2010 UBO/UBU Conference

Title: Foreign Military Billing

Session: T-3-1430

Objectives

Better understanding of billing foreign military members and their dependents – UBO MSA perspective

Reciprocal Healthcare Agreements– DoD Reference page

Invitational Travel Orders Identify and discuss some important issues Provide ideas for improved performance Share helpful references for future use

2

Foreign Military Programs

The programs are numerous:– International Military Education and Training (IMET)– Foreign Military Sales (FMS) – TW-P-TAX

FMS – Paid for by host country– NATO Status of Forces Agreements (NATO SOFA)– Partnership for Peace (PFP) with a Status Of Forces

Agreement (PFP SOFA)– Reciprocal Health Care Agreements (RHCA)– Acquisition & Cross Servicing Agreements (ACSA)

3

Training Programs

Counterterrorism Fellows Program (CTFP) – JO-B-B05 Counter-Narcotics – MX-B-INL or POT

– IMET, CTFP, and Counter-Narcotics– Primarily funded by U.S. government– Only covers student’s care– Dependents should be covered by insurance or an

international agreement

4

Non-Students

Not issued an ITO – Embassy employees– Personnel Exchange Program (PEP) – Reciprocal– Liaison Officer program (LNO) – Country funds– Foreign Visitor Program– Coalition Exercises in CONUS– WHINSEC guest instructors

5

Process Changes

Past – Foreign military were not enrolled in DEERS Present – Foreign Military Members and dependents

automatically enrolled in DEERS on application and/or receipt of new ID Card – DEERS assigns Foreign Identification Number (FIN)

in lieu of a Social Security Number– FIN used for foreign military, foreign nationals, and

their eligible family members– Billing rules do not account for those with insurance– Foreign language documents

Future – No idea, but the programs continue to evolve

6

Collection Process

Coordinating with TRICARE Office or assigned office at your facility– Foreign Military Registration Card

Verifying country of foreign military member Notation of country in CHCS

Collecting Invitational Travel Orders (ITOs)– Tells you where they’re from, what they’re authorized,

and financial responsibility for health care of family members

Communicating with;– Schools– FLO Coordinators– Foreign Members

7

Foreign Military Registration Card

DeWitt Health Care Network card

Identification to billing office can come in various forms

8

Benefit Sheet

Example of Beneficiaries Svs. sheet

9

Reciprocal Health Care Agreements

Provide care at no charge for military members and dependents in DoD facilities only

Each agreement is unique, and some have restrictions All expired agreements are under renewal (with the exception

of Venezuela) https://fhp.osd.mil/portal/rhas.jsp

10

Reciprocal Health Care Agreements

https://private.fhp.osd.mil/portal/rhas.jsp

DoD Reference Sheets

11

DoD Reference Sheets

12

Reference Sheet Codes

13

Invitational Travel Order

Important items on ITO– Home Country– Funding– Invitation– Authorized Training– Dependents– Medical Services– Special Conditions

14

Invitational Travel Order

15

Invitational Travel Order

16

Country Code, Case ID, and Case Line

Important for deposits When using sales code 73 address cannot be built without country,

case, and line. Reference DFAS—DE 7077.2-M 13.6 & 13.8 Country Code Criteria: Main country code (i.e., for Italy, use IT for

the Country Code criteria) Case ID and Case Line: The Case ID and Case Line is a

programmed number for the training – Example:

Netherlands, Country Code: NZ Pseudo Country Code: S4 Case ID: NZS989 Case Line: D111158

The ITO number will have the 2-character main country code at the beginning of the ITO Number and the 2-character country code at the end of the ITO Number (i.e., ITO#: NZS989D111158S4)

17

Invitational Travel Order

18

Invitational Travel Orders

ITO contains billing information

19

Example of Address Line Request

Invalid charge//aar

aarCountry/Case/Line code is available on the ITO or is obtained from the Foreign Liaison Officer

20

Authorizations for Care

ITOs for students and dependents ID card Invitational letter DEERS Agreements

21

22

Submitting Bills

Documentation– SF 1080– Bill (DD7, DD7A, etc…)– ITO/copy of ID card– Amendment to ITO (if applicable)– Insurance Info

I&R: Invoice and Receipt– IMET Students– FMS – Dependents– Embassies

UB-04: – Prepared for whomever requests billing on this form

23

Submitting Bills

US Air Force AFSAT/FMF ATTN: FMS Claims 315 J Street West Randolph AFB, TX 78150

US Army USAMEDCOM ATTN: MCRM-F 2050 Worth Rd, Ste 9 Ft Sam Houston, TX 78324

US Navy Commanding Officer Naval Ed & Security Assistance Field Activity Code-N5 Naval Air Station Pensacola, FL 32508

Embassies in DChttp://embassy.org/embassies

References:

Joint Security Assistance Training (JSAT)AR 12-15SECNAVINST 4950.4AAFI 16-105

DoD 5105.38-M (Security Assistance Management Manual)

Chapter 4 - FMS General Information

Chapter 10 - International Training

DFAS 37-100-2007

24

Contact Information

Foreign Military Student (FMS) and IMET Billing

Air Force Security Assistance Training (AFSAT)

Mailing Address:

AFSAT/FMF

315 J Street West

Randolph AFB TX 78150-4349

25

Challenges

Inconsistent training in Foreign Military Billing– No guidance on reading ITOs

Billing for reimbursement of care provided difficult due to lack of appropriate PATCAT information– Often difficult in getting appropriate personnel to

make appropriate PATCAT corrections Over 60 counties currently covered by some type of

healthcare agreements with DoD– Agreements expiring and being renegotiated– The program is in constant motion

26

Lessons Learned Along the Way

DoD Reference sheet and CHCS PATCATs not in alignment– CHCS does not always generate FRR bills and Ins

co. does not accept DD7 billings More foreign military now carry health insurance

– CHCS does not allow the input of insurance for this category of patient

– Collect a DD2569 on patient regardless of duty status– Active Duty subsistence rate not updated since

Congress stopped charges for U.S. active duty– Travelers Insurance– Patients do not understand medical billing in the U.S.– Embassies are moving away from paper checks

Daily Challenges – Make CHCS Work for You

DEERS TRICARE Standard issues

27

28

Rates

http://www.tricare.mil/ocfo/_docs/FY_2011_DC_Inpt_Rate_dtd_9_28_10.pdf

Rates

Know your rates

29

Rates

International Military Education and Training (IMET) and Inter-Agency Outpatient Rate (IOR) rate tables

2010 Government Discount Calculation Rate Factor

PATCATIMET 0.64IOR 0.94IOR 0.94 K611IOR 0.90 K612

http://www.tricare.mil/ocfo/mcfs/ubo/mhs_rates/imet_ior.cfm30

Sample SF 1080

31

32

Helpful Hints

Know who gets the bill and how you get your money– Air Force Security Assistance Center (AFSAC) (pays

the MTF directly)– Air Force Security Training (AFSAT) (pays Air Staff…

but does not notify MTF when they have processed the bill for payment)

– Embassy (pays by check or electronic method)– Insurance company (how to get the bills to the Hub

since encounters do not flow to TPOCS) Work with GSUs to obtain listing of their foreign military Keep track of when member is leaving the country Establish working relationship with FLO-Coordinators

Helpful Hints cont…

Recommendation: Pull M2 query and perform 100%

audit on foreign military being seen in your facility– Validate billing requirements

Work with Beneficiary Services to clarify PATCATS and billable services (They are human too, and mistakes can happen)

Identify billing issues to your service representative Audit at least quarterly!

Work MSA accounts monthly to stay on top of open foreign military accounts

33

Web Sites

https://fhp.osd.mil/portal/rhas/dependentsmatrix.jsp http://www.armymedicine.army.mil/hc/ip/medical-eligibility.ht

m#spain https://fhp.osd.mil/portal/rhas.jsp http://www.embassiesabroad.com/ International Military Students & Medical Care Desk Top

Guide http://www.disam.dsca.mil/DR/14%20Chapter.pdf http://www.cs.amedd.army.mil/imso/Medical.htm (Ft. Sam

Houston site, but good explanations)

34

35

Summary

Better understanding of billing foreign military members and their dependents – UBO MSA perspective

Reciprocal Healthcare Agreements– DoD Reference page

Invitational Travel Orders Identify and discuss some important issues Provide ideas for improved performance Share helpful references for future use

36

Questions