Briefing : What TPCP Metrics Do You Need to Succeed?

1. Briefing: What TPCP Metrics Do You Need to Succeed? Date: 23 March 2010 Time: 1300 – 1350

2. Objectives Know what data to collect Know where to find the data Know what the data means Know what action to take after analyzing the data

3. What Data Should You Collect? Billing, collections, and write-off data by MEPRS code Collected-to-billed ratio Write-off amounts by reason code Inpatient versus clinic versus ancillary data At least five years’ worth of data Your top five insurance carriers and what their plans cover The number of non-active duty outpatient appointments for your MTF

4. Where Do You Find This Data? • Use the TPOCS Summary by Clinic Report to capture outpatient billing, collections, and write-off data by MEPRS code by dollar and number of claims • Track ancillaries billed under MEPRS codes FCCA. Ancillary claims may also be billed under DAAA, DBAA, DCAA or DDAA • Labs, rads, and prescriptions generated during clinic visits are usually billed to the clinic MEPRS code

5. TPOCS Summary by Clinic Report Always send this report to the printer. It cannot be saved electronically.

6. TPOCS Summary by Clinic Report

7. TPC Inpatient Data Collect inpatient data from CHCS on the TPC Monthly Medical Services Activity Report (from the PAD menu MSA<IFM<OPM<MMR) and the Detail Report (MSA<IFM<OPM<REC) You mainly want to track changes from one fiscal year to another or changes in benefit plans

8. Non-active Duty Appointments • Use the Workload Assignment Module (WAM) in CHCS to obtain the number of non-Active Duty outpatient appointments per month • The menu path from the PAD menu is WAM<2<1 then enter the month • This is an extremely large report that can be spooled then downloaded electronically • Add all outpatient monthly totals together to calculate each quarterly amount to report on the DD 2570 • Track number of non-Active Duty appointments by MEPRS code to see changes from year to year

9. DD 2570 TPCP Program Results • Write-off dollars by reason code can be found on the DD 2570 report printed from TPOCS and CHCS • This is a cumulative amount by fiscal year so you need to print the report monthly and post only changes in the numbers from month to month • The inpatient report can be found at MSA<IFM<PRR<QRP and select the current quarter • The path for the TPOCS report is on the following slide

10. Where Do You Find DD 2570 Data? This report must be printed. The system will enter the “from” and “through” dates. You must verify that the last date of the month is shown. Always send this report to the printer.

11. Top Five Insurance Carriers If you open the TPC mail daily, you can probably name the top insurance carriers One way to obtain actual data is to run a query of billed encounters in TPOCS for an entire fiscal year Save the data to a spreadsheet then sort by insurance name Sort and count the number of bills created for each carrier Total the dollar amount billed to each You can also run a separate query by NDC to determine the top pharmacy carriers

12. How To Analyze The Data – Outpatient • Look at Outpatient TPCP data by clinic (MEPRS code) to note changes • Compare data from month to month and year to year • Has a provider PCS’d, deployed, or was one added? • Has a very ill patient with OHI died recently? (This could affect ancillary collections also) • Has the number of write-offs gone up as the collections have gone down or vice versa? • Have new clinics or specialty clinics been opened or closed? • Have billings increased in proportion to collections and write-offs?

13. Compiling Summary by Clinic Report Data Here is a sample of data compiled for quick analysis

14. Comparing Data by Fiscal Year Tracking billings or collections throughout the year lets you know if you are on target to reach your goal

15. 5-Year Outpatient Billed vs. Collected Tracking the collected-to-billed ratio shows how effective your program is, know the reason for changes  good 43% 32% 38% 36% 41%

16. 5-Year # of Outpatient Billed vs. Collected Tracking the # of bills can give a very different result  good 64% 51% 62% 61% 60%

17. How To Analyze The Data – Outpatient • On the DD 2570 report, compare write-offs by code by fiscal year • Increases in co-pays or deductibles could result in a decrease in collections • Additional write-offs to HMOs or Medicare supps would do the same. Should these have been billed? • Were write-offs posted to a site-specific code that is not identified? • Were billings put in “U” status, which means they were sent to the JAG for collection? • Have there been significant rate changes?

18. Postings by Write-off Code

19. TPC Inpatient Data • Track billings/collections/write-offs data per month and fiscal year to look for changes • Have billings increased or decreased? • Was there a proportional increase or decrease in collections and write-offs? • Have there been changes at your MTF regarding access to inpatient care (increase in beds, construction projects)?

20. What Action to Take? • If you see a significant increase or decrease in billings and collections for one clinic • Check their performance on DD 2569 collections • Ask the NCOIC if there have been significant manpower changes/deployments or if they need additional training due to new check-in clerks • Are more claims for this clinic being denied? Is coding the reason? • Do a query in TPOCS of billed encounters under that MEPRS code to see if most bills go to one insurance company or several. Have those insurance plans changed?

21. What Action to Take? • If you see significant changes in write-offs • Pull a query of postings for one day and compare them to the actual explanations of benefits for posting accuracy • Look for denials due to no valid insurance (claim never should have been billed) • Discuss either of these issues with the persons or contractors performing billing, posting, and insurance validation

22. Other Reports Available If you see discrepancies and need additional information, run the AR by Month Report in TPOCS This report can be run at any time for any month It will show all activity for a given month Look at adjustments, write-offs, and refunds Some are expected but excessive amounts should be investigated

23. Accounts Receivable by Month Report

24. Other Reports Available • Another report to review is the Positive Balance Report • This is a “picture in time” similar to an A/R report • It will show when payments are posted but claims are left open; should have very few claims on it • Investigate why the write-offs are not being posted along with the payments, especially on old claims • Always track accounts receivables by age • Know the age and status of your claims and when to send them to the JAG for collection

25. Summary • Collect your data monthly • Analyze your data to look for problems • Know your program • Have the answers readily available when management asks questions

26. Q&A • Questions?