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Briefing: The Rest of the Worms (CMBB, CDML, GFEBS, SFIS…THISISCRAZY) Date: 22 March 2007 Time: 1110 - 1200. Objectives. Provide a brief overview of various UBO-related acronyms, programs, projects, and buzzwords

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Briefing the rest of the worms cmbb cdml gfebs sfis thisiscrazy date 22 march 2007 time 1110 1200

Briefing: The Rest of the Worms (CMBB, CDML, GFEBS, SFIS…THISISCRAZY)

Date: 22 March 2007

Time: 1110 - 1200


Objectives
Objectives SFIS…THISISCRAZY)

  • Provide a brief overview of various UBO-related acronyms, programs, projects, and buzzwords

  • Answer questions raised by attendees regarding other UBO-related acronyms, programs, projects, and buzzwords

  • Solicit feedback from attendees regarding other topics/items that TMA UBO should address in future TMA UBO educational programs and/or or newsletters


Cots gots
COTS & GOTS SFIS…THISISCRAZY)

  • Is not what you slept on at summer camp as a child

  • Commercial Off-The-Shelf (COTS) system

    • CMBB – GE Centricity/IDX Flowcast

    • Lab COTS – Cerner

  • Government Off-The-Shelf (GOTS) system

    • CHCS is a GOTS

  • MHS moving to using existing COTS systems rather than spending money for developing a MHS GOTS

    • Adopt the use of commercial best practices in healthcare when we use COTS products


Gfebs
GFEBS SFIS…THISISCRAZY)

  • General Fund Enterprise Business System (GFEBS)

    • An Enterprise Resource Planning (ERP) system designed to replace the Standard Army Finance System (STANFINS), the Defense Joint Accounting System, and the Standard Operation and Maintenance Army Research & Development System (SOMARDS)

    • Uses a COTS ERP package from SAP

    • Requirements validation and integration is currently underway

    • GFEBS Release 1.3 will begin being deployed to Army MTFs in August 2008

    • Deployment of GFEBS Release 1.3 to Army MTFs is currently scheduled to be completed by June 2010


CMBB SFIS…THISISCRAZY)

  • Charge Master Based Billing (CMBB)

  • Uses Commercial Off-the-Shelf (COTS) system

  • Systems configuration currently underway

  • Milestone C Decision currently scheduled for July 2008

    • Authorizes deployment of CMBB to 3 to 6 MTFs for “real world” operational testing

    • Scheduled to take 12 months

  • Full deployment of CMBB

    • Begins 4th Qtr of FY 2009

    • Ends 1st Qtr of FY 2011

    • Scheduled to take 18 months


Idx flowcast ge centricity
IDX Flowcast & GE Centricity SFIS…THISISCRAZY)

  • IDX is the company that developed the COTS application that was purchased for use by CMBB

  • Flowcast is the brand name of the IDX patient accounting product that CMBB bought for use by the MHS

  • GE Healthcare purchased IDX in 2005 and rebranded IDX Flowcast as part of their GE Centricity suite of healthcare software applications


CDML SFIS…THISISCRAZY)

  • Charge Description Master List (CDML)

  • List of all items for which CMBB has a charge/price

  • Usually called a Charge Description Master (CDM) in the civilian healthcare world

    • We call it CDML since the CDM acronym is already used for the Clinical Data Mart (CDM)


SFIS SFIS…THISISCRAZY)

  • Standard Financial Information Structure (SFIS)

    • A comprehensive, standard “business language” that defines financial information that supports all DoD-wide budget, cost/performance management, and external reporting requirements

    • SFIS is NOT an IT system

    • http://www.defenselink.mil/dbt/sfis_resources.html


Cset version 3 0
CSET Version 3.0 SFIS…THISISCRAZY)

  • Cosmetic Surgery Estimator Tool (CSET) Version 3.0

    • TMA UBO developed software tool for use in estimating the cost of elective cosmetic surgery

    • Cosmetic surgery patient pays the estimated amount before the procedure can occur

    • Version 3.0 will be the most current available for use by MTFs

    • Replaces Version 2.0 currently in use by MTF UBOs

    • Version 3.0 currently in development

    • Will be deployed to MTF UBOs in June 2007

      • Service UBO Managers determine which MTFs get the CSET


PPET SFIS…THISISCRAZY)

  • Pharmacy Pricing Estimator Tool (PPET)

  • Microsoft Access-based software application that pay patients can use to calculate their pharmacy prescription bill prior to having their prescription filled by the MTF pharmacy

  • Enables pay patients to compare prices

  • Pay patients enter their drug prescription name, dosage strength, and quantity into the PPET

  • Calculated price will include the $8.00 MHS prescription dispensing fee

  • PPET will be deployed to MTFs by June 2007 prior to deployment of the new pharmacy pricing update

  • Envisioned that the PPET will be located in the MTF UBO for use by pay patients


Hipaa
HIPAA SFIS…THISISCRAZY)

  • Health Insurance Portability and Accountability Act (HIPAA) – P.L. 104-191

  • Also known as Kennedy-Kassebaum Bill (K2) or Kassebaum-Kennedy, depending on your party affiliation

    • House of Representatives passed it 421-2

    • Senate passed it unanimously

  • Signed into law on August 21, 1996, by President Clinton


Hipaa components
HIPAA Components SFIS…THISISCRAZY)

  • Insurance Portability

  • Accountability (Fraud

    & Abuse)

  • Administrative Simplification


Intents of hipaa administrative simplification
Intents of HIPAA SFIS…THISISCRAZY)Administrative Simplification

  • Reduce Paperwork

  • Improve Efficiency of Health Systems

  • Protect Security and Confidentiality of Electronic Health Information


Timetable for adoption of standards

Standard SFIS…THISISCRAZY)

Notice of Proposed Rule Making (NPRM)

Final Rule Publication

Compliance Required

Transactions & Codes Sets

05/07/1998

08/17/2000

10/16/2003 - with extension

National Provider Identifier

05/07/1998

01/23/2004

05/23/2007

(2008<$5M)

National Employer Identifier

06/16/1998

05/31/2002

07/30/2004

(2005<$5M)

Security

08/12/1998

02/20/2003

04/20/2005

(2006<$5M)

Privacy

11/03/1999

12/28/2000

04/14/2003

(2004<$5M)

Timetable for Adoption of Standards


Hipaa covered transaction sets
HIPAA-Covered Transaction Sets SFIS…THISISCRAZY)

  • 837 – Health Care Claim (3 types)

    • Institutional

    • Professional

    • Dental

  • Retail Pharmacy Drug Claim

    • National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard Implementation Guide, Version 5.1, September 1999

    • NCPDP Batch Standard Batch Implementation Guide, Version 1.1, January 2000

      —Continued—


Hipaa covered transactions sets
HIPAA-Covered Transactions Sets SFIS…THISISCRAZY)

  • 270/271 – Health Care Eligibility Benefit Inquiry and Response

  • 276/277 – Health Care Claim Status Request and Response

  • 278 – Health Care Services Review

  • 820 – Payroll Deducted and Other Group Premium Payment for Insurance Products

  • 834 – Benefit Enrollment and Maintenance

  • 835 – Health Care Claim Payment/Advice

  • 837 – Coordination of Benefits


275 electronic claim attachment
275 – Electronic Claim Attachment SFIS…THISISCRAZY)

  • New proposed HIPAA Transaction Set in development

  • Will simultaneously use both ANSI X12 and HL7 EDI standards

  • Six different attachment types proposed

    • Clinical Reports

    • Laboratory Results

    • Medications

    • Rehabilitation Services

    • Ambulance Service

    • Emergency Department


Ncpdp
NCPDP SFIS…THISISCRAZY)

  • National Council for Prescription Drug Programs (NCPDP)

  • Develops and maintains the EDI standard used by retail pharmacies to bill prescription claims

  • Version 5.1 is the approved HIPAA standard currently used by retail pharmacies


Ansi asc x12n igs
ANSI ASC X12N & IGs SFIS…THISISCRAZY)

  • ANSI – American National Standards Institute

  • ASC X12 – Accredited Standards Committee (ASC) chartered by ANSI to develop standards for inter-industry electronic business transactions (EDI)

  • X12N – is the Subcommittee for Insurance who developed the HIPAA EDI standards

  • IGs – Implementation Guides that provide detailed formats for implementing the HIPAA EDI standards

  • Version 4010A of the HIPAA IGs is the standard

  • National Council for Prescription Drug Programs (NCPDP) developed standards for retail pharmacy drug claims


Icd 9 cm
ICD-9-CM SFIS…THISISCRAZY)

  • ICD-9-CM – International Classification of Diseases – Clinical Modification for Diagnoses, 9th Edition (Volumes 1 and 2)

    • Modified U.S. version of ICD-9 developed by the World Health Organization

  • ICD-9-CM – International Classification of Diseases – Clinical Modification for Inpatient Procedures, 9th Edition (Volume 3)

  • Implemented in the U.S. in 1978


Icd 10 cm icd 10 pcs
ICD-10-CM & ICD-10-PCS SFIS…THISISCRAZY)

  • International Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10-CM)

    • U.S. version of ICD-10 developed by the World Health Organization (WHO) for reporting morbidity data in all healthcare setting

    • Maintained by National Center for Health Statistics (NCHS) and the Centers for Disease Control (CDC)

  • International Classification of Diseases and Related Health Problems, 10th Revision, Procedural Coding System (ICD-10-PCS)

    • Developed by CMS

    • Replaces the current inpatient procedural coding system included in ICD-9-CM

  • Earliest U.S. implementation might be 1 October 2009


National provider identifier npi
National Provider Identifier (NPI) SFIS…THISISCRAZY)

  • National Provider Identifier (NPI)

    • Health care providers began applying for NPIs beginning May 23, 2005

    • Health care providers, health plans, and health care clearinghouses must begin using the NPI in standard transactions NLT May 23, 2007

    • Small health plans have until NLT May 23, 2008

    • Is a 10-position numeric identifier (last digit is a check figure)

    • Is an intelligence-free number

    • NPI Type 1 – for health care providers who are individual human beings

    • NPI Type 2 – for health care organizations


Use of the npi type 1 in the mhs
Use of the NPI Type 1 in the MHS SFIS…THISISCRAZY)

  • HA Policy 05-002 issued 26 January 2005 regarding NPI Type 1

    • Requires “all Health Care Providers who furnish billable health care services or who may initiate and/or receive referrals must obtain an NPI Type 1.”

    • Services are responsible for ensuring all privileged/credentialed providers (including Reserve Component) obtain and submit their NPI to the TMA designated data base/repository prior to 23 May 2007

    • Services SGs have issued Memoranda of Instruction detailing Service-specific instructions

  • As of 27 February 2007, 19,711 NPI Type 1 identifiers have been entered into DMHRSi

  • Still need an estimated 8,711 more NPI Type 1 identifiers!

  • Only 64 days remaining until 23 May 2007 deadline


Use of the npi type 2 in the mhs
Use of the NPI Type 2 in the MHS SFIS…THISISCRAZY)

  • HA Policy 05-012 issued 1 August 2005 regarding NPI Type 2

    • Requires all organizational health care providers within the MHS to obtain an NPI Type 2. These include:

      • MTFs that bill third party insurers

      • Pharmacy dispensing Sites

    • The Services are responsible for ensuring all applicable organizational health care providers obtain NPI Type 2 identifiers prior to 23 May 2007

  • As of 27 February 2007

    • 128 NPI Type 2 identifiers for MTFs have been entered into DMHRSi

    • 600 NPI Type 2 identifiers for Pharmacy Dispensing Sites have been entered into DMHRSi

  • Only 64 days remaining until 23 May 2007 deadline


Ub 04
UB-04 SFIS…THISISCRAZY)

  • New paper claim form that replaces the UB-92

  • Health Plans and Clearinghouses need to be ready to receive the UB-04 form by 1 March 2007. Providers can begin to use the UB-04 beginning 1 March 2007

  • Transitional period between 1 March 2007 and 22 May 2007 where either form (UB-92 or UB-04) can be used

  • Use of new UB-04 paper claim form required beginning 23 May 2007

  • UB-04 paper claim form must be used for rebilling of discharges that occurred prior to 23 May 2007 even if originally billed on a UB-92


Ub 04 con t
UB-04 (con’t) SFIS…THISISCRAZY)

  • Require use of NPIs on the UB-04 beginning 23 May 2007

  • MHS System Change Request (SCR) has been submitted for making changes to CHCS MSA module to support the new UB-04 paper claim format

  • CHCS software change package to support the UB-04 will be available for MTFs to load onto CHCS beginning in early May 2007

  • MTFs need to start ordering the new UB-04 and CMS 1500 forms now


Revised cms 1500
Revised CMS 1500 SFIS…THISISCRAZY)

  • Use of new revised CMS 1500 Form required beginning 1 April 2007

  • Prior version of CMS 1500 Form should be discontinued after 31 March 2007

  • Beginning 1 April 2007, the revised CMS 1500 Form should be used for rebilling encounters with dates of service before 1 April 2007 even if originally billed on the old CMS 1500 Form

  • New form requires use of NPIs beginning 23 May 2007

  • MHS System Change Request (SCR) has been submitted for making changes to TPOCS to support the new paper claim format

  • MTFs need to start ordering the new revised CMS 1500 forms as well as the new UB-04 forms now


Other topics that need addressing
Other Topics That Need Addressing SFIS…THISISCRAZY)

  • What other UBO-related acronyms, programs, projects, and buzzwords would you like addressed during today’s session?

  • What other topics/items should TMA UBO address in future TMA UBO educational programs and/or or newsletters?


Objectives1
Objectives SFIS…THISISCRAZY)

  • Overview of various UBO-related acronyms, programs, projects, and buzzwords

  • Questions from attendees regarding other UBO-related acronyms, programs, projects, and buzzwords

  • Feedback from attendees regarding other topics/items that TMA UBO should address in future TMA UBO educational programs and/or or newsletters


Quiz SFIS…THISISCRAZY)

  • When does GFEBS arrive at my Army MTF?

  • Just what is IDX Flowcast?

  • What is the current CMBB timeline?

  • What is SFIS?

  • So what is CSET and PPET?

  • Do I need to buy my new ICD-10 coding books tomorrow?

  • Why do I care about NPIs?

  • What new form replaces the UB-92?


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