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Briefing: Air Force Medical Affirmative Claims (MAC) Process – How Should MAC Work? Date: 21 March 2007 Time: 0900 - PowerPoint Presentation
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Briefing: Air Force Medical Affirmative Claims (MAC) Process – How Should MAC Work? Date: 21 March 2007 Time: 0900 - - PowerPoint PPT Presentation


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Briefing: Air Force Medical Affirmative Claims (MAC) Process – How Should MAC Work? Date: 21 March 2007 Time: 0900 - 0950 . Objectives. Today we will discuss: What MAC is Responsibilities Training Medical Staff on Program Creating Bills Elements of a Successful MAC Program

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slide1
Briefing: Air Force Medical Affirmative Claims (MAC) Process – How Should MAC Work?

Date: 21 March 2007

Time: 0900 - 0950

objectives
Objectives

Today we will discuss:

  • What MAC is
  • Responsibilities
  • Training Medical Staff on Program
  • Creating Bills
  • Elements of a Successful MAC Program
  • Future of Air Force MAC Program
what is mac
What Is MAC?

Medical Affirmative Claims (MAC)

  • Program outlined in DoD 6010.15, AFI 41-114, AFI 41-115, AFI 41-120, and AFI 51-502, Personnel and Government Recovery Claims (primarily SJA responsibility)
  • Dollars recouped from liability insurance for retirees, family members, and AD who receive treatment at government expense as a result of injury (includes food poisoning) or illness sustained as a result of an injury
    • Dollars for MTF treatment deposited directly into MTF O&M—separate from TPC/MSA (sales code 94)
    • Civilian medical care costs deposited into General Treasury unless MTF pays for care
what is mac4
What Is MAC?

MAC (Cont’d)

  • Types of tort insurance billed
    • Automobile
    • No-fault and/or personal injury protection (PIP)
    • Boat and airplane
    • Products and/or manufacturers
    • Premises
    • General casualty (slip/fall) or umbrella (covers a variety of personal properties)
    • Homeowners’ and/or Renters’
    • Medical malpractice (other than federal)
responsibilities yours and sja s
Responsibilities – Yours and SJA’s

Responsibilities

  • Have a written MOU between MTF and SJA that outlines notification, preparation, and follow-up procedures
  • MTF provides updated fund cite to SJA at FY start
  • MTF identifies all injuries to base SJA using the AF 1488, Daily Log of Patients Treated for Injuries
  • SJA determines if injury and subsequent treatment represents a potential recoverable claim and then pursues payment to Federal Medical Care Recovery Act
responsibilities yours and sja s6
Responsibilities – Yours and SJA’s

Responsibilities (cont’d)

  • MTF prepares AF 438, Medical Care–Third Party Liability
  • MTF provides billing rates
    • Rates available on UBO Web site by locality code (FY03-Rates)
  • MTF provides a quick response to all SJA medical record documentation requests/SJA mails claim
  • MTF and SJA reconciliation of open, transferred, and closed claims
  • Money will be deposited by the SJA
    • Verification during reconciliation process
train your staff
Train Your Staff

Training Medical Staff

  • You are responsible for ensuring that all clinic personnel are properly trained regarding the identification of potential MAC cases
  • Set up a training plan to include:
    • Regularly scheduled training sessions at least quarterly, for providers, nurses, technicians, records clerks, and administration staff
    • Initial training for all incoming personnel
how to create bills
How to Create Bills

Creating Bills

  • Air Force is working on an automated billing system for MAC, but right now there are a couple of billing methods currently available. They include, but are not limited to:
    • Submit bills to SJA on AF Form 438
      • If this is working for your MTF, then continue with this process
    • TPOCS Read-only access (FY03-Rates ONLY)
      • UB-92 will change 23 May 07 to UB-04
      • CMS 1500 will change 1 April 07
how to have a successful program
How to Have a Successful Program

Elements of a Successful MAC Program

  • Successful business relations with legal and medical staff
  • Timely identification/notification of possible MAC cases
  • Organizing the MAC program
  • Audit procedures (at least monthly)
    • With legal staff (open/closed MAC cases)
    • With medical staff (to ensure clinics are catching potential MAC cases)
  • Training medical staff on MAC
mac enhancement tool
MAC Enhancement Tool

Elements of a Successful MAC Program (cont’d)

  • Understand the MAC Enhancement Tool
    • Change Package (279-281) released on 3 Nov 05 (CHCS administrator must issue security keys)
    • New fields/functionality
      • Injury/Accident related indicator
      • Date/Place of Injury/Accident
      • Injury cases codes
      • Identify possible liability cases
      • Capture, store, and link specific clinical data/medical codes related to injury and accident information
      • Ability to generate reports
the future of mac
The Future of MAC

Future of Air Force MAC

  • Due to resourcing constraints, SJA is proposing a program reorganization
  • SJA proposal includes:
    • Regional offices with dedicated staff to work MAC
    • Possible fee (% of collections) to help fund the program
    • Effective date is TBD
  • AF SJA / AF SG meeting to discuss specifics
  • Bottom line
    • Current policy/process has not changed
    • JA should still be supporting you, if they are not, notify your MAJCOM Manager
    • We will advise when we know more
review
Review

Let’s Review:

  • What is MAC?
  • Responsibilities
  • Training Medical Staff on Program
  • Creating Bills
  • Elements of a Successful MAC Program
  • Future of Air Force MAC Program?
references
References
  • AFI 41-114, Medical Health Service System Matrix
    • Determines eligibility and appropriate charges for health care
  • AFI 41-115, Authorized Health Care and Health Care Benefits in the Military Health Services System (MHSS)
    • Determines eligibility for health care, health care benefits, and extent of care that the AF authorizes (Civilian Employees)
  • AFI 41-120, Medical Resource Management Operations
    • Guidelines for RM or UBO Flight commanders in MTFs
  • DoD 6010.15, Military Treatment Facility Uniformed Business Office Manual
    • Guidelines for operations of MTF business offices. Prescribes procedures and accounting systems for management of accounts and TPC activities
  • AFI 51-502, Personnel and Government Recovery Claims (SJA)
websites
Websites
  • http://www.tricare.mil/ocfo/mcfs/ubo/index.cfm
    • UBO Web site
  • http://www.dtic.mil/comptroller/ratesindex2002.html
    • Rates