Preparation: MSA Billing

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Instructions: MSA Billing Date: 22 March 2010 Time: 1010 – 1100

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Objectives MSA Billing controlled by Patient Category Family Member Hospitalization (FMR) Interagency Billing (IAB) Foreign Military & Family Members Civilian Emergency Elective Cosmetic Surgery DoD Civilians & Contractors Reservists

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Family Member Rate There is an every day charge for all Active Duty relatives not selected in TRICARE Prime and all relatives of retirees New Born of Active Duty TRICARE Prime charges ought to be composed off This day by day charge is utilized to take care of the expense of the contracted administrations connected with an inpatient doctor's facility remain The patient is charged for the day of affirmation yet not the day of release. In the event that a patient is conceded and released that day, there is a charge

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Other Health Insurance When a patient has other medical coverage we can charge their protection for their hospitalization Once the protection has been checked, the protection should be advised of the patient's affirmation Follow the protection rules for their use audit to guarantee the most extreme measure of claim installment Notification might be finished by the Third Party Department or Utilization Review Nurse

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Inter-Agency Billing Coast Guard, Public Health, and NOAA (IAB Report) IAB charging is done on a month to month premise. We are not subsidized to treat these patients , it is vital that we catch each billable visit which incorporates all ancillaries and all medicines that have a rate connected Follow Service-indicated rules when preparing this report

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Medicare & Medicaid Billing Medicare We can charge the non-qualified for their visit to the MTF when they have Medicare. Take after Medicare rules when charging. Medicaid State by state rules would apply Example: Washington states requires an assention between the state and the individual MTF

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Veterans Administration Veterans Administration (Not VA/DoD Sharing) When a veteran is seen at the MTF and is not qualified, their visit is billable The cases should be sent to: Department of Veterans Affairs Financial Services Center Non-VA Emergency Claims P.O. Box 149364 Austin, TX 78714-9364

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Veteran's Billing All VA claims must incorporate outline notes, Report of Contact for Non-VA Hospital, and VA shape 10-583 If a Veteran has Other Health Insurance or Medicare, we will charge their insurance agency or Medicare. Something else, the Veterans Administration will deny the claim

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Foreign Military Billing Inpatient & Outpatient Billing There are more than 80 nations that are right now secured by some kind of social insurance concurrence with DoD Programs Include: NATO Status of Forces Agreements (SOFA) Partnership for Peace (PFP) Reciprocal Health Care Agreements (RHCAs) NATO Military and Family Members International Military for Education & Training (IMET) Patient Category (PATCAT) will be dictated by their status

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Foreign Military Billing Access to the Invitational Travel Order (ITO) is scratch Tells where they are from and what they are approved to get Determines money related obligation regarding human services of wards May not generally be right as to secured medicinal services administrations Verify qualification by means of DEERS. Work with front work area faculty or Admissions, so the MSA office will have the capacity to gather all required documentation for charging

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Civilian Emergency The patients seen at the MTF and not qualified for advantages, will be in charge of their accuses Work of your Emergency Department and different purposes of passage to assemble the greater part of the required documentation and demographics from the patient Once the visit (inpatient or outpatient) is coded by Patient Admin and went into CCE, it bolsters into CHCS and after the holding time frame, the Invoice and Receipt (I&R) is created in CHCS MSA

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Civilian Emergency If non military personnel has Other Health Insurance, charge the insurance agency as a "politeness" to the patient If quiet has an inpatient affirmation, charge the protection through CHCS MSA If understanding has an outpatient visit, physically charge the insurance agency utilizing TPOCS or other program Any charges not paid by the insurance agency must be paid by the patient inside 30 days

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Elective Cosmetic Surgery Elective Cosmetic Surgery is not a TRICARE secured advantage, the recipient will be in charge of everything. This additionally incorporates Active Duty Patient must sign Letter of Acknowledgment Cost of surgery is resolved utilizing the Cosmetic Surgery Estimator (CSE) Payment in full is required, before surgery Tickler record kept in MSA office

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DoD Civilians & Contractors DoD Civilians who are harmed at work, have an open and endorsed OWCP claim, can be seen at MTF for their treatment DoD Civilians are charged for their non-business related visits. We can charge their insurance agency (Both OCONUS & CONUS). They are in charge of their co-pay and deductible Contractors are charged for the majority of their visits. Special case is if there is a Memorandum of Understanding (MOU)

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Reservists Members of National Guard and Reserve, including their relatives are qualified for various TRICARE benefits relying upon their status Verification is done in DEERS Benefits change, check TRICARE Web webpage for changes National Guard and Reservists are required to meet physical capabilities for maintenance. They have required yearly screenings. These visits are not Billable visits incorporate disease or harm not identified with a line of obligation damage. (Reservist has influenza and come in amid the center of the week – visit would be billable)

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Summary We realized there are a few segments to MSA charging. It is not simply relative inpatient charging, but rather a ton more By knowing and seeing how to distinguish each MSA charging part, it will make your part in the MSA office more proficient Most of this MSA charging is non-financed mind gave at your office

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Quiz If a patient is conceded and released that day, do you charge him or her? Will we charge Other Health Insurance for doctor's facility visits? By what classification, do we know what to charge the outside military? Do dynamic obligation need to pay for their Elective Cosmetic Surgery?

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