Briefing:Charge Master Based Billing

1

• Briefing Charge Master Based Billing
• Date Thursday, March 22, 2007
• Time 900 am

2
Objectives

• Provide you with an overview of the Charge Master
  Based Billing (CMBB) project

3
Summary

• CMBB is the replacement system for the Third
  Party Outpatient Collections System (TPOCS) and
  the billing functions in CHCS
• Provides one system for all patient inpatient and
  outpatient billing within the MHS including Third
  Party Collections (TPC), Medical Services
  Accounts (MSA) and Medical Affirmative Claims
  (MAC)
• CMBB is a web-based, commercial off-the-shelf
  (COTS) software product
• CMBB is currently being configured to meet
  Department of Defense (DoD) requirements

4
What is Charge Master Based Billing?

• The Patient Accounting System incorporates two
  COTS products
• Coding and Compliance Editor (CCE)
• Charge Master Based Billing (CMBB)
• CMBB is a patient billing and accounting system
  that incorporates the use of a Charge Description
  Master

5
What is a Charge Master?

• A Charge Description Master, or charge master, is
  a comprehensive listing of items that could be
  billed to a patient, payer or healthcare provider
• Charge Master Based Billing incorporates a charge
  master as part of the system used for patient
  accounting
• A Charge Master is not intended to be used as a
  mechanism to measure performance (workload)

6
What is the COTS product for CMBB?

• RITPO, in conjunction with the Services and the
  UBO, held a best value panel to select a COTS
  product during the spring and summer of 2006
• GE Centricity Business was selected as the CMBB
  solution

7
I have never heard of GE Centricity Business?

• GE Centricity Business was formerly known as
  IDX/Flowcast
• IDX/Flowcast was purchased by GE in January 2006
  and re-branded as GE Centricity Business
• IDX/Flowcast, as GE Centricity Business, remains
  a market leader in patient accounting systems

8
CMBB provides a Single Financial Solution

• GE Centricity Business provides a suite of
  applications built toward automation and focuses
  on preventing errors and delays to assure prompt
  payment
• The DoD purchase includes the following products
• Transaction Editing System (TES)
• Combined Business Office (CBO), including credit
  card processing
• Revenue Cycle Management plays a major role in
  driving business success and ensuring patient
  satisfaction through a streamlined revenue cycle

9
What are the benefits?

• Built-in payer rules ensure that patient
  information is collected correctly and completely
  
• Automatic charge capture reduces the need to
  process data manually claims rejections, re-work
  and lost charges are reduced, maximizing
  reimbursement
• Electronic claims, claims status checks and
  remittance posting drive more efficient overall
  processing and decrease time to payment
• Charges are automatically checked for accuracy
  prior to submission for cleaner claims, fewer
  rejections and less effort to correct and re-bill
  denials
• Workflow tools automate and streamline claims
  management and production to accelerate
  reimbursement and maximize staff productivity
• Simplified, patient-friendly statements reduce
  patient calls and improves patient satisfaction

10
What is TES?

• TES is a front-end transaction editing and
  suspense system designed to capture, evaluate,
  correct, and extract charge and claim
  transactions into the CBO program
• TES helps streamline workflow and prevent
  incomplete or incorrect information on claim
  forms
• Allows information to be entered as it is
  available
• Tests for missing or incorrect information
• Filters transactions into work lists for
  efficient editing
• Allows transactions to be edited for completeness
  and requested before the transactions are
  transferred to the CBO

11
What is CBO?

• CBO provides consolidated operations to improve
  performance and compress the revenue cycle
• CBO streamlines workflow by presenting a
  consolidated view of all hospital and
  professional financial data for a patient,
  guarantor or a clinical encounter
• CBO increases patient satisfaction by combining
  all charges for both hospital and professional
  services on a single statement, decreases calls,
  paper and postage costs

12
What electronic transactions are included?

• CMBB will incorporate the following electronic
  transactions
• 270/271 Eligibility inquiry and response
• 837/835 Claims submission and remittances
• 276/277 Claims status and response
• When the rules are finalized, GE will incorporate
  the 275, claims attachment, transaction CMBB
  will incorporate this change as part of a COTS
  upgrade

13
Will I get reports?

• GE Centricity Business provides many standard
  reports
• Current TPOCS reports and CHCS reports will be
  matched against the standard reports to ensure
  that the current reporting functionality is met
• Ad hoc reporting is available in GE Centricity
  Business
• New functionality will be provided through
  Business Analyzer for Service-wide and UBO-wide
  advanced ad hoc reporting (version 1.0.1.0)

14
What Claim Forms will be supported?

• UB-04
• CMS 1500
• Universal Claim Form
• Dental
• DoD-specific forms, including
• DD7
• DD7A
• DD139
• Invoice and Receipt (IR)
• SF 1080

15
Will training be provided?

• Training will be provided during deployment
• Follow-on training will be provided in a manner
  similar to what TPOCS does today

16
When is CMBB coming?

• GE Centricity Business is currently being
  configured to meet DoD requirements
• Testing is expected to start in early in 2008,
  including Service supported System Qualification
  Testing (SQT) in late spring 2008
• Milestone C is expected to be awarded by
  mid-summer of 2008
• Limited Deployment to two (2) Service-selected
  sites will begin shortly after Milestone C is
  awarded
• Operational Test and Evaluation (OTE) will be
  conducted during Limited Deployment
• If OTE is successful, full deployment will begin
  in late 2009

17
Quiz

• What is the COTS product for CMBB?
• What is a Charge Description Master?
• What modules will be incorporated into CMBB?
• What EDI transactions will be supported?