Briefing: Using e- and Other Tools to Improve the MSA Collections and AR Management Process

Briefing: Using e- and Other Tools to Improve the MSA Collections and AR Management Process Date: 24 March 2010Time: 0800-0850 RepeatedDate: 25 March 2010Time: 1010-1100

Background • The Composite Healthcare System (CHCS) provides a very reliable and dependable set of technologies for meeting the necessary requirements of the Dept of Defense to account for the production of invoices, document supporting medical information, bill patients, and provide an audit trail for funds received. • However … CHCS is woefully behind many of the common 21st century methods used in the rest of the world for moving these sets of medical information to health insurers, patients and other payers, and employed to provide a faster / more secure / easily traced means of accounting for the bills / funds in an end-to-end fashion.

Background • Available now (and mostly at no cost) are multiple 21st century tools that MTFs can use to dramatically improve the collections process and reduce the size of the accounts receivable (AR) (while probably also greatly increasing patient satisfaction with your MTF’s billing / insurance filing process).

Background • U.S. Naval Hospital Naples has implemented /employed multiple of these new AR management methods and processes over the last 3 years. During this time, NavHosp Naples has realized significant improvements to the AR as follows:

Objectives • This presentation details some of the methods and processes used by NavHosp Naples to realize this improvement (that your MTF may also wish to consider using). These methods and processes include: • Moving towards a more cash-free office by receiving funds via: • Credit card • Check or debit card (Automated Clearinghouse (ACH) transfer) • Electronic funds transfer (EFT) • Providing better funds accountability, documentation, speed of deposit via: • Direct scanning, uploading, e-storage of checks to the Dept of Treasury

Objectives • Faster, more accurate processing of insurance claims via: • Use of a direct entry, Web-based medical insurance claims clearinghouse • Consolidated patient billing through use of a: • Simple, command-changeable CHCS ad hoc • Collection of delinquent debtors with: • Direct DFAS garnishment of pay (for DoD appropriated fund employees) • Offset of funds from any Federal source (for all other persons) through the Treasury Offset Program (TOP)

Possibilities • Available now, MSA Offices can – • Allow payers (normally large payers like governments (including many foreign) and insurance companies) to directly transfer funds into a U.S. Treasury account specifically designated for your hospital’s MSA Office. • Allow payers (normally small payers) to write electronic checks, versus paper checks. • Allow payers to pay with a credit card (no transaction fees). • Allow payers to pay over the Internet. • Scan, upload for deposit and locally destroy all paper checks received in person or thru the mail. - continued -

Possibilities • Involuntary collection on delinquent debtors (for almost any debtor with an SSN). • (Nearly) instantly file virtually 100% of all outpatient claims to any medical insurer thru an extremely easy to use commercial Web portal (possible costs to your MTF). • Conduct easy-to-understand consolidated billing for your pay patients.

Cash Reduction Tools • Following are tools to provide easy, cashless methods for your patients to pay their hospital debts. • Records are automatically kept electronically in Dept of Treasury Web-based servers for 6+ years.

Credit Cards • Credit cards through Pay.gov: • At no cost to your hospital, the U.S. Treasury offers to accept credit card payments and then credit those funds to your designated finance office. • How does it work? • Patient provides credit card info; MSA personnel then post the payment with an internet-connected computer to www.pay.gov. • The Treasury sends the credit card collection to a designated commercial bank (Fifth Third Bank) for processing. • The commercial bank processes the payment and then sends a SF 215 Deposit Ticket to DFAS (reported via CA$HLINK II). • DFAS applies the deposit against an LOA using the electronic DD 1131 that you provide. • Also, you may complete your own refunds with credit cards (no DFAS support required!) (credit card refunds generate an SF 5515 Debit Voucher)

Credit Cards • Logging into pay.gov:

Credit Cards • Entering credit card info into pay.gov:

Credit Cards • Listing of pay.gov processed payments/refunds: • No personal info on this screen – simulated data.

Credit Cards • Logging into CA$HLINK II to obtain SF 215 reports:

Credit Cards • Credit card CA$HLINK II SF 215 report:

Electronic Checks • e-Checks through Pay.gov: • Similar to credit card processing, pay.gov will accept electronic check payments and then post them to your line of accounting. • How does it work? • Patient provides e-check info (routing and account numbers) & MSA personnel post the payment with an Internet-connected computer to pay.gov. • The Treasury sends the e-check collection to the patient’s bank for processing. • The bank processes the payment and then sends a SF 215 Deposit Ticket to your DFAS (via CA$HLINK II). • DFAS applies the deposit against your LOA using the electronic DD 1131 that you provide.

Electronic Checks • Screen to enter electronic check payments:

Electronic Checks • Pay.gov summary of electronic check payments: • No personal info on this screen – simulated data.

Electronic Checks • Electronic check CA$HLINK II SF 215 report:

Pay via the Internet • Patients may pay directly at pay.gov (no need for the patient to waste their time (or yours!) by making an unnecessary trip into your office): • Pay.gov will host your payment form (at no cost to you). You may advertise the Web address of your pay.gov hosted Web page, or you may link to it thru your hospital’s Web page. • How does it work? • The patient goes to your hosted form at pay.gov and enters information, such as CHCS account numbers, name, address (you choose what information is required). The patient then enters his or her own credit card or e-check info and submits the payment. • MSA Office personnel periodically check (normally daily) at pay.gov and look for any new payments. New payments are then posted into CHCS and invoices sent to the patient.

Internet Payments • Easy Payment letter enclosed with each invoice:

Internet Payments • Hospital Web site/payment form hosted by pay.gov: • No personal info on this screen – simulated data.

Internet Payments • Screen where the patient enters account info: • No personal info on this screen – simulated data.

Internet Payments • Location where USNH finds patient payments: • No personal info on this screen – simulated data.

Payments Directly to MSA “Bank” Account • Remittance Express (REX): • With REX, your hospital has its own depository-only bank account at the U.S. Treasury (for deposits only; no funds are available for withdrawal). You have your own 9-digit routing number and account number. - continued - Large payers who will use REX include: AETNA, MailHandlers, Foreign Service Benefit Plan, UnitedHealthcare and the U.S. Treasury’s Treasury Offset Program (TOP). Expect this list to grow.

Payments Directly to MSA “Bank” Account Remittance Express (REX): • How does it work? • You provide your routing and account number to a payer; the payer then provides this information to his or her bank and asks the bank to make a payment. The payer notifies the MSA Office (normally via an Electronic Remittance Advice (ERA)) that a direct payment is forthcoming. • Funds appear at the Treasury, which then sends a SF 215 Deposit Ticket to your DFAS (via CA$HLINK II). • MSA personnel post the payments using the ERA info. • DFAS applies the deposit against your LOA using the electronic DD 1131 that you provide.

REX • REX CA$HLINK II SF 215 report:

REX • REX Electronic Funds Transfer (EFT) payment e-mail notification:

REX • EFT Electronic Remittance Advice (ERA) info via Internet:

REX • REX / EFT via CA$HLINK II:

Speed of Deposit / Documentation Tools • Following are tools to provide a safe, fast, secure method of depositing checks, while retaining Web-based electronic records for 6+ years.

Get Rid of Paper Checks and Cash • With Paper Check Conversion – Over the Counter (PCC OTC): • The MSA Office receives paper checks (thru the mail or in person). • The payment is posted in CHCS (at any point you choose). • The check is sent thru your Treasury-provided check scanner for scanning / upload / deposit (within 14 days, you must either return the check to the patient or shred it). • Treasury processes the check(s) (normally as a batch) and then sends a SF 215 Deposit Ticket to your DFAS (via CA$HLINK II). • DFAS applies the deposit against your LOA using the electronic DD 1131 that you provide. Also, you may deposit cash by exchanging it for a cashier’s check (at your community bank), and then uploading the cashier’s check via PCC OTC.

PCC OTC • PCC OTC Hardware / Scanning Software: • No personal info on this screen – simulated data.

PCC OTC • PCC OTC Batch Upload Summary: • No personal info on this screen – simulated data.

PCC OTC • PCC OTC SF 215 Report: • No personal info on this screen – simulated data.

PCC OTC • Copy of check info from the US Treasury’s Web site (available for 6+ years): • No personal info on this screen – simulated data.

Faster Insurance Claims Submission • Instead of paper filing, mail filing of your insurance claims, electronically file them (some of these services may cost to use). • Records are automatically kept electronically on commercial Web-based servers for a minimum of several years.

Medical Insurance Claims Clearinghouse • Filing of insurance claims via paper is slow and provides little ability to prove or verify delivery to a health insurer, insurance claims payer. Errors may not be discovered for weeks or months. • Commercial vendors possess powerful Web-based systems that allow for hospitals and providers to enter medical claims data directly into the servers of medical claims clearinghouses. • From there, the clearinghouse electronically delivers the claim to the payer (normally, delivery to the health insurer occurs within 24 hours of the claim data being entered by MSA personnel). Note: Most clearinghouse services require a paid subscription, although some limited services may be provided for no cost. However, most clearinghouse costs can be justified by postage savings alone. NavHosp Naples does not endorse any specific service.

Medical Insurance Claims Clearinghouse Commercial clearinghouses offer the following advantages: • Direct data entry (prepare, and electronically file, your claim in less time than you used to spend in just preparing, printing, and putting into the mailbox your paper claims) • Verified “proof’ of claims delivery • Fast delivery of claims • Instant verification of claim for correct usage of CPT/ICD-9 code and other data • Ability to quickly resubmit and modify previously submitted claims • Electronic, online storage of claims data (at least several years of data) • Powerful tools to sort claims by patient, claims status, dates of service, payer, etc. • Online download of EOB/ERA data (for some payers).

Medical Insurance Claims Clearinghouse

Consolidated Invoicing • Perform more easily understood consolidated billing for your MSA pay patients.

Consolidated Invoicing • The Consolidated Invoice is a locally written ad hoc report that USNH Naples uses in lieu of all follow-on individual acct invoices. The Consolidated Invoice pulls data from all accounts under the specified sponsor and produces a mail-ready report that provides/lists: • Mailing insert (for window envelopes), including address field, statement of requirement to pay, methods of payment. • Sponsor name • Patient name (repeating for all patients under the sponsor) • Type of acct (user chooses ‘All’, or just ‘O’, ‘Z’, ‘P’, etc. (or a combination of acct types)) - Continued -

Consolidated Invoicing • Acct number • Date of service • Total charges • Payment /charge calculation history, including payment date, payment amount, payment type, check number • Remarks field (used primarily to indicate insurance filing/processing status) The Consolidated Invoice does not contain: • Social Security numbers • Medical information

Consolidated Invoicing • USNH Naples uses the Consolidated Invoice as follows: • Original invoices are still sent to the sponsor after producing (and being verified) from the nightly run. Unless requested by the patient, this invoice will not be mailed again – patients are asked to keep the original invoice for future reference (greatly reduced chance of mis-mailing HIPAA-protected info!). - Continued -

Consolidated Invoicing • For patients who have provided their insurance information to the MSA Office, invoices are stamped “Information Copy – Health Insurer will be billed.” The invoice Remarks field is annotated as “PEND” to indicate that this invoice is still pending processing by the health insurer. • After completing insurance processing, the invoice Remarks field is annotated as “DUE” to indicate that insurance patients should now pay any remaining balance. • For patients who have not provided insurance information to the MSA Office, the invoice is mailed to the patient for payment. The invoice Remarks field is annotated as “DUE” to indicate that this invoice should be paid.

Consolidated Invoicing • Once per month, each patient with an open balance (on any acct under their sponsorship) is mailed the Consolidated Invoice. • Other than mailing of the original invoice, this is the only mailing to the sponsor that occurs (an average mailing reduction to patients of 60%). • Since the Consolidated Invoice goes out monthly, Delinquent Letters are no longer printed and sent. • On request (such as income tax filing season, Flexible Savings Account filing, or PCS checkout), MSA personnel simply print the entire Consolidated Invoice for the patient to reference (provides a single document that historically lists all (open, closed, pending, etc.) acct/payment information under a sponsor).

Consolidated Invoice – Mail Insert/Payment Methods

Consolidated Invoice – Monthly Mailing/‘O’ Accts • Simulated data only – no personal information included

Briefing: Using e- and Other Tools to Improve the MSA Collections and AR Management Process