JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas –
Brooke Army Medical Center is launching a number of initiatives aimed at helping patients navigate the complex maze of medical billing.
From financial counseling to a revamped collections process, BAMC officials are hoping to alleviate billing concerns, particularly for civilian trauma patients.
“We want our patients to focus on their recovery, not be stressed with billing issues,” said Air Force Col. Patrick Osborn, BAMC’s deputy commander for surgical services.
As a military hospital, BAMC is known for its mission of caring for the nation’s warfighters, retirees and family members. However, BAMC also has a unique, and perhaps lesser-known, commitment to its community. As the Department of Defense’s sole Level I Trauma Center, the hospital provides complex emergency care to civilian patients in an area that encompasses 22 counties in Southwest Texas.
“We are able to care for civilians without military benefits through a special Secretary of Defense-authorized program,” Osborn explained. Through the Secretarial Designee program, with approval, BAMC is permitted to provide trauma and trauma-related follow-on care to non-military beneficiaries for up to six months.
Caring for trauma patients has a two-fold benefit, Osborn noted. “It aids the community in which we work and live, while also offering our military medical professionals vital hands-on training that translates directly to battlefield care,” he said.
Military Treatment Facilities are required by federal law to bill for any care provided to civilians without military benefits. As in other medical facilities, civilian trauma patients with medical insurance rely on their private carrier for coverage.
“If the patient has insurance and we have that information on file, we file a claim with their carrier as a courtesy to our patients,” explained Army Maj. Matt Slykhuis, BAMC’s deputy chief financial officer. “Once a bill is generated, we have 120 days to work with the insurance company to help facilitate a payment, whether it’s payment in full or payment less a deductible or copay.”
Patients are billed if an insurance company denies a claim and all appeals, if there is a balance remaining after insurance payment, or if a patient’s insurance information is not on file. In the absence of payment, as a federal healthcare facility, BAMC is required by law to transfer the remaining balance to the U.S. Department of Treasury for collections.
“Military Treatment Facilities are not authorized to waive, reduce, suspend or terminate debt,” Slykhuis said.
New, improved process
Until recently, once transferred to the Treasury, the debt immediately began accruing significant interest and fees, resulting in additional stress for patients, he noted.
Aware of patients’ struggles with mounting debt, BAMC worked closely with the Defense Health Agency and Treasury Department to implement a new, more flexible process. Effective November 2020, rather than bill patients directly, BAMC now automatically transfers any remaining balance to the Treasury Department’s Centralized Receivables Service after the 120 days of insurance processing.
Unlike BAMC, CRS has the ability to set up longer-term payment plans or to suspend collections based on demonstrated hardship. As an additional relief effort, CRS is not required to tack on the fees and penalties generated by the central Treasury department.
“This gives patients a flexibility in collections that BAMC is not permitted, by law, to provide,” Slykhuis said.
Additionally, BAMC is working to better educate patients and their families throughout treatment about the financial process to help combat misinformation and confusion.
“We are in the process of bringing experienced financial counselors on board who can help patients navigate the insurance and payment process,” said Army Maj. Rebecca Morrell, chief, strategic healthcare innovation and transformation. The counselors will be assigned to the Emergency Department and inpatient wards to aid the patients and their families, she explained.
Additionally, the counselors will serve as a liaison with insurance companies, facilitating claims, and determining additional eligibility for optional enrollment in programs that offer payment assistance for specific patient populations. This includes insurance programs for patients who do not have coverage and federal, state and local grant programs.
In or out?
One of the most common areas of confusion is BAMC’s status as a federal healthcare facility, Morrell noted. Since BAMC is not authorized to enter into a contract with insurance carriers, many carriers treat BAMC as an “out of network” facility. However, the law requires all insurance companies to consider federal health care facilities as “in network” for billing purposes.
“Unfortunately, insurance carriers often consider BAMC as being ‘out of network’ and either deny claims or reimburse at a reduced ‘out of network’ rate,” she said. BAMC works behind the scenes to provide clarification and information to aid patients, but the delay can cause undue stress and additional financial liability for patients facing the collection process.
The counselors will also help to navigate the insurance process for patients in the event of an accident, from vehicular to workplace.
BAMC is working to bring these counselors on board in the near future. In the meantime, the hospital will continue to aid patients through initial counseling sessions and financial information forms and brochures.
The billing team is also looking forward to the implementation of a new electronic health record called Genesis at BAMC in January 2022 and an updated billing system in January 2023. The new EHR and billing system have the potential to provide itemized inpatient billing for military treatment facilities, which is not an available feature with the legacy systems currently in place.
“This will enable us to be more transparent about our healthcare costs and aid insurance companies seeking itemized information,” Morrell noted.
Aware of the challenges, community leaders are also working to change laws to the benefit of patients. Recent state legislation outlined in Texas House Bill 2365 enables military treatment facilities to be considered as participating providers with Medicaid effective Sept. 1, 2021. This will enable BAMC to take Medicaid reimbursements as payment in full. Additionally, BAMC will be able to bill Medicaid for outpatient services, which wasn’t the case prior.
“This is great news for our Medicaid patients and for our providers who will be better able to provide continuity of care,” Osborn said.
As BAMC works to implement these improvements, billing experts recommend several steps patients can take to better navigate the billing process:
1. Ensure BAMC has all current information, including the name of insurance carrier, mailing address and contact information, prior to hospital departure.
2. Review all BAMC invoices/documents received in the mail without delay. Insured patients who receive a bill for the full amount should contact the BAMC Uniform Business Office as soon as possible to ensure that a claim was appropriately filed to their insurance carrier.
3. For billing questions/concerns, contact the BAMC Uniform Business Office, or UBO, email firstname.lastname@example.org or call 916-8563/5772.
4. Contact insurance companies directly to confirm their level of coverage and personal responsibility.
BAMC will continue to explore ways to improve the billing process for patients, Osborn noted.
“We are incredibly proud and honored to serve our community as a Level I Trauma Center, and a significant part of this commitment is ensuring our patients are treated with empathy and compassion in every aspect of their care,” he said. “This extends to ensuring they receive the best possible financial counseling and education.”