Briefing: MSA Billing & Collections for DoD Civilians

2010 UBO/UBU Conference

Health Budgets & Financial Policy

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Briefing: MSA Billing & Collectionsfor DoD Civilians

Date: 24 March 2010Time: 0900–0950

2010 UBO/UBU ConferenceTurning Knowledge Into Action Objectives

Types of MSA Billing Billing Process Collection Process Challenges with DoD Civilians

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2010 UBO/UBU ConferenceTurning Knowledge Into Action MSA Billing Type of Patient

Civilian Emergencies DoD Civilians DoD Contractors Medicare Visitors (Family member) Daily Subsistence (TRICARE standard) Foreign Military /NATO KATUSA (Local National Military who

support U.S. Army) Inter-Agency (U.S. Embassy Workers VA,

PHS)

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Type ofBilling

2010 UBO/UBU ConferenceTurning Knowledge Into Action Billing Process

1. Print bills from CHCS using the following menu path:– Nightly Processing Menu (NPM)– Print Nightly Reports (PRT)– Select Batch Invoice and Receipts

2. Sort out bills: EEC/MEC, Sports physical, Occupational Heath exam and all other exams reviewed by patient appointment history (PRAP). ICD 9 Code are V70.5 X and V70.3

3. 40% of MSA bills are EEC/MEC and other occupational exams.

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2010 UBO/UBU ConferenceTurning Knowledge Into Action

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Billing Process

4. Precaution with mixed bills (PHY exam with other treatment, medication, lab or x-ray)


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Billing Process

5. Precaution with duplicate bills (same day visit with two or three different bills)

Same day visit / Same code/ 7 different bills


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Same visit day/ Same code/ 7 different bills

Billing Process


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Billing Process

6. When a bill is large, request a coding review prior to sending a claim to the insurance carrier.

Ex: wart removal bill $97.38 ( but coded as wart removal $800.00)


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Billing Info to CMS-1500

2010 UBO/UBU ConferenceTurning Knowledge Into Action Collection Process

1. Payment should be posted to the appropriate patient account and specify Cash (C) or Check (K and the check number)

2. Prior to posting the check, open and review the account by; – Casher Function Menu (CFM)– Casher Action Screen (CLK)– Type account #– From the bottom of Main Screen: Select OIBOIB and

review what was paid/covered and what is not covered.

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PHR Example

Collection Process


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OPE Example

Collection Process


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RAD Example

Collection Process


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Collection Process


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There is 1 PHR, 1 OPE, 4 RAD’s, and 2 LAB’s

Collection Process

One Account # / Mixed-up Payment


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Collection Process

Wrong Account # / Mixed-up Payment


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Collection Process

Wrong Account # / Mixed-up Payment


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MSA Payment

TPCPayment

Collection ProcessMSA / TPC Payment on One Check


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3. Do not send the invoice and receipt for remaining balance until all the requested claims are covered by the insurance.(If only paid office visit, wait for the other charges

like LAB test, X-ray and MEDS)

4. If the personal check bounced and was returned back from DFAS, back out from the account and request payment with cash/money order from the patient.

Collection Process


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• 96% of MSA bills are outpatient (Civilian Emergency in CONUS) • Takes a huge amount of time to post check (Ex: $5792.96 was collected against 60 accounts

that were paid. 24 accounts were not paid )

Paid : 60 accountsNot Paid: 22 accounts

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Challenges with DoD Civilian

PT did not provide DD 2569 information until UBO sent several delinquent letters and they request all accounts be claimed to their insurance company.

Patient’s insurance policy expires and they fail to submit new insurance information.

Patient’s claim they never received I&R or 1st delinquent letter, only the final notice.

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Challenges with DoD Civilian

Large number of soldiers ETS’d and obtained contractor status, yet their PAT CAT still reflects active duty

Problems with civilians parents age over 65 (MEDICARE)

Reservist from CONUS who participate in the Military Exercises


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Insurance benefits paid directly to patient. Patient denies receiving the payment and insurance denies sending explanation of benefit without patient’s consent.

Large numbers of civilians request payment agreement


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Invalid reasons for requesting charges be excluded: – Sports physical with other symptoms– Periodic reserve physical with meds (Ex: Levitra)– Patient denies receiving meds from the pharmacy– Pick up meds for existing condition while participating in the

exercise. (Ex: Synthroid)– TRICARE standard with daily substance rate


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Coding /Billing problems (Need Billing help desk) – Coded as unspecified exam (Ex: ICD 692.9)– Coumadin patient– Patient with alcohol abuse treatment for 5 weeks was

charged a little over $500.00 instead of $16,000.00 in the states

2010 UBO/UBU ConferenceTurning Knowledge Into Action Today We Discussed

Outline Billing Problems Overseas Identify which claims are applicable Explain the collection process Dealing with different categories of civilians in an

OCONUS environment

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Questions?

Documents

Briefing: MSA Billing & Collections for DoD Civilians