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Briefing: MSA Billing Date: 19 March 2007 Time: 1110 – 1200. Objectives. Discuss what occurs when a TPCP Inpatient Claim is denied, and how that affects MSA Demonstrate and explain billing for : Subsistence Family Member Hospitalization Coast Guard VA Foreign Military.

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Briefing msa billing date 19 march 2007 time 1110 1200

Briefing: MSA Billing

Date: 19 March 2007

Time: 1110 – 1200


Objectives
Objectives

  • Discuss what occurs when a TPCP Inpatient Claim is denied, and how that affects MSA

  • Demonstrate and explain billing for :

    • Subsistence

    • Family Member Hospitalization

    • Coast Guard

    • VA

    • Foreign Military


Effect of inpatient tpc denial on msa
Effect of Inpatient TPC Denial on MSA

  • What happens when an inpatient TPC account is closed in the CHCS MSA module?

    • When a 100% denial is received and the appropriate reason code for the denial is entered into the TPC account, an MSA is automatically generated for the appropriate charge based on the Patient Category

    • The “clock” starts for the MSA Accounts Receivable


Subsistence
Subsistence

Subsistence (SR)

The daily charge to all Active Duty Members and retired officers for food while hospitalized as an inpatient. Prior or Iraq war, all Active Duty and retired officers were charged. In FY06 this charge was suspended; the suspension was recently extended through FY07

Prior to the suspension of the charge, MSA automatically calculated the SR charges from the date of admission to the day prior to discharge, creating a one-day charge if the patient was admitted and discharged on the same day

The Subsistence charge may still be applied to Secretary Designee patients. If designated in the Secretary Designee letter, MSA will calculate the appropriate charge based on the PATCAT assigned


Family member hospitalization
Family Member Hospitalization

Family Member Hospitalization (FMR)

The daily charge to all Active Duty Family Members not enrolled in TRICARE Prime and All Family Members of Retirees. The Family Member Charge is not only a charge for food; this charge was developed to cover the cost for meals and defray the costs for contracted services associated with an inpatient hospital stay (e.g., laundry, housekeeping, local telephone calls)

MSA automatically calculates the SR charges from the date of admission to the day prior to discharge. Creating a one-day charge if the patient was admitted and discharged on the same day


Coast guard
Coast Guard

Coast Guard, Public Health Service, and NOAA (PATCATs

beginning with C , P, and B)

  • DD7 and DD7A Bills are generated by CHCS

  • DD7 – Inpatient Bill

    • Once coded by PAD in the Encoder Grouper (which calculates the DRG), CHCS MSA calculates the charge for the admission at the Inter-Agency Rate (IAR). The DD7 report can be printed and submitted to the USCG, NOAA, or PHS with an SF1080 as the coversheet

      —Continued—


Coast guard1
Coast Guard

  • DD7A – Outpatient Bill

    • Once coded by the Outpatient Clinic staff in the ADM Module of CHCS, and released from CCE by the Outpatient Coders, the coding information is passed to CHCS MSA, which calculates the charge for each CPT-4, HCPCS, or CDT code at the Inter-Agency Rate (IAR). Ancillary services are generated when the service is performed and entered into the LAB, RAD, or Pharmacy module in CHCS. At the same time, the information is passed to CHCS MSA and charges are calculated at the IAR

    • DD7A report can be printed and submitted to the USCG, NOAA, or PHS with an SF1080 as the coversheet


VA

VA – PATCAT K61

The same process as the DD7 and DD7A


Foreign military
Foreign Military

Foreign Military


Foreign military1
Foreign Military

  • Inpatient Bill

    • Once coded by PAD in the Encoder Grouper (which calculates the DRG), CHCS MSA calculates the charge for the admission at the appropriate rate for the PATCAT. Either the DD7 or the Invoice & Receipt (I&R) DD7 report is created and can be printed and submitted

  • Outpatient Bill

    • Once coded by the Outpatient Clinic staff in the ADM Module of CHCS, the outpatient encounter is released from CCE by the outpatient coders. Ancillary services are generated when the service is performed and entered into the LAB, RAD, or Pharmacy module in CHCS. When the information is passed to CHCS, MSA charges are calculated for each CPT-4, HCPCS, CDT code, or prescription at the appropriate rate for the PATCAT


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