology 6 4 2 67% 7 5 2 71%Ophthalmology 7 6 1 86% 16 15 1 94%Orthopedics 7 6 1 86% 11 9 2 82%ENT/Audiology 7 5 2 71% 60 28 32 47%

CODE 04 TOTAL 90 71 19 79% 151 101 53 67%CODE 05 7-Mar-11 28-Jan-11

Physical Therapy 43 37 6 86% 33 14 19 42%CODE 50 7-Mar-11

Everett FP 63 56 7 89%Bangor FP 30 11 19 37%

CODE 50 TOTAL 93 67 26 72%HOSPITAL TOTALS 745 598 147 80% 584 262 325 45%

Summary

• Doubled Form Collections

• 2K average to 4K average or more

• Clinic Verification Improvement

• 45% to 80% with Valid Form

• New OHI

• Jan-Feb 90 New OHI Policies

• March *7 Work-Days* 25 New OHI Policies

March 15th, 2011

Navy UBO Break Out Session2011 MHS Revenue Cycle Educational Conference

BUMED SOPs for UBO and TPC/AR Updates

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Purpose and Objectives

• Third Party Outpatient Corrective Action

•Execution Performance Metrics

• Navy Medicine SOPs for UBO

• IAB

•Outpatient TPC Billing

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• Third Party Outpatient AR Corrective Action deployed for Q4 FY10

• 20 MTFs have used the Navy Medicine Allowance Calculation Tools to predict NRV on monthly TPOCS billings

• Resolves longstanding material weakness for Navy Medicine

• Navy Medicine reported AR, Public for Q4 FY10 Financial Statements

Third Party Outpatient Corrective Action

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•Accounting entered value on time

AR entered in STARS-FL prior to COB 4th calendar day of month

(A)

•Accounting entered AR correctly: date and value

AR amount entered accurately per the Tool Monthly Report and

backdated(B)

•Documents forwarded to requested parties

MTF Package submitted to BUMED and DFAS by COB 4th calendar day

of month(C)

•Monthly Package Complete- Tool Reports

•Monthly Package Complete- Collection Reconciliation

•Monthly Report Signed

Package contains all required documentation and all Tool report

values are within reason(D)

•IOP used to operate Tool successfully

•MTF works with Region to resolve issues

Monthly Process completed without BUMED support

(E)

Measuring Execution Performance

FY11 Sustainment Performance Metrics

Inter-Agency Billing (IAB) SOP: Overview

Review, Approve, and Submit Bills

MTF UBO Staff MTF UBO Manager

Activity Accounting Technician

Regional UBO Manager

BUMED UBO Manager

START

Gather Billing Information and Create Bills

Review Random Sampling of Bills and Track Audit Metrics

Compile Billings & Collections Trackers

Serve as Central POC for USCG, NOAA, PHS Monitor IAB Program

Monitor Collections in STARS-FL and Enter Work Estimates & Cost Transfers

Track Billings & Collections

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IAB SOP: Contents and Roles

• Roles Included:

• MTF UBO Staff• MTF UBO Manager• Activity Accounting Technician• Regional UBO Manager• BUMED UBO Manager

• Processes Included:

• Bill Preparation• Bill Review• Bill Submission• Reconciliation of Billings• and Collections• STARS-FL Entries• Monitoring the IAB Program

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Outpatient TPC Billing SOP: Overview

MTF UBO Staff

MTF UBO Manager

START

Collect DD 2569s and Verify Insurance

Prepare and Process Bills in TPOCS

Process Electronic Claims in ePREMIS

Follow-up and Close-out Claims in TPOCS

Run Aging Reports Run Write-Off Reports

Outpatient TPC Billing SOP: Contents and Roles

• Roles Included:

• MTF UBO Staff• MTF UBO Manager

• Processes Included:

• Insurance Verification• Outpatient Medical Bill Set-up• Pharmacy Bill Set-up• ePREMIS Billing• Claim Closeout• Running Aging Reports• Running Write-Off Reports

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Title Description

IAB Interim Procedures

Required in preparation for executing the IAB for Medical Services SOP due to importance of finalizing the DD7A on a monthly basis. Note: Completion of Interim Procedures is due NLT April 1st, 2011

IAB for Medical Services SOP

Improves the efficiency and quality of the process through decreased hand-offs, decentralization, and standardization to avoid missed billings; creates greater transparency of local execution by BUMED HQ.

Outpatient TPC Billing SOP

Improves efficiency, accuracy, and transparency of the process through standardization, including audit check-points to ensure that no bills are lost due to system errors and collections are maximized; decreases the billing/collection timeline and aims to increase the amount of payments received over claim denials

UBO SOP Deployment Information

UBO SOPs are required for execution starting April 1st and can be downloaded from the Navy Medicine FIP NKO site: https://wwwa.nko.navy.mil/portal/navymedicine/fip/home/sop

● SLIDE REDACTED

Contact Information

BUMED UBO topic – MSA/MAC/TPC(in) NRV Reporting Tools

In preparation for an audit of the Navy’s ‘Balance Sheet’, BUMED/MTFs have been levied with a requirement to produce a Net Realizable Value (NRV) for its accounts receivable

In July 2010, BUMED rolled out an NRV-reporting tool that works by determining an allowance factor for TPC (outpatient) accounts

BUMED is researching the development of NRV-reporting tools for TPC (inpatient), MSA and MAC claims/invoices

Implementation date: TBD (audit occurs in FY-13)

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BUMED UBO Topic – USCG IAB Proposal

Discussion of ending IABs for USCG Details unclear, but could include:

– USCG makes one payment to DoD each 1 Oct Payment based on total healthcare bill for USCG previous year

– DoD splits the funds amongst Services; Services split funds amongst Regions/MTFs

– At mid-year point, MTFs produce a 12-month wrap-up IAB; wrap-up IAB is used to prepare following year USCG payment

– Possible application for other IABs as well (however, no active discussions of other IABs yet)

Possible date to implement: FY-12

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BUMED UBO topic – FY for MSA Funds

As per BUMED ltr 7000 Ser M84/10UM841822 of 5 Oct 2010:– MSA payments will be credited to LOAs in the year of

receipt, vice year of service– Implements ASD(HA) ltr of 6 Feb 2006

Implementation date: 1 Oct 2010

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BUMED UBO Topic – Standard TPC Write-off Codes

As per BUMED ltr 7000 Ser M84/10UM841821 of 24 Sep 2010:– All MTFs using TPOCS will use listed write-off codes

Implementation date: 1 Oct 2010

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BUMED UBO Topic – TPC Pharmacy e-Billing

Contract has been awarded to PSI to implement the e-billing feature in TPOCS– E-billing feature will produce a NCPDP (Natl Council for

Prescription Drug Programs) universal claim form for all TPC pharmacy prescriptions

– E-billing has been implemented at Camp Lejeune and is being tested at NMC Portsmouth and NH Bremerton

– BUMED has funded the TPC pharmacy e-billing for FY-11 (contract payments are made on a per-claim basis to RelayHealth)

For FY-12 and beyond, MTFs will need to self-fund if they wish to retain the capability

Estimate to have all TPOCS facilities on line: Mar-May 2011

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BUMED UBO Topic – e-2569

As of 11 Jan 2011, USAF has granted an Authority to Operate (ATO) for AF MTFs to operate the e-2569 OHI collection form

NAVMISSA is conducting an AoA regarding the feasibility of employing the e-2569 at Navy MTFs

If found feasible, Navy will have to accept the AF ATO exactly as is, or allow for significant delays while the system undergoes a lengthy DIACAP (Defense Information Assurance Certification and Accreditation Process) review

BUMED intends to push for acceptance of the AF ATO exactly as written– BUMED will mandate that MTFs purchase hardware and

employ the e-2569 at all patient points of service Estimated date for e-2569: Spring/Summer 2011

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BUMED UBO Topic – MSA Write-off Actions

MTF UBO offices process unpaid invoices/claims as follows:– For MSA, invoices can only be zeroed out by:

Paying the invoice in full (invoice is considered as ‘paid’ when the funds have been deposited into the U.S. Treasury)

Excluding invalidly-produced charges (e.g. unbundled labs, wrong PatCat registration that isn’t support by DEERS, etc) (justification must be supported!)

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BUMED UBO Topic – MSA Write-off Actions

MTF UBO offices process unpaid invoices/claims as follows: (cont’d)

Transferring the debt to DFAS (see FMR Vol 5 Ch 28) (Debt and Claims Management Office (DCMO)) (mandatory for out-of-service debts of more than $225 combined that are more than 60 days old)

– Note that the FMR only requires one demand letter, before referring the debt

– If sponsor is a military AD/retiree, submit a DD139 (MTF must track)

– If sponsor is a DoD employee, submit a DD2481 (MTF must track)

– Way ahead: BUMED researching use of the Treasury Offset Program (TOP) by MTFs (instead of submitting packages to the DCMO)

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BUMED UBO Topic – MSA Write-off Actions

MTF UBO offices process unpaid invoices/claims as follows: (cont’d)

Debts that total less than $225 may be held for one year and then written off

– Although the DCMO only wants debts larger than $225, smaller debts may be submitted via DD139/DD2481/TOP

DFAS adjudicates all questions regarding unpaid invoices; neither BUMED nor the Regional Commanders have the authority to authorize MSA write-offs, or adjudicate billing disputes. Do not send debt packages to BUMED.

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BUMED UBO Topic – TPC Write-off Actions

MTF UBO offices process unpaid invoices/claims as follows:– For TPC, claims can only be zeroed out by:

Payer pays 100% of the claimed amount; Payer provides a valid reason for paying less than 100% of the

claimed amount (write-off codes W08 thru W15 and W17 thru W50);

Referring invalid claim denials (code W16) to the MTF’s Judge Advocate General.

– Neither BUMED nor the Regional Commanders have the authority to authorize TPC write-offs, or the resources to coordinate JAG support for claim disputes; invalid denials should be coordinated with the MTF’s JAG office. Do not send claim packages to BUMED.

BUMED does not possess the staff nor the necessary level security to maintain medical records / PII / HIPAA-protected data 29

BUMED UBO Topic – Standard Sales Codes/CHCS Posting

BUMED is preparing a draft memo that will:– Prescribe a standard list of Sales Codes to use by all

MTFs– Require that all UBO receipts (MSA, TPC,

miscellaneous) be posted into CHCS Estimated date to execute standard process: 1 Oct 2011

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BUMED UBO Topic – TPOCS Sunset

As per OSD(HA) memo of 13 Dec 2010, TPOCS will sunset 1 Oct 2013 (TMA will cease funding). – TPOCS will remain as a legacy system until 1 Oct 2014– TPOCS sunset coincides with ICD-10 rollout 1 Oct 2013

Replacement plan:– Beginning in FY-13, TMA will implement the Central

Events Billing Repository (CBER). The CBER will be a warehouse that uploads billable events (MSA, TPC and MAC) from every MHS MTF’s CHCS into a single database.

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– Services have been tasked with developing a plan to replace TPOCS.

The replacement system is not limited to TPC (outpatient); the replacement system may provide for all

– MSA (IAB and non-IAB), – TPC (inpatient and outpatient) and – MAC billing.

The replacement system will interface with the CBER, vice individual CHCS systems

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BUMED UBO Topic – TPOCS Sunset

As per OSD(HA) memo of 13 Dec 2010, TPOCS will sunset 1 Oct 2013 (TMA will cease funding). – TPOCS will remain as a legacy system until 1 Oct 2014– TPOCS sunset coincides with ICD-10 rollout 1 Oct 2013

Replacement plan:– Beginning in FY-13, TMA will implement the Central

Events Billing Repository (CBER). The CBER will be a warehouse that uploads billable events (MSA, TPC and MAC) from every MHS MTF’s CHCS into a single database.

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BUMED UBO Topic – TPOCS Sunset

Replacement plan: (cont’d)– Services have been tasked with developing a plan to

replace TPOCS. The replacement system is not limited to TPC (outpatient); the

replacement system may provide for all – MSA (IAB and non-IAB), – TPC (inpatient and outpatient) and – MAC billing.

The replacement system will interface with the CBER, vice individual CHCS systems

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BUMED UBO Topic – TPOCS Sunset

NAVMISSA is currently conducting an Analysis of Alternatives (AoA)– AoA is looking at a broad range of options for systems,

locations and workforces Systems: options include Government-procurement or

Government-leasing; the system could either be an existing off-the-shelf system, or one specially produced to meet the Navy’s needs

Locations: The CBER does not reside on an MTF server, but rather off-site. With CBER access, UBO functions can be moved, as necessary

Workforce: options include a Government workforce, contract workers and/or a combination workforce structure

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BUMED UBO Topic – TPOCS Sunset

NAVMISSA is currently conducting an Analysis of Alternatives (AoA) (cont’d)– BUMED/NAVMISSA will work collaboratively with

Regions/MTFs to build the post-TPOCS requirements document

The goal is to develop a system that maximizes all-sources funding for the MTFs, while minimizing system/personnel costs

Estimate to have replacement: NLT 1 Oct 2013 (preferably FY-12, or early FY-13)

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BUMED UBO Topic – CHCS/TPOCS Alternatives

As per OSD(HA) policy memo 08-007, MTFs may conduct billing/collection activities as per the following:– Sites are not mandated to using CHCS and/or TPOCS– Sites may use Govt workers, contract workers or a

combination thereof – Billing/collection activities may occur at the MTF,

contract location or a combination thereof– MTFs wishing to use non-CHCS/TPOCS should review

-- OASD (Networks and Information Integration) DTM 08-027, FMR Vol 4 Ch 3 (allowance methodology), and the TMA UBO metrics reporting requirements

Note: The AR NRV Reporting Tool only works with TPOCS. MTFs that depart from the use of the TPOCS will need to compile their own NRV (methodology is subject to review/approval by BUMED)

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BUMED UBO Topic – CHCS/TPOCS Alternatives

As per OSD(HA) policy memo 08-007, MTFs may conduct billing/collection activities

BUMED is drafting guidance to the Regional Commanders/MTFs to implement the above policy memo (cont’d)

MTFs should coordinate with their Regional Commanders / BUMED before contracting / purchasing any billing support products.

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BUMED UBO Topic – Treasury Deposit Products

BUMED is preparing a draft memo that will require all MTFs to use, and accept (to receive payments), the following U.S. Treasury products:– Credit/Debit cards (thru pay.gov)– Electronic checks (thru pay.gov)– Remote payment (via a pay.gov-hosted MTF payment

page)– Payment via Electronic Funds Transfer (EFT) (using a

Remittance Express (REX) / Credit Gateway acct)– Preparation of SF215s via Over-the-counter Net

(OTCNet) (formerly Treasury General Accounting Net (TGANet))

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BUMED UBO Topic – Treasury Deposit Products

BUMED is preparing a draft memo that will require all MTFs to use, and accept (to receive payments), the following U.S. Treasury products: (cont’d)– Depositing of all checks with a check scanner thru

OTCNet (formerly Paper Check Conversion-Over the Counter (PCC OTC))

– Download of SF215 data from the Treasury Reporting System (TRS) (formerly CA$HLINK II)

Draft memo will include methods / procedures for submitting associated DD1131s

All of the above products are supported by the FMR Vol 5 Ch 28

Estimated date to implement standard deposit products: 1 Oct 2011

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BUMED UBO Topic – Other Items

Lab unbundling – BUMED UBO will re-engage on the BUMED (Lab Specialty Leader) mandated practice of unbundling labs for productivity count reasons

Known/possible CHCS/TPOCS systems issues:– Rates do not appear for APV anesthesia charges– Other?

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Questions?

Questions?

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