I've been in the healthcare industry since 1984; I was still in college when I got my first job in the business, doing old-fashioned data entry on a night shift after class.
I've seen many changes to the industry. I've been with companies that don't exist anymore, and worked to merge a few. I was present when the EDI industry was pretty much invented back in '96 by a little bill co-sponsored by the late Senator Kennedy met with approval by a far more functional Congress.
So it pains me to have to report on things that seem to be from a different era. We'll start today at the Navy hospital in Yokosuka, Japan. Despite being 8,000 miles from home, it's still a United States facility. As such, it has to comply with coding standards, ANSI specifications, and that HIPAA thing previously mentioned. Submitting a hospital bill should be easy. (not processing one - that's still hard.) I mean coding one correctly, formatting it for transmission, and submitting it to the primary payor.
YOKOSUKA NAVAL BASE, Japan -- For years, no one did much about thousands of civilian medical bills stacking up at U.S. Naval Hospital Yokosuka.
One hospital employee familiar with the backlog estimated the number of bills that were never sent to patients or insurance companies had reached 20,000 by 2014.
"Oh, we're working on it," Beth de la Cruz recalled being told in 2012, after she asked why she hadn't received any bills in six months.
Over the past 18 months, de la Cruz, a mother of three and spouse of a Navy Criminal Investigative Service special agent, has received bills up to 2 years old, totaling tens of thousands of dollars.
She said she's lost count of how many midnight calls she has made to the United States, explaining to her insurance company why the bills were so late and were riddled with coding errors.
De la Cruz had to follow up with calls to Centralized Receivables Service, set up by the Department of Treasury as a pilot project for bill collection across the government's myriad agencies. All of the Navy's 26 hospitals worldwide are now using CRS, according to service officials in Washington -- a decision that came after a Defense Department inspector general report about the Navy's Portsmouth, N.H., hospital showed lax, often nonexistent collection efforts. The IG found 1,533 accounts that were more than 180 days delinquent, with little action taken to collect.
If that IG report reflects procedures throughout the Navy system, it is likely that its hospitals have been unable or unwilling to collect millions of dollars.
In an era of tightening defense budgets, the uncollected medical debt issue goes beyond the Navy. The IG recently announced a review of Army hospitals, after finding $73.1 million in delinquent debt at Brooke Army Medical Center in 2014.
The Navy began using the CRS system last year as its financial remedy for medical billing and collection issues. Navy officials say the new system makes it easier for hospitals to locate patients, send bills and collect payments.
But the transition hasn't gone smoothly for overseas patients like de la Cruz.
CRS forwarded her $2,500 bill -- receipts provided to Stars and Stripes show that she paid on time -- to FedDebt, the Treasury Department's more aggressive collection agency. FedDebt immediately added about $800 in late fees to the balance.
FedDebt's response to her pleas for a refund? Talk to CRS -- which said she should call the hospital.
"It will take an act of God, if at all, to get them to resolve this," de la Cruz said in February.
De la Cruz did receive a partial refund in April but is still pursuing the full amount.
Now, I don't know what insurance company is the one in question here. We all have different filing limits. My plan's is 120 days. If we received a bill that was two years old...Appeals wouldn't even look at it. The hospital would have to eat it, or as noted in the story, chase the patient for anything they could recover. I once made a hospital write of a bill for Javier because they messed up so many times and it never ever made it to the correct payor. Imagine a military spouse that has to deal with this, along with everything else military families have to face?
Staying on the insurance front, the military's single-payor source has recently entered the 21st century by relaxing an almost ridiculous requirement. It's now possible to seek and receive urgent care under Tricare coverage without a pre-approval. It's purely policy, but what this means is that emergent situations that aren't quite serious enough for the ER, but serious enough to see a doctor, don't need pre-approval before you go. We fought this battle in the civilian world almost 20 years ago. Now for the most part, if you're hurting, pick up the phone and seek the care you need, no referral or authorization needed. (My appendix being a good example - I didn't need approval from the plan, I just called my doctor and said "ouch". I could have gone to the ER directly, where I eventually wound up, but I didn't need to get anything "approved" before I did so.) Back in the day, insurance companies would use that technicality as an excuse to not cover your visit or any subsequent care.
Some Tricare users will soon be allowed to use in-network urgent care providers without receiving any authorization under a new Tricare pilot program set to start May 23, according to policy documents released Tuesday.
The three-year pilot, ordered by Congress as part of the 2016 National Defense Authorization Act, will allow most Tricare users two urgent care visits per beneficiary, per fiscal year without official authorization from a provider or official. After those two visits have been used, beneficiaries can continue to use urgent care as long as they receive a referral.
"The purpose of the pilot is to ... determine if the elimination of the requirement to obtain a referral or preauthorization for urgent care visits improves access to urgent care, helps enrollees to choose the most appropriate source for the health care they need â€¦ potentially lowers health care costs for the Department of Defense (DoD) and/or improves patient satisfaction," the policy document states.
Currently Tricare Prime users must receive prior authorization to visit an urgent care. Emergency room visits, however, are free. Because of that military families often default to emergency room use when they cannot get an appointment with their primary care provider, military family watchdogs say. The urgent care pilot program, they say, is aimed at fixing that.
Most Tricare users will be a part of the pilot, the document states. Active-duty service members and activated Guard and Reserve members enrolled in Tricare Prime Remote and all other beneficiaries enrolled in Tricare Prime, Tricare Prime Remote or Tricare Young Adult, including retirees, will be allowed two non-authorized visits per year. Tricare Overseas Program users seeking care in the U.S. will be permitted unlimited urgent care visits without authorization, the policy state.
Not included in the pilot, however, are enrollees in Tricare Standard, Tricare Reserve Select or Tricare Retired Reserve. Those users currently do not need urgent care authorization and receive care there at no cost provided their yearly $300 deductible and up to $3,000 catastrophic cap has been met. Tricare Overseas Program users who are not in the U.S. also do not qualify for the program. Tricare for Life users are also not included in the pilot program.
One wonders what the GOP will do about this - things with TriCare were never addressed by the Affordable Care Act, as that was mostly about commercial coverage.
Finally today, I'll wrap up with something completely different, and the rarest of the rare - an act of bipartisanship and unity in the halls of Congress. You're probably historically aware of a highly-specialized group of WWII veterans. Called the WASPs, or Women Airforce Service Pilots, only about a thousand ladies flew our latest aircraft in the unglamorous, but necessary, business of getting warplanes from where they were manufactured to the marshaling grounds on the coasts prior to their male counterparts flying them across the pond and into war. While they never saw combat, some were killed in crashes and other incidents. For almost 70 years now, the dwindling survivors have been fighting for recognition as WWII veterans, and the right to be interred at Arlington National Cemetery near their combat veteran brethren. Congress recently approved the bill allowing final rest among the hallowed grounds, and has sent it on to the President. (Fox News link, and I'm glad to include it today.)
Congress has sent President Barack Obama a bill that would allow female World War II pilots known as WASPs to continue placing their ashes at Arlington National Cemetery.
The House approved the bill Wednesday hours after it cleared the Senate by voice vote. The legislation won broad support from Republicans and Democrats.
"It's been just 19 weeks since the Army's decision to kick out our pioneering female World War II pilots was brought to light, and we've been fighting ever since," said Rep. Martha McSally, R-Ariz., one of the bill's sponsors and a retired Air Force fighter pilot.
The WASPs served in a unit called Women Airforce Service Pilots. They flew noncombat missions to free up male pilots for combat.
During the war, the women were considered civilians. But since 1977, federal law has granted them status as veterans. They had been eligible since 2002 to have their ashes placed at Arlington with military honors. In March 2015, then-Secretary of the Army John McHugh ruled that WASPs never should have been allowed in and revoked their eligibility.
The legislation reverses that decision.
Just over 1,000 women were accepted into the WASP program, which ran from 1942 to 1944.
The family of a WASP who died after McHugh's ruling, Elaine Harmon, pushed to have the eligibility restored. Her ashes are sitting in a closet in her daughter Terry Harmon's home.
A petition on change.org to overturn McHugh's directive received more than 178,000 signatures.
Eligibility for in-ground burial at Arlington, which has severe space limitations, is extremely tight, and not even all World War II veterans are eligible for burial there. But eligibility for placement of ashes, or above-ground inurnment, is not quite as strict. Arlington's rules state that "any former member of the Armed Forces who served on active duty (other than for training) and whose last service terminated honorably" is eligible to have their ashes placed at Arlington.