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From Registration to Accounts Receivable – The Whole Can of Worms

2007 UBO/UBUConference

Briefing: CHCS PATCATs vs HCDPs

Date: 21 March 2007

Time: 1610 - 1700

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2007 UBO/UBU ConferenceFrom Registration to Accounts Receivable Objectives

Be aware that DEERS and CHCS count and categorize patients differently when it comes to status and eligibility

Understand what Patient Categories (PATCATs) are, and how they are used within CHCS

Understand what HCDPs are, and how they represent a patients true eligibility within the MHS

Understand the relationship between the HCDP and the PATCAT, and how DEERS and CHCS communicate eligibility

Be able to identify/verify/correct mismatches between PATCAT/HCDP within the enrolled patient population

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2007 UBO/UBU ConferenceFrom Registration to Accounts Receivable PATCATs

PATCATs are used to categorize patients within CHCS by service and eligibility type (Active Duty, Retired, etc…)

EXAMPLE: PATIENT CATEGORY CODE SUMMARY USAF ACTIVE DUTY F11 ACTIVE DUTY

USAF RET LOS ENLISTED F31 DEPENDANT/RETIREE USAF FAMILY MBR RET F43 DEPENDANT/RETIREE

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2007 UBO/UBU ConferenceFrom Registration to Accounts Receivable PATCATS/HCDP

PATCATs are also key in separating out the enrolled population within the MCP file

The MTF’s enrolled population consists of the primary patients that visit the MTF, and that the MTF is responsible for

DEERS does not update a patients PATCAT as eligibility changes to reflect a change in overall eligibility, or a change in the sponsor’s service

Many mismatches exist that blur the true eligibility/status of the patient, and cause errors in placement within the enrolled population

These errors can affect billing and OHI collection

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2007 UBO/UBU ConferenceFrom Registration to Accounts Receivable ENROLLED POPULATION

PCM Group PCM Total ADY AFM OTH RET RFM TRP

305 FAMILY PRAC TEAM 1 AMUTH,ARAVINDAN 839 515 182 33 47 61 1

305 FAMILY PRAC TEAM 1 HODGES,MICHAEL G 1797 895 447 11 206 221 17

305 FAMILY PRAC TEAM 1 KIESOW,CHRISTOPHER J 1538 899 401 6 104 120 8

305 FAMILY PRAC TEAM 1 SAVARD,DILLON J 1569 788 398 2 167 205 9

305 FAMILY PRAC TEAM 1 WELCH,ANGELA J 1451 642 493 8 112 182 14

305 FAMILY PRAC TEAM 2 LUCAS,PATRICIA M 1579 570 626 8 117 253 5

305 FAMILY PRAC TEAM 2 MUSSER,JASON L 1511 774 422 2 120 174 19

305 FAMILY PRAC TEAM 2 TERZELLA,MATTHEW 1795 844 564 6 123 249 9

305 FAMILY PRAC TEAM 2 WONG,WILBUR P 37 18 6 6 2 5 0

305 FLIGHT MEDICINE BICALDO,DOMINGO R 539 423 115 0 0 1 0

305 FLIGHT MEDICINE JANI,ALAP R 680 520 153 0 6 1 0

305 PEDIATRICS ELACATE,MARYANN J 1586 0 1450 10 0 126 0

305 PEDIATRICS GEORGE,STEPHEN L 1692 0 1523 4 0 165 0

305 PEDIATRICS KREJCI,KATHLEEN S 201 0 145 0 0 56 0

    16814 6888 6925 96 1004 1819 82

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2007 UBO/UBU ConferenceFrom Registration to Accounts Receivable HCDPs

HCDPs are used to identify the patients true eligibility within DEERS/MHS

EXAMPLE: 106 TRICARE Prime Individual Coverage for Active Duty Sponsors 107 TRICARE Prime Individual Coverage for Active Duty Family Members 117 TRICARE Prime Family Coverage for Retired and Medal of Honor Sponsors and Family Members

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2007 UBO/UBU ConferenceFrom Registration to Accounts Receivable PATCAT/HCDP

Become familiar with PATCAT/HCDP key to detect errors (see key for reference)

Types of possible errors: PATCAT/HCDP PATCAT/HCDP/sponsor/dependant service Sponsor service/dependant service Sponsor deceased/dependant retired family member

Query DEERS through BHCF (Healthcare Finder Booking) to verify patients status

DEERS check will display CHCS Patient Category as well as current HCDP

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2007 UBO/UBU ConferenceFrom Registration to Accounts Receivable PATCAT/HCDP

By running a CHCS adhoc against the enrolled population we can compare the patient HCDP/Sponsor PATCAT/Patient PATCAT to easily identify any potential errors that might exist– When running the adhoc sort by

HCDP/PATCAT/SPON PATCAT and scroll through. Errors will be found where changes occur between any data elements

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2007 UBO/UBU ConferenceFrom Registration to Accounts Receivable ADHOC EXAMPLE OUTPUT

BEN CAT HCDP PATCAT SPON PATCAT

RFM 116 N43 N00

ADY 117 A11 A11

ADY 117 A11 A11

AFM 117 F41 F11

AFM 117 F41 F31

AFM 117 F41 F31

AFM 117 F41 F31

AFM 117 N41 M31

AFM 117 N41 M31

RFM 117 N43 N11

RFM 117 N43 N11

RFM 117 N43 N11

ADY 117 N11 N11

ADY 117 N11 N11

ADY 117 N11 N11

ADY 117 N11 N11

ADY 117 N11 N11

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2007 UBO/UBU ConferenceFrom Registration to Accounts Receivable DEERS CHECK

DEERS ELIGIBILITY DATA Name: SMITH,MICHAEL M FMP/SSN: 20/800-09-0909 Patient Category: USAF ACTIVE DUTY SEX/DOB/AGE:M/27Oct1961/45Y ───────────────────────────────────────────────────────────────────── Eligibility Date: 22 Jan 2007

Name First: MICHAEL Sponsor SSN: 800-09-0909

Middle: M Branch of Service: AIR FORCE

Last: SMITH Pay Grade: 07

Cadency: Sponsor Cat Code: Retired

DOB: 27 Oct 1961 Sponsor Rank: SERGEANT

Sex: MALE Sponsor UIC: Relationship: Self UIC Zip Code: HCDP Code: 117 Type: MEDICAL Enr DMIS ID: 0326

TRICARE PRIME FAMILY COVERAGE FOR RETIRED AND MEDAL OF HONOR SPONSORS AND FAMILY MEMBERS

HCDP Start Date: 22 Jan 2007 Region Code: 17 HCDP

End Date: 22 Jan 2007 Network Provider: Direct Care Net

ECHO Code: ECHO Start Date: ECHO End Date:

─────────────────────────────────────────────────────────────────────eXit PCM HCDP Demographics prInt hElp

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2007 UBO/UBU ConferenceFrom Registration to Accounts Receivable PATCAT/HCDP

Reference PATCAT/HCDP key to make corrections after verifying through DEERS the patient’s actual status

Make corrections through Mini Registration Many of these patients are really billable

– Can now query for OHI or enter OHI Patients will now fall into the correct categories within

the MCP files CHCS will also now count these patients and identify

them as their DEERS status truly reflects Would run this adhoc and perform this procedure once

every two weeks

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2007 UBO/UBU ConferenceFrom Registration to Accounts Receivable PATCAT/HCDP

PATCAT/HCDP key and ADHOC are available for copying or can be requested through email

QUESTIONS???