briefing: msa billing & collections for dod civilians
DESCRIPTION
Briefing: MSA Billing & Collections for DoD Civilians. Date: 24 March 2010 Time: 0900–0950. Objectives. Types of MSA Billing Billing Process Collection Process Challenges with DoD Civilians. MSA Billing Type of Patient. Type of Billing. Civilian Emergencies DoD Civilians - PowerPoint PPT PresentationTRANSCRIPT
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2010 UBO/UBU Conference
Health Budgets & Financial Policy
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Briefing: MSA Billing & Collectionsfor DoD Civilians
Date: 24 March 2010Time: 0900–0950
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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
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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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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
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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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Challenges with DoD Civilian
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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Challenges with DoD Civilian
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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Challenges with DoD Civilian
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
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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?