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Briefing:Charge Master Based Billing


Briefing: Charge Master Based Billing Date: Thursday, March 22, 2007 Time: 9:00 am Objectives Provide you with an overview of the Charge Master Based Billing (CMBB ... – PowerPoint PPT presentation

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Title: Briefing:Charge Master Based Billing

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

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

  • 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
  • CMBB is a web-based, commercial off-the-shelf
    (COTS) software product
  • CMBB is currently being configured to meet
    Department of Defense (DoD) requirements

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

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
  • A Charge Master is not intended to be used as a
    mechanism to measure performance (workload)

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

I have never heard of GE Centricity Business?
  • GE Centricity Business was formerly known as
  • 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

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
  • 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

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
  • 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
  • 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

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
  • Allows information to be entered as it is
  • 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

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

What electronic transactions are included?
  • CMBB will incorporate the following electronic
  • 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

Will I get reports?
  • GE Centricity Business provides many standard
  • 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
  • New functionality will be provided through
    Business Analyzer for Service-wide and UBO-wide
    advanced ad hoc reporting (version

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

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

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
  • Operational Test and Evaluation (OTE) will be
    conducted during Limited Deployment
  • If OTE is successful, full deployment will begin
    in late 2009

  • 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?
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