Billing Medicare

The Defense Health Agency and the Centers for Medicare and Medicaid Services have established a working relationship and have collaborated to improve billing practices between the two agencies. DHA, on behalf of their Military Treatment Facilities, has signed up as non-participating providers using the CMS election form. The below documents will assist MTFs as they submit claims to CMS.

• DHA Medicare Billing Guidance Memorandum
• Attachment A
• Frequently Asked Questions
• CMS Checklist for MTF Claims

For any questions that are specifically addressed in the above documents, please reach out to the DHA UBO Helpdesk.

Billing the U.S. Coast Guard

Per Interagency Agreement, the U.S. Coast Guard reimburses the Army, Navy, Air Force, and DHA MTFs annually, and on a prospective basis, for inpatient and outpatient care provided to USCG eligible beneficiaries at their MTFs. Payments are calculated based on historical encounter data and DHA UBO rates. They are normalized using the appropriate medical inflation factors, force structure adjustments, and other health insurance adjustment (a discount). The USCG directly distributes prospective payment amounts to Army, Navy, Air Force, and DHA MTFs based on individual treatment Defense Medical Information System [facility] identifier PPA calculations. For more information, see the USCG Billing section in the DHA UBO User Guide. The Memorandum of Understanding between the DOD and the U.S. Coast Guard is available upon request to the DHA UBO Help Desk. 

Billing NOAA and USPHS

The DHA has current Memorandum of Agreements with both the US Public Health Service Commissioned Corps and the National Oceanic and Atmospheric Administration Commissioned Officer Corps regarding participation in TRICARE and eligibility for care within MTFs. The MOAs are available upon request to the DHA UBO Help Desk.

Multi-Site/Regional Billing

Multi-site billing (sometimes referred to as regional billing) allows one facility to perform claims processing for one or more facilities. The concept of Multi-site billing has been accomplished to various degrees by the Services and NCR MD.  There are some key points, though, involved in any arrangement when a facility or agency is contracted to perform this function for another facility. At a minimum: 

• A written agreement should be in place between the contracting and contracted facility/agency. This agreement is to be approved by the Service or NCR MD Program Managers prior to implementation to ensure it meets UBO compliance requirements. 
• When a service is contracted out, the contracting facility/agency is ultimately responsible for assuring work is being accomplished within appropriate compliance guidelines. 
• No military facility performing this service for another MTF should charge anything other than actual cost. The formula for determining the cost of operations is the number of claims divided by the total MEPRS EBH costs. You may need to review your EBH data to ensure it represents your costs. 
• The facility/agency contracted to perform collections and the contracting facility must have an audit process in place to ensure record documentation supports claims developed. 
• Accounts receivable processes must separate out claims by facility/agency against which funds were collected. 
• The contracting facility/agency must receive reports on accounts receivable, metrics reports, and has a right to audit the process for accurate accounting and billing processes. 
• Quarterly metrics reports data are separated out for each facility/agency for which the claims are processed. 
• The contracting facility/agency has a right to access data from the contracted facility/agency to assess the effectiveness of third party collection operations for their patient population. These requirements should be included in the contractual agreement. 

For further information, please contact your Service or NCR MD Program Manager.