DHA Business Support Directorate: Business Tools – An Enterprise View AMSUS 2015 Annual Continuing Education Meeting 2 December 2015 Mr. Darrell Landreaux Acting Director, DHA Business Support Directorate “Medically Ready Force…Ready Medical Force” 1
MHS Reform Goals: • Creating a more globally integrated health system – built on our battlefield successes • Driving enterprise-wide shared services; standardized clinical and business processes that produce better health and better health care • Implementing future-oriented strategies to create a better, stronger, more relevant medical force “Medically Ready Force…Ready Medical Force” 2
DHA Vision and Mission Vision A joint, integrated, premier system of health, supporting those who serve in the defense of our country. Key Mission Aspects § A Combat Support Agency supporting the military services § Supports the delivery of integrated, affordable, and high quality health services to beneficiaries of the Military Health System (MHS) § Executes responsibility for shared services, functions, and activities of the MHS § Serves as the program manager for the TRICARE Health Plan, medical resources, and as the market manager for the National Capital Region (NCR) enhanced Multi-Service Market § Manages the execution of policy as issued by the Assistant Secretary of Defense for Health Affairs § Exercises authority, direction and control over the inpatient facilities and the subordinate clinics assigned to the DHA in the NCR Directorate. “Medically Ready Force…Ready Medical Force” 3
Defense Health Agency Secretary of Defense USD(P& R) ASD(HA) CJCS POLICY DEVELOPMENT & OVERSIGHT POLICY EXECUTION IPO Combat Support Agency Responsibilities Defense Health Agency Director Deputy Director Advisor PEO DHMS DHA OGC Sr. Enlisted Advisor Sr. Enlisted EHR Functional Champion Chief of Staff Special Staff HA / DHA Liaison Component Acquisition Executive Strategic Mgt Prog Integration Healthcare Operations Directorate (CMO) Procurement Communicatio ns Innovation Def Health Board Do. D/ VA PCO Admin & Mgt EEOO Manpower Comptroller Analytics Small Business Research Development & Acquisition Directorate Health IT Directorate (CIO) Education & Training Directorate Business Support Directorate Facility Planning Walter Reed National Military Med Center Medical Logistics Ft. Belvoir Community Hospital TRICARE Health Plan Advanced Development Innovation and Advanced Technology Dev (CTO) METC HQ Pharmacy Science & Technology Portfolio Mgmt and Customer Relations DMRTI Clinical Support Clinical Infrastructure Program Infrastructure & Operations JMESI Veterans Affairs R&D Liaison Solution Delivery Academic Review & Oversight Financial Integrity Readiness Information Delivery Prof Development , Sustainment, & Prog Mgmt Contract Resource Management Warrior Care Program Cyber Security NCR Medical Directorate Public Health Defense Health Service System (DHSS) Defense Health Clinical Systems (DHCS) Program, Budget & Execution Joint Pathology Center Programming Program Integrity Financial Management Division Business Information Management 4
DHA Budget & Resource Management Shared Service DHA Shared Services 1. Facility Planning 2. Medical Logistics 3. Health Information Technology 4. TRICARE Health Plan 5. Pharmacy 6. Public Health 7. Contracting 8. Budget & Resource Management (B&RM) 9. Medical Education & Training 10. Medical Research, Development & Acquisition MHS Quadruple Aim The B&RM Shared Service promotes cost-effective use of program and budgeted funds, increased reimbursements, and improved financial transparency and utilization. Initiatives: (1) Common Cost Accounting Structure (CCAS) / NCR-MD Transition to GFEBS (2) Armed Forces Billing and Collections Utilization Solution (ABACUS) (3) Remote Coding (4) DHP Financial Audit (5) ICD-10 Implementation “Medically Ready Force…Ready Medical Force” 5
Common Cost Accounting Vision One Accounting System The DHA requires consistent and comparable financial data across the DHP One Database Provides an effective approach for data collection, analysis, consolidation, mapping and storage of financial data CCAS Vision Uniform Accounting Provides a comprehensive approach to reduce variability in cost accounting across the MHS by standardizing cost data critical to the operations across the DHP and providing additional transparency through extensions of current accounting guidance Dr. Woodson, ASD(HA), envisions having the MHS on one financial accounting system and database utilizing uniform accounting practices with consistent and reliable reporting. “What is the timeline? ” “Medically Ready Force. . . Ready Medical Force” Consistent Reporting Improved data quality and standardized reporting for leadership, audit readiness efforts, and oversight bodies 6
Common Cost Accounting Framework The CCAS Framework provides a systematic feedback loop to continually improve financial & data integrity across all relevant financial systems Governance & Data Stewardship MDAG MBOG Policy and Guidance Financial and Performance Reporting System (Sub-Work Group) Data Quality Assessment (Sub-Work Group) Implementation Support (Sub-Work Group) CCAS Working Group Data Quality Analysis Standard Data Budgetary Accounting Data Quality Analysis • • • Recommended System Changes & Data Mapping MEPRS & PB&E Reporting Key Performance Indicators Compliance Validation Tables Reduction of Manual Adjustments Program Management Cost Accounting • Budget Structure: Budget Activity, Budget Sub Activity, and Budget Line Item • Functional Area • Agency Initiatives: Agency Initiative Code, Agency Program Code, Cost Breakdown Structure • DMIS Codes • Object and Sub Object Class Codes • Product Service Codes “Medically Ready Force…Ready Medical Force” 7
Armed Forces Billing and Collection Utilization Solution (ABACUS) ∎ History q Legacy Military Health System (MHS) billing systems are 18+ years old - Third Party Outpatient Collection System (TPOCS) (since mid 1990 s) Specific modules of Composite Health Care System (CHCS) (since early 1990 s) q Cost recovery processes varied among the Services q In 2009 DASD (HB&FP) directed TMA (now DHA) to provide robust billing data to enable the Services to conduct billing and collections using billing solution/system of choice ∎ Armed Forces Billing and Collection Utilization Solution (ABACUS) q Single source of financial information for the accounting of Uniform Business Office (UBO) receivables and will contain the subsidiary records that will replace the medical billing, collections and accounting functionality provided in the current Third Party Outpatient Collection System (TPOCS), Composite Health Care System (CHCS) Third Party Collection Program (TPCP) Inpatient and Medical Service Account (MSA) modules q Will provide all incidental support for the Services’ medical billing, collections, reporting and utilization services at world-wide locations q Will generate claims for all 3 MHS cost recovery programs (MSA, TPCP and Medical Affirmative Claims (MAC)) q Supports billing and collections functions including denial management and interfacing with Service Systems q Initial Operating Capability expected May 2015; Full Operating Capability expected October 2015 “Medically Ready Force…Ready Medical Force” 8
Remote Coding Goals and Objectives Ø Reduce cost-to-collect Ø Minimize current operational footprint Ø Aggregate disparate processes into core standard operating procedures Ø Optimize enterprise-wide performance via procedural standards Ø Routinely assess operational risk Ø Design/Deploy stringent internal controls program Ø Limit future negative audit findings Ø Improve centralized oversight into tactical operations Ø Enhance forecasting (both workload and demand) Ø Recent Do. D IG Audits have resulted in numerous discrepancies with denials management and overall management of Aged A/R Ø Improve efficiencies across the delivery system Ø Explore economies of scale and strategic partnerships across industry 9
Remote Coding Alternative End-State Options The below table describes the alternative remote coding end state options across access, technology, and management considerations. Both options are currently being evaluated for feasibility within the DHA. Option A Option B Enterprise Model Dedicated Model (3 Phased Approach) (Single phase) • Initially standardizes and ultimately centralizes the remote access process through electronic workflow • Creates an SOP for the “Access” process to be followed at each MTF • Creates a single-sign on for all applications and locations through the Joint Active Directory (JAD) • Creates a queuing system used to distribute and share workload Primary (Day to Day) Remote Coding • Develops and refines an operating model for distributing workload and sharing workload where needed across the regions and eventually the services • Develops and refines a structure for accountability and performance management across the enterprise Access Technology • Development of standardized form with continued service specific remote access process • Creates a single-sign on for all applications and locations through the Joint Active Directory (JAD) Primary (Day to Day) Remote Coding • Services maintain existing operating model Management Backlog (Contingency) Remote Coding • DHA offers a surge support capability to augment the Services with coding resources that can remotely assist in decreasing backlog “Medically Ready Force. . . Ready Medical Force” 10
ICD-10 Implementation Key Process Performance Areas Services/NCR • Coding Backlog • Coding errors • Coding Accuracy • Provider Queries • Coding Hotline Tickets/Issues • Coding Staff Vacancies • TPC Backlog • TPC Rejections Global Services Center • Trouble Tickets Private Sector Care/TRICARE • EDI Claim Submissions: – Claim receipts (totals and by submitter) – Batch receipts (totals and by submitter) – Claim return volumes (totals and by submitter) – Batch return volumes (totals and by submitter) – Line of Business Edits (totals and by submitter) • Paper Claim Submissions: – Claim receipt volumes – Claim return volumes – Returned edits* • Claims Adjudication: – Deferral claim reports (totals and by provider)* – Denial/Rejected Report (totals and by provider)* – Point of Service (POS) paid codes increase may show an Referral matching issue – Penalties Volumes - increase may show an Authorization/Referral matching issue • Authorizations/Referrals: – Authorization/Referral denial reports – Interface error reports HGB MSR to PGBA TNAV system • TRICARE Encounter Data (TED) Records: – TED Edit Reports (Internal and DHA) “Medically Ready Force…Ready Medical Force” 11
Legend Status Reporting Issue Notification / Escalation Issue Response Deputy Director Defense Health Agency Director Healthcare Operations Purchased Care Level 2: Executive Awareness and Decision Making Level 1: Analyze, Control, and Escalate PDASD Health Affairs Director Defense Health Agency Director TRICARE Health Plan Director Business Support Chief of Staff TRICARE Health Plan Director Healthcare Operations Virtual ICD-10 Transition Ready Room Purchased Care SME POC SDD Clinical Support POC SDD EHR Core Global Svc Center POC Billing SME POC Analytics SME POC Director HIT Direct Care Level 0: Monitor, Assess, Mitigate and Escalate Asst. Secretary of Defense Health Affairs MDAG MOG/MBOG Ready Room Leader Theater (JOMIS) SME POC Coding SME POC HIPAA TCS&I Team: Receive Status and Issue Notifications Analyze and Determine Appropriate POC for Notification and/or Mitigation TRO-N COR TRO-S COR TRO-W COR TDEFIC COR TOP COR TPharm COR NCR POC Navy POC Army POC AF POC DHA POC Services/Central Help Desk MCSCs MTFs Direct Care Purchased Care. Ready Force…Ready Medical Force” “Medically Func.
DHP Audit Reporting Entities MERHCF DHP DHA Consolidated Comptroller CRM * USUHS * SMA Consolidated SMA Army SMA Navy SMA Air Force NCR MD 97 -0130 O&M 97 -0130 Operations & Maintenance (O&M) 97 -0130 PROC 97 -0130 Procurement (PROC) 97 -0130 RDT&E 97 -0130 Research Dvlpmt Test & Eval. (RDT&E) (except NCR-MD) 97 -0130 O&M DHP: Defense Health Agency – SMA: Service Medical Activity SMA: Service Medical Activities MERHCF: Medicare-Eligible Retiree Health Care Fund CRM: Contract Resource Management USUHS: Uniformed Services University of the Health Sciences NCR-MD: National Capital Region-Medical Directorate 97 -0130: Defense Health Program Appropriation 97 -0500 MILCON (except NCR-MD) 97 -0501 Recovery Act – MILCON (except SMA-AF, NCR-MD) 97 -0150 Recovery Act – FSRM (except SMA-AF, NCR -MD) “Medically Ready Force…Ready Medical Force” *MERHCF and CRM are currently under a standalone full financial statement audit. 13
DHP FY 15 Schedule of Budgetary Activity (SBA) Examination Overview SBA Overview Responsibilities SBA Scope What is the SBA? The SBA is a quarterly financial schedule that provides a cumulative view of budgetary activity. The SBA shows total budgetary resources and status of budgetary resources for the current fiscal year 2015 appropriated activity and does not include activity funded with prior year appropriations SBA FY 15 Examination • The objective of the FY 15 SBA Examination is to determine additional corrective actions that can be implemented prior to the official audit of the DHP full financial statements (SBR, BS, SNC, and SNP) in FY 16 • The FY 15 SBA Examination contract was awarded to the Independent Public Accounting (IPA) firm, Kearney & Company. They are reviewing the budget accounts, transactions, and documentation of all DHP Components for the period ending October 2014 to 31 March 2015 OUSD(C) In Scope – DHP Enterprise • Key Supporting Documents for: - Appropriated Receipts - Reimbursable Work Orders –RWO - Medical Revenue (Only SMAs) - Civilian Payroll - Contract Vendor Pay - Consumables (Only SMAs) • Internal Controls for: - RWO - Civilian Payroll - Contract Vendor Pay (except NCR) - Consumables (Only SMAs) Out of Scope Responsible for managing audit contracts and performing main liaison function with the auditors. Responsible for managing audit response tool and providing official responses to the auditors. DHA Responsible for providing quality assurance and guidance related to audit response utilizing subject matter experts across the business segment(s) to assist the DHP Components in responding to audit requests and to assist the auditors in understanding the business, data, and financial processes DHP Components Responsible for demonstrating business processes and responding to auditor requests for interviews, source data, documentation, and reports. Prior Year Activity Lessons Learned So Far Adjustments Preparation is Key Miscellaneous Transactions Internal Controls for Appropriated Receipts Complete the following before testing begins: Internal Controls for Medical Revenue • Implement audit response process and train personnel Internal Controls for Contract Vendor Pay and • Validate that processes and controls are operating Consumables for NCR effectively, including corrective action plans • RWO-Performer for DHA-C and NCR • Organize and retain files for quick audit response • • • Auditor Training Audit Timeline SBA CY 15 Audit Timeline Testing Planning Internal Control APR MAY JUN Reporting Full Financial Statement Audit (SBR, BS, SNC, SNP) Auditors need to be educated on: • Key Processes • Internal Controls • DHP Intricacies Well trained auditors minimize follow up questions Increase Communications Communication improves audit response quality and timeliness • Attend update meetings and working groups • Read and share newsletters and meeting minutes JUL AUG “Medically Ready SEP 01 Oct 2015 Medical Force” Force…Ready
DHP Audit Timeline Defense Health Program Audit Milestones: Full Financial Statement Audit SBA Examination FY 2015 Jun (On-going Annual Requirement) FY 2017 FY 2016 Sep Dec Mar Jun Sep Dec FY 2018 Mar Line Service / Service Provider Audit Milestones: DFAS: • SBR Reconciliation Tool Line Army: • Real Property • Internal Use Software Undetermined Milestones DFAS: • Balance Sheet Reconciliations (e. g. , FBWT) • Statement of Net Cost Reconciliation • U. S. SGL posting logic validation Line Army, Navy, Air Force: • Remaining Balance Sheet Line Items Line Army, Navy, Air Force: • Full Financial Statement Audit “Medically Ready Force…Ready Medical Force” 15
QUESTIONS “Medically Ready Force…Ready Medical Force” 16
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