DHA Business Support Directorate:Business Tools – An Enterprise View

AMSUS 2015 Annual Continuing Education Meeting2 December 2015

Mr. Darrell LandreauxActing Director, DHA Business Support Directorate

““Medically Ready Force…Ready Medical Force”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 ForceMedically Ready Force…Ready Medical Force”” 2

DHA Vision and Mission

Key Mission AspectsKey Mission AspectsA Combat Support Agency supporting the military servicesSupports 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 MarketManages 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.

VisionVisionA joint, integrated, premier system of health, supporting those

who serve in the defense of our country.

““Medically Ready Force…Ready Medical ForceMedically Ready Force…Ready Medical Force”” 3

USD(P&R)ASD(HA)

Defense Health Agency Director

Deputy Director Sr. Enlisted Advisor

POLICY DEVELOPMENT & OVERSIGHT

POLICY EXECUTION Combat Support Agency Responsibilities

Admin & Mgt EEOO

TRICARE Health Plan Facility Planning

Medical Logistics

Program, Budget & Execution

Walter Reed NationalMilitary Med Center

Ft. BelvoirCommunity Hospital

Joint Pathology Center

Comptroller

DHA OGC

Special Staff

Manpower

EHR Functional Champion

METC HQ

DMRTI

Programming

Portfolio Mgmt and Customer Relations

Innovation and Advanced Technology Dev (CTO)

Infrastructure & Operations

Solution Delivery

JMESI

Defense Health Agency Director

Deputy Director Sr. Enlisted Advisor IPO PEO DHMS

Defense Health Service System (DHSS)

Defense Health Clinical Systems (DHCS)

Information Delivery

Secretary of Defense

Chief of Staff

Component Acquisition Executive

Analytics

Communications

Prog Integration

Small Business

Def Health BoardStrategic Mgt

HA / DHA Liaison

Procurement

Innovation

DoD/ VA PCO

Cyber Security

CJCS

NCR MedicalDirectorate

Business Support Directorate

Health IT Directorate (CIO)

Research Development & Acquisition Directorate

Healthcare Operations Directorate (CMO)

Education & Training Directorate

Defense Health Agency

Academic Review& Oversight

Prof Development , Sustainment, & Prog Mgmt

Pharmacy

Clinical Support

Public Health

Readiness

Warrior Care Program

Advanced Development

Science & Technology

Clinical Infrastructure Program

Veterans Affairs R&D Liaison

4

Financial Integrity

Contract Resource Management

Program Integrity

Financial Management Division

Business Information Management

DHA Budget & Resource ManagementShared Service

““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force” 5

MHS Quadruple Aim

DHA Shared Services1. Facility Planning2. Medical Logistics3. Health Information Technology4. TRICARE Health Plan5. Pharmacy

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

DHA Shared Services6. Public Health7. Contracting8. Budget & Resource Management (B&RM)9. Medical Education & Training 10. Medical Research, Development & Acquisition

Common Cost Accounting Vision

6““Medically Ready Force . . . Ready Medical Medically Ready Force . . . Ready Medical ForceForce””

The DHA requires consistent and comparable financial data across the DHP

One Accounting System

Provides an effective approach for data collection, analysis, consolidation, mapping and storage of financial data

One Database

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

Uniform Accounting

Improved data quality and standardized reporting for leadership, audit readiness efforts, and oversight bodies

Consistent Reporting

CCASVision

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?”

Common Cost Accounting Framework

““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force” 7

Governance & Data Stewardship

MDAG

MBOG

The CCAS Framework provides a systematic feedback loop to continually improve financial & data integrity across all relevant financial systems

Recommended System Changes & Data Mapping

CCASWorking Group

Data Quality Analysis

•MEPRS & PB&E Reporting•Key Performance Indicators•Compliance•Validation Tables•Reduction of Manual Adjustments

Financial and Performance

Reporting System(Sub-Work Group)

Data Quality Assessment

(Sub-Work Group)

Implementation Support

(Sub-Work Group)

Armed Forces Billing and Collection Utilization Solution (ABACUS)

∎ History Legacy Military Health System (MHS) billing systems are 18+ years old

- Third Party Outpatient Collection System (TPOCS) (since mid 1990s)- Specific modules of Composite Health Care System (CHCS) (since early 1990s)

Cost recovery processes varied among the Services 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) 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

Will provide all incidental support for the Services’ medical billing, collections, reporting and utilization services at world-wide locations

Will generate claims for all 3 MHS cost recovery programs (MSA, TPCP and Medical Affirmative Claims (MAC)) Supports billing and collections functions including denial management and interfacing with Service Systems Initial Operating Capability expected May 2015; Full Operating Capability expected October 2015

““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force” 8

Remote Coding Goals and Objectives

Reduce cost-to-collect Minimize current operational footprint Aggregate disparate processes into core standard operating procedures

Optimize enterprise-wide performance via procedural standards Routinely assess operational risk Design/Deploy stringent internal controls program

Limit future negative audit findings Improve centralized oversight into tactical operations Enhance forecasting (both workload and demand) Recent DoD IG Audits have resulted in numerous discrepancies with

denials management and overall management of Aged A/R Improve efficiencies across the delivery system

Explore economies of scale and strategic partnerships across industry

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Remote CodingAlternative End-State Options

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Option AEnterprise Model (3 Phased Approach)

• 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

Backlog (Contingency) Remote Coding•DHA offers a surge support capability to augment the Services with coding resources that can remotely assist in decreasing backlog

Access

Technology

Management

Option BDedicated Model

(Single phase)

• 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

Backlog (Contingency) Remote Coding•DHA offers a surge support capability to augment the Services with coding resources that can remotely assist in decreasing backlog

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.

““Medically Ready Force...Ready Medical Force”Medically Ready Force...Ready Medical Force”

““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force”

ICD-10 ImplementationKey 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)

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““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force”

Deputy DirectorDefense Health Agency

DirectorDefense Health Agency

PDASDHealth Affairs

Asst. Secretary of DefenseHealth Affairs

MDAG

MOG/MBOG

LegendStatus Reporting

Issue Notification / Escalation Issue Response

Chief of StaffTRICARE Health Plan

DirectorHealthcare Operations

DirectorTRICARE Health Plan

POCPOC

POC POCPOC

Billing SME

Coding SME

Virtual ICD-10 Transition Ready Room

Purchased Care SME

Global Svc Center

SDD EHR Core

Purchased Care Direct Care

POC

Theater (JOMIS) SME

MTFs Func.

POC

Analytics SMESDD Clinical Support

POC

TRO-NCOR

TRO-SCOR

TRO-WCOR

TDEFICCOR

TOPCOR

MCSCs

TPharm

CORNCR POC

ArmyPOC

NavyPOC

AFPOC

DHAPOC

Services/Central Help Desk

HIPAA TCS&I Team:Receive Status and Issue Notifications

Analyze and Determine Appropriate POC for Notification and/or Mitigation

Purc

hase

d Ca

re

DirectorBusiness Support

Direct Care

DirectorHealthcare Operations

DirectorHIT

Ready Room Leader

““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force”

DHP Audit Reporting Entities

DHP

DHA Consolidated

Comptroller CRM USUHS

SMA Consolidated

SMAArmy

SMANavy

SMAAir Force

NCRMD

97-0130 O&M

97-0130 PROC

97-0130 RDT&E

97-0130 O&M 97-0130 O&M

97-0130 PROC

97-0130 RDT&E

97-0130 Operations & Maintenance (O&M)

97-0130 Procurement (PROC)

97-0130 Research Dvlpmt Test & Eval. (RDT&E) (except NCR-MD)

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)

DHP: Defense Health Agency – SMA: Service Medical ActivitySMA: Service Medical ActivitiesMERHCF: Medicare-Eligible Retiree Health Care FundCRM: Contract Resource ManagementUSUHS: Uniformed Services University of the Health SciencesNCR-MD: National Capital Region-Medical Directorate97-0130: Defense Health Program Appropriation

MERHCF

*MERHCF and CRM are currently under a standalone full financial statement audit.

*

*

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““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force”

DHP FY15 Schedule of Budgetary Activity (SBA) Examination Overview

Planning Testing

Internal Control Reporting

JULJUNMAY AUGAPR SEP01 Oct 2015

SBA OverviewSBA Scope

Complete the following before testing begins:•Implement audit response process and train personnel•Validate that processes and controls are operating effectively, including corrective action plans•Organize and retain files for quick audit response

Preparation is KeyPreparation is Key

Auditor Training

Increase Communications

Auditors need to be educated on:• Key Processes• Internal Controls• DHP Intricacies

Well trained auditors minimize follow up questions

Communication improves audit response quality and timeliness•Attend update meetings and working groups•Read and share newsletters and meeting minutes

Audit Timeline

• The objective of the FY15 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 FY16

• The FY15 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

Full FinancialStatement

Audit (SBR, BS, SNC,

SNP)

SBA CY 15 Audit Timeline

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

Responsibilities

Lessons Learned So Far

What is the SBA?What is the SBA?

SBA FY15 ExaminationSBA FY15 Examination

•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)

•Prior Year Activity•Adjustments•Miscellaneous Transactions•Internal Controls for Appropriated Receipts•Internal Controls for Medical Revenue•Internal Controls for Contract Vendor Pay and Consumables for NCR•RWO-Performer for DHA-C and NCR

OUSD(C)OUSD(C)

DHADHA

DHP ComponentsDHP Components

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.

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

Responsible for demonstrating business processes and responding to auditor requests for interviews, source data, documentation, and reports.

In Scope – DHP Enterprise

Out of Scope

““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force”

DHP Audit Timeline

Defense Health Program Audit Milestones:

Line Service / Service Provider Audit Milestones:

FY 2017

MarDecSepJunMarDecSepJun

FY 2016

SBA

Examination

Full Financial Statement

Audit

(On-going Annual Requirement)

Line Army:•Real Property•Internal Use Software

DFAS:•SBR Reconciliation Tool

Line Army, Navy, Air Force:•Remaining Balance Sheet

Line Items

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:•Full Financial Statement Audit

FY 2018

15

FY 2015

““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force” 16

QUESTIONS