CHCS Provider File Impacts _PPT_ - TRICARE by dfhdhdhdhjr

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									                 2007 UBO/UBU
                 Conference
From Registration to Accounts Receivable – The Whole Can of Worms




  Briefing: Impacts of CHCS Provider
            Files
  Date:           20 March 2007
  Time:           1510 - 1600




                                                                    1
2007 UBO/UBU Conference
From Registration to
Accounts Receivable                    Overview

   MHS Systems Review
   CHCS (Common File) Provider File
     – Key Elements
     – Common Errors
     – Touch-Points
   Practical Options
   Conclusion
   Short Quiz
   CHCS Reports (Examples)
   Adding New Providers (Pharmacy)



                                              2
2007 UBO/UBU Conference
From Registration to
Accounts Receivable       Systems Overview

   The web we work in!




                                         3
       2007 UBO/UBU Conference
       From Registration to
       Accounts Receivable                                                                   Systems Overview


                            Clinical                                                                    Air Force
                           Data Mart                                                                          Navy
        TRICARE                                                                                                      Army
       Ops Center                                                Worldwide Workload Report

                                                  DoD/VA                                         Service Repository (BDQAS)
                                                  SHARE                                               MHS Data Repository
                                                                      WWR
                                                                      (Count Visits)                                MDR
                                                  Coding Compliance
                                                        Editor

                                                           CCE

                                                     SADR 1/SADR 2      SADR           Standard Ambulatory          Pop Health
                                       ADM
  PDTS                                              EAS IV
                                                                      (Encounters)         Data Record              Portal

Pharmacy Data                                       Extract
                                                                                                                    MHS Mart
Transaction
System                                                                                                              M2
                                                                                   EAS
                                                                                Repository
         TPOCS WAM                                    EAS IV
              Billable           Count Visits &     “Eligible” Encounters
            Encounters           Raw Services             CPT Codes
                                                       Units of Service


                                                                                                                                 4
2007 UBO/UBU Conference
From Registration to
Accounts Receivable                                        Key Elements

   Provider File Key Elements
     – Name (last, first, middle initial)
     – Provider flag
     – Provider specialty code
                Incorrect or null = No Money!
     –    Location (= MEPRS)
     –    Identification, (SSN, license, or DEA #)
                Forthcoming National Provider Identification (NPI)




                                                                      5
2007 UBO/UBU Conference
From Registration to
Accounts Receivable                                     Common Errors

   Kinks in the chain
     – Provider specialty codes 500-518 & above 910
                500-516 no longer available but may exist in records
     –    Improper or incomplete naming conventions
     –    Providers assigned to wrong location
     –    Duplicate providers




                                                                        6
2007 UBO/UBU Conference
From Registration to
Accounts Receivable                                     Common Errors

   Other contributing factors
    – No formal guidance
    – No accountability/ownership
    – No functional experts
    – No training/continuity
    – Shared CHCS platforms
                Differing viewpoints & business practices




                                                                    7
2007 UBO/UBU Conference
From Registration to
Accounts Receivable                                          Touch-Points

   Systems impacted
     – Third Party Outpatient Collection System (TPOCS)
                Improper specialty code = No money
     –    National Enrollment Database (NED)
                Patient enrollments contain wrong specialty code
     –    Pharmacy Data Transaction Service (PDTS)
                Prescriptions filled with no DEA for provider
     –    Medical Expense & Performance Reporting System
          (MEPRS)
                Wrong workload credit




                                                                        8
2007 UBO/UBU Conference
From Registration to
Accounts Receivable                                     Touch-Points

   Where are the money and workload?
    – Lost/delayed Third Party Collection (TPC) claims
                Time to correct errors
     –    Perspective Payment System (PPS)
                Credit for medical services provided
     –    Lost Relative Value Unit (RVU) credit
                Business plans




                                                                   9
2007 UBO/UBU Conference
From Registration to
Accounts Receivable                                          Practical Options

   Damage control
                Restrict functional access
                     – Who inputs new providers files?
                     – Typically credentials, ancillary services, and systems
                Access control (restrict use of Provider Specialty Codes)
                Provide training
                Medical group instruction/process ownership
   CHCS reports
                Who has specific functional access (minimize)?
                All active providers in CHCS
                New provider added (user-defined date range)
                     –    Correct discrepancies regularly




                                                                                10
2007 UBO/UBU Conference
From Registration to
Accounts Receivable                     Additional Information




                            CHCS Reports
                          Adding New Provider




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable       New Providers Added




                                           12
2007 UBO/UBU Conference
From Registration to
Accounts Receivable       All Active Providers




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         2007 UBO/UBU Conference
         From Registration to
         Accounts Receivable                Adding New Providers
Menu Path
  Pharmacy System Menu (PSMGR)
       Outpatient Menu (PSOMGR)
          Prescriptions Menu (PSO ORDERS)


   BPL       Batch Print Labels
   RX        New Prescription Entry
   RAP       Refill a Prescription
   PRI       Prescription Inquiry
   EAP       Edit a Prescription
   RNW       Renew a Prescription
   DAP       Discontinue a Prescription
   LRP       Label Reprint
   CCS       Clinical Screening
   PEM       Patient Education Monograph
   DRX       Dispense a Prescription
   PPQ       PDTS Prescription Inquiry
   SPM       Secondary Prescriptions Menu
   IN        TransLux Scan In Rx Label
   OUT       TransLux Scan Out Rx Label

Select Prescriptions Menu Option:

 Above is the menu option and menu path used by pharmacy staff to fill
 new prescriptions and the same option they add new providers.
 Note: The CHCS user account FILE MANAGER access must contain
 “P.”

                                                                         14
     2007 UBO/UBU Conference
     From Registration to
     Accounts Receivable                                          Adding New Providers



Select PATIENT: PATIENT,ANY                   20/555-55-5555 24 Jun 1962 M FE6




 PATIENT,ANY
                             Patient ID: 1088651150
Allergies:
1. NKDA
Reaction(s): Unknown; Note: per pt 5jan05leq

YOU MAY SELECT:                A FOR   ACTIVE PRESCRIPTIONS ONLY
                               B FOR   BOTH ACTIVE AND INACTIVE PRESCRIPTIONS
                               R FOR   RANGE OF DATES
                               <RET>   TO BYPASS PROFILE

SELECTION:      (Select an option above – in this example Carriage Return)

Select DRUG: IBUPROFEN--PO 400MG TAB




                                                                                     15
     2007 UBO/UBU Conference
     From Registration to
     Accounts Receivable                              Adding New Providers

 PRESCRIPTION: ER1032155                                New Prescription Entry

  Patient: PATIENT,ANY                           RX #: ER1032155
  Pharmacy Comment: NONE
  Drug: IBUPROFEN--PO 100MG/5ML SUSR   In: 120ML/BT
  Sig: T 1 TSP Q6H WF PP OR FFE #1


  Quantity: 1       Metric Qty:                  Refills Allowed: 0
  Provider:
  MEPRS Code:                                    Days Supply: 10
  Order Date/Time: 29 Jan 2007@1201              Expiration Date: 08 Feb 2007
  Child Resistant Container: YES
  Comments:
  NONE




Once the technician gets to the provider field, and enters a provider that is not
“active” in the database, the user will be prompted, “Are you adding ‘PROVIDER,
NEW’ as a new Provider?”




                                                                                    16
     2007 UBO/UBU Conference
     From Registration to
     Accounts Receivable                            Adding New Providers
 Quantity: 40      Metric Qty:                   Refills Allowed: 0
 Provider: PROVIDER,NEW
 MEPRS Code:                                     Days Supply: 10
 Order Date/Time: 29 Nov 2006@1114               Expiration Date: 09 Dec 2006
[------------------------------------------------------------------------------]
 PROVIDER,NEW
                                   OK? Y

[------------------------------------------------------------------------------]


If adding a new provider, users should be aware the provider could already be in
the system, use of standard naming conventions can help prevent duplicate
files. This includes using additional punctuation and professional titles in the name.
CHCS is case sensitive and will not distinguish the difference between:

SMITH,JOHN J
SMITH, JOHN J
SMITH,JOHN J MD
SMITH,JOHN J.

 The above examples can cause duplicate entries. Only the first is correct!

                                                                                   17
     2007 UBO/UBU Conference
     From Registration to
     Accounts Receivable                               Adding New Providers
After being prompted are you adding, “PROVIDER,NEW” and the technician
Answers Y for yes, another question is prompted, “Is ‘PROVIDER,NEW’ an
outside Provider?”


[------------------------------------------------------------------------------]
   Are you adding ‘PROVIDER,NEW' as a new PROVIDER? Y

Is ‘PROVIDER,NEW' an outside Provider? NO//Yes




[------------------------------------------------------------------------------]




For ancillary services personnel; Pharmacy, Laboratory, and Radiology should
always answer “Yes” to outside Provider, only credentials and systems
personnel add internal providers.



                                                                                   18
    2007 UBO/UBU Conference
    From Registration to
    Accounts Receivable                                  Adding New Providers
PROVIDER: PROVIDER,NEW                                                    DA PROVIDER ADD
                      Name: PROVIDER,NEW
             Provider Flag: PROVIDER
 Select PROVIDER SPECIALTY:
 000

PROVIDER:       PROVIDER,NEW                                             DA PROVIDER EDIT
                                                                         EDI_PN:

Provider Specialty Code:             000

Provider Specialty Description:
GENERAL MEDICAL OFFICER

HIPAA Provider Taxonomy Code:              208D00000X

HIPAA Provider Taxonomy Description:
PHYSICIANS/ALLOPATHIC/OSTEOPATHIC/GENERAL PRACTICE


CMAC Provider Class:          01 -    MEDICAL DOCTOR/DOCTOR OSTEOPATHY

If an improper specialty code is used (e.g., 500-518 and above 910), the
HIPAA Provider Taxonomy Code, HIPAA Provider Taxonomy Description,
and CMAC Provider Class will be blank. This has a direct, negative
impact on Third Party Collections and PPS.                               19
     2007 UBO/UBU Conference
     From Registration to
     Accounts Receivable                                  Adding New Providers
PROVIDER: PROVIDER,NEW                                                     DA PROVIDER ADD
                      Name:     PROVIDER,NEW
             Provider Flag:     PROVIDER
 Select PROVIDER SPECIALTY:
 000
                     Class:     OUTSIDE PROVIDER
                  Location:     CHAMPUS SUPPORT or OTHER MTF
               Provider ID:     PRONEW (See Notes Below)
Req. Supervising Provider?:      Yes
         Person Identifier:
                      DEA#:
                      HCP#:
                 Clinic ID:
             Department ID:
                       DOB:
                      RANK:     Civilian or appropriate Rank
                 LICENSE #:
                       SEX:
    ACTIVE CHCS II ACCOUNT:
 DEA #s are preferred. If provider does not have a DEA # and the License field is
 used, enter the state abbreviation then the number (i.e., FL123456). If the provider
 is from another MTF and does not have either a DEA or State License #, enter the
 Provider’s SSN in the License field with “SSN” in front of the number (i.e., SSN123456789).
 NOTE: Provider ID is a local policy; it should be standardized. Example, first three & last 3
 initials of last & first name.
 Fields left blank – These are only required for MTF providers.
                                                                                            20
2007 UBO/UBU Conference
From Registration to
Accounts Receivable                Summary

   Systems Overview(s)
   CHCS provider file
   Key elements & common errors
   Systems impacted
   Damage control & options




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable                                     Quiz


1. What type of provider file should have a specialty
  code 910 & above?
  a. Non-Professional Staff
  b. None
  c. Non-MTF Staff
  d. All Files




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable                                 Quiz

2. Of the examples listed below, what is a proper CHCS
   Provider file naming convention?

   a. SMITH, JOHN J
   b. SMITH,J
   c. SMITH,JOHN J MD
   d. SMITH,JOHN J




                                                         23
2007 UBO/UBU Conference
From Registration to
Accounts Receivable                               Quiz

3. Who typically should add new providers?

   a. Anyone who wants to
   b. Credentials
   c. Ancillary staff
   d. Systems
   e. Credentials, ancillary staff, and systems




                                                     24
2007 UBO/UBU Conference
From Registration to
Accounts Receivable                                  Quiz

4. TPOCS will generate a claim if a provider has a
   specialty code 910 and above, or is blank

   a. True
   b. False




                                                        25
      2007 UBO/UBU Conference
      From Registration to
      Accounts Receivable                                 Quiz/Answers
 1. What type of provider file should have a specialty
code 910 & above?
            a. Non-Professional Staff
            b. None
            c. Non-MTF Staff
            d. All Files
2. Of the examples listed below, what is a proper CHCS
Provider File Naming Convention?
            a. SMITH, JOHN J
            b. SMITH,J
            c. SMITH,JOHN J MD
            d. SMITH,JOHN J

3. Who typically should add new providers?
           a. Anyone who wants to
           b. Credentials
           c. Ancillary Staff
           d. Systems
           e. Credentials, Ancillary Staff, and Systems


4. Will TPOCS generate a claim if a provider has a
specialty code 910 and above or is blank?
            a. True
            b. False


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