Briefing: Medical Positive Cases .


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2. Targets. Distinguish Legal Authority requiring Medical Care Recovery/Medical Affirmative Claims (MAC)Identify what is incorporated into the MAC ProgramIdentify how to enhance the recognizable proof and accumulation of MAC informationIdentify the prerequisites of the MAC Billers in the MTFIdentify necessities of the NLSO Claims Office
Transcripts
Slide 1

Briefing: Medical Affirmative Claims – How ought to MAC work? Date: 21 March 2007 Time: 1610 - 1700

Slide 2

Objectives Identify Legal Authority requiring Medical Care Recovery/Medical Affirmative Claims (MAC) Identify what is incorporated into the MAC Program Identify how to enhance the ID and gathering of MAC data Identify the prerequisites of the MAC Billers in the MTF Identify necessities of the NLSO Claims Office – JAG Code 15 Identify reporting necessities Identify the Charge Master Based Billing framework will affect MAC

Slide 3

Legal Authority Federal Medical Care Recovery Act (42 U.S. Code, Chapter 32, Sections 2651 – 2653) Collections From Third Party Payers (10 U.S. Code, Chapter 55, Section 1095 Federal Claims Collections Act (31 U.S. Code, Chapter 37, Section 3711) Worker\'s Compensation Statutes - Federal and State

Slide 4

What is incorporated into the MAC Program? Engine Vehicle Accidents - Automobile, Motorcycle, Boating, and so forth., brought about by another gathering or the recipient harmed Personal Injuries – Slip & Falls, Dog Bites, and so on. Item Liability – Silicone Breast Implants, Phen Diet Pills, and so on. Therapeutic Malpractice – suit is against a non military personnel healing center, or private medicinal practice. Treatment/care to right/repair was given by the MTF Worker\'s Compensation – Treatment/mind gave to recipients to business related wounds. Does exclude mind/treatment gave to Federal workers or Active Duty Military Personnel who are harmed on their DoD work

Slide 5

Who Is Responsible? Everybody in the MTF is in charge of the achievement of the MAC Program, yet the UBO is in charge of regulating the MAC Program at the MTF UBO MAC staff must give preparing to the greater part of the offices/facilities/subordinate administrations in the MTF on the best way to recognize "potential" MAC cases The UBO must give the office/centers/auxiliary administrations with the MAC polls to be finished by the patient

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Duties of the MAC Biller Train and keep up an association with the front work area staff in the different facilities, subordinate administrations all through the MTF, particularly in the ER and Admission Office Obtain finished MAC surveys and figure out whether there is a potential MAC case Receive asks for Medical/Dental care costs from regular citizen attorney\'s, insurance agencies, and military lawful workplaces (All solicitations ought to come by means of the NLSO) Identify all inpatient mind, outpatient mind, and auxiliary administrations gave to the patient since the Date of Accident/Injury/Illness that are identified with the harm/ailment Obtain every single medicinal record and other documentation supporting the care/administrations distinguished as identified with the damage/sickness

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Duties of the MAC Biller (con\'t) Generate the suitable case form(s)/receipt to be given to the NLSO, Army JAG, or Air Force JAG in charge of settling the administration\'s case Maintain a record (electronic or paper) of all cases/receipt submitted to the NLSO, Army JAG, or Air Force JAG, incorporating all documentation submitted with the claim(s)/receipt Maintain a cases following framework, distinguishing all cases submitted, where they were submitted, unique measure of the cases submitted, and the genuine sum gathered, and purpose behind any alteration or disavowal Submit reports to the BUMED Regional UBO Program Managers

Slide 8

Reporting Requirements

Slide 9

NLSO Responsibilities Receive all approaching solicitation for expenses of Medical Care from Civilian lawyers and insurance agencies Obtain a consented to arrangement from non military personnel lawyer\'s that state they will speak to the interests of the legislature. Setting the lawyer/insurance agency on notice that the legislature will have a case if any therapeutic/dental care was given by the MTF identified with the mischance/damage Forward solicitations and all extra documentation to the MAC Office Forwards all cases/solicitations to the suitable lawyer or potentially insurance agency in an opportune way to conform to the statute of impediments relating to that case/case Collect all monies because of the administration, keeping the accumulations to the right Line of Accounting (LOA) for the MTF that presented the case/receipt

Slide 10

NLSO Responsibilities (Con\'t) Provide month to month reports to BUMED Regional UBO Program Manager, recognizing claims got, sum charged, sum gathered, claims shut, and explanation behind receipt of under 100% of what was charged or add up to foreswearing Meet with the BUMED Regional UBO Program chief and Legal Officer to talk about traded off cases, claims shut without accumulations, and create prepare upgrades

Slide 11

Summary Be educated of the legitimate power requiring Medical Care Recovery/Medical Affirmative Claims (MAC) Know precisely what is incorporated into the MAC Program so you don\'t squander time producing claims that will never be sought after Work with the centers and auxiliary administrations in your MTF to distinguish and gather MAC data Work with the NLSO Claims Office – don\'t squander time making and sending them claims they will never seek after Only with the data we are gathering on the MAC Tracking spreadsheet would we be able to demonstrate what is being sent to NLSO for handling Be understanding, the Charge Master Based Billing framework is coming and will incorporate MAC. CMBB will have an indistinguishable charging abilities and reports from MSA and TPC

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