Briefing: MSA Billing

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Briefing MSA Billing Collections for DoD
Civilians
Date 24 March 2010 Time 09000950
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Objectives

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

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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)

Type of Billing
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Billing Process

• 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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Billing Process
Same visit day/ Same code/ 7 different bills
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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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Collection Process

• Payment should be posted to the appropriate
  patient account and specify Cash (C) or Check (K
  and the check number)
• 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 OIB and
  review what was paid/covered and what is not
  covered.

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Collection Process
Multiple insurance payments On one account
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Collection Process
Multiple insurance payments On one account
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Collection Process
Multiple insurance payments On one account
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Collection Process
Multiple insurance payments On one account
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Collection Process
One Account / Mixed-up Payment
There is 1 PHR, 1 OPE, 4 RADs, and 2 LABs
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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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Collection Process
MSA / TPC Payment on One Check
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Collection Process
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.
Continue to Challenges with DoD Civilian
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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 )

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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.
• Patients insurance policy expires and they fail
  to submit new insurance information.
• Patients claim they never received IR or 1st
  delinquent letter, only the final notice.

Continue
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Challenges with DoD Civilian

• Large number of soldiers ETSd 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

Continue
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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 patients 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

Continue
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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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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?