June 2013 Important TOP Updates DOCTOR-TO-DOCTOR Welcome to the June 2013 edition of the TRICARE Overseas Program (TOP) Provider Newsletter. We are pleased to introduce a new editorial feature, spotlighting an International SOS Network Provider delivering care under the TRICARE Overseas Program. This edition includes an in-depth interview with Dr. Niko Mihic, a General Practitioner in Madrid, Spain (see pp.1-2). If you are interested in being featured in a future TOP Provider Newsletter, please contact your TOP Regional Call Center and press Option #5 to speak with a member of the TOP Provider Support Services team. Also included in this edition are articles regarding the following topics:  Abortion as a TRICARE Covered Service Under Certain Circumstances  Ensuring Physical Therapy Claims are Submitted Correctly  Cervical Cancer Screening Guidelines and Updates  TRICARE Latin America & Canada (TLAC) Prime Provider Events in Puerto Rico (April 2013) INTERNATIONAL SOS NETWORK PROVIDER PROFILE: International SOS is available to assist you 24 hours a day, 365 days a year. Contact us if you have any questions regarding authorized care, approvals and referrals, or TRICARE covered benefits, limitations and exclusions. Dr. Niko Mihic General Practitioner International SOS Network Provider When contacting your TOP Regional Call Center, you will receive the following menu options. Knowing these options ahead of time will help expedite your request. Option #1 Option #2 Option #3 Option #4 Option #5 Option #6 Emergency Care Claims Support Authorizations Beneficiary Support (GTSC) Provider Support Services TOP Prime Remote Wellness On behalf of the entire International SOS organization and our TOP Regional Medical Management staff worldwide, thank you for the very important care you provide to TRICARE beneficiaries overseas. Ken McDonnell, MD Medical Director, TRICARE Global Operations Please remember the many advantages and benefits of signing a Mutual Cooperation Protocol (MCP) with International SOS. Dr. Niko Mihic is a General Practitioner and International SOS Network Provider delivering care to TRICARE Overseas Program (TOP) beneficiaries in and around Madrid, Spain. Having served the local and international patient community in the Spanish capital since 1988, Dr. Mihic offers internationally oriented, integrated medical care services to TOP beneficiaries living in and around Madrid. Dr. Mihic studied and worked in the United States and Canada for 15 years, which makes his experience and multi-cultural awareness extremely valuable to International SOS. In addition to operating two inhouse hospital offices in H.M. Sanchinarro and H.M. Monteprincipe, Dr. Mihic also serves as a contracted physician at the Retamares NATO (North Atlantic Treaty Organization) Base as well as Medical Advisor for various Global/Fortune 500 corporations. (Cont.) Eurasia-Africa +44-20-8762-8384 Latin America & Canada +1-215-942-8393 Puerto Rico +1-877-867-1091 Asia-Pacific +65-6339-2676 Australasia +61-2-9273-2710 Recently, International SOS’ Eurasia-Africa TOP Provider Support Services team interviewed Dr. Mihic to learn more about his experiences treating TRICARE beneficiaries overseas. As we found out, what Dr. Mihic likes most about working with TOP beneficiaries is the ‘added variety of dealing with a community of international diverse patients,’ which makes him feel as if he’s working at home. “I receive great support from International SOS all around!” Additionally, he values the great support of International SOS as the TOP contractor on all fronts, including ‘the effective, streamlined administrative processes for TOP Authorizations and TOP Claims Submission.’ improved TOP Claims reimbursement/payment procedures through Electronic Funds Transfer (EFT). As an International SOS Network Provider accepting EFT payment for TOP Claims, Dr. Mihic receives automated EFT Notifications, which are sent with each EFT payment and help to reconcile outstanding claims at a glance. International SOS’ support and these streamlined processes help him ‘provide all that’s needed on a patient-to-patient basis. Thank you Dr. Mihic and your entire administrative staff for all you do on behalf of TOP beneficiaries every day! One important milestone in the TRICARE Overseas Program, which Dr. Mihic acknowledged is the ‘faster turnaround of TOP Authorizations’ as well as ELECTRONIC PAYMENT ALTERNATIVES TO TOP CLAIMS REIMBURSEMENT BY CHECK: ELECTRONIC FUNDS TRANSFER (EFT) & AUTOMATED CLEARING HOUSE (ACH) Electronic funds transfer (EFT) and Automated Clearing House (ACH) payments offer several key advantages over paper checks, including speed and security. EFT is an electronic reimbursement procedure that allows TOP Providers to be paid for TOP Claims via the global banking system. Payments are deposited directly into the TOP Provider’s bank account on a weekly basis by the TOP Claims Processor (via Citibank N.A.). Payment via EFT is available in most countries. Automated Clearing House (ACH) is yet another alternative process, whereby electronic payments are deposited directly into the TOP Provider’s bank account. The payment is made by the TOP Claims Processor once every week. ACH differs slightly from EFT, as the payment is cleared through a local clearing process. Note: ACH payments are currently only available in a limited number of 1 currencies and countries. The key advantage of ACH (versus EFT) is that the fees charged to TOP Providers (by their local bank) for receiving ACH payments are normally significantly lower than the fees charged for receiving EFTs. If you are interested in learning more about EFT or ACH TOP Claims reimbursement/payment options, please contact your TOP Regional Call Center and press Option #5 to speak with a member of the TOP Provider Support Services team. Please verify with your bank for actual fees charged for receipt of ACH versus EFT payments. ACH payments are processed via batches in large volumes. Banks receive their ACH transactions all at once, processing them as a single transaction and simplifying the process. As a result, ACH payments may take 1-4 days longer than EFT payments to reach your bank account. 1 Note: ACH payments are currently only available in 11 currencies and in 21 countries, including: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Hong Kong, Italy, Ireland, Netherlands, New Zealand, Norway, Portugal, Singapore, Spain, Sweden, United Kingdom, United States, and U.S. Territories. For more information, contact International SOS. (Cont.) Eurasia-Africa +44-20-8762-8384 Latin America & Canada +1-215-942-8393 Puerto Rico +1-877-867-1091 Asia-Pacific +65-6339-2676 Australasia +61-2-9273-2710 PHYSICAL THERAPY: PROPERLY CODING INVOICES TO ENSURE REIMBURSEMENT As stated in the TRICARE Policy Manual (TPM) Chapter 7, Section 18.1 (General Rehabilitation), TRICARE will allow any rehabilitative therapy that will improve, restore or maintain function OR to minimize or prevent deterioration of function of a patient when prescribed by a physician. When TOP Providers invoice for Physical Therapy services and use an unclear narrative description or procedure code such as 97039 (Physical Therapy Treatment) OR they do not attach an itemized breakdown showing exactly which Physical Therapy services were provided, the TOP Claim may be pended or denied. TOP Providers delivering Physical Therapy services are reminded to include a descriptive CPT (current procedural terminology) code on the invoice. If this is not possible, then it is important to include a written description of each Physical Therapy service provided. Note: Even if a general description is included on the invoice, the TOP Claims Processor may not be able to reimburse the Provider because some services may be covered under TRICARE Policy while others are not. Therefore, services should be itemized and broken out individually (i.e., not bundled). According to the TRICARE Policy Manual (TPM), Chapter 7, Section 18.1 (Exclusion D), bundling of Physical Therapy services (programs) as allinclusive is not appropriate or covered. Eurasia-Africa +44-20-8762-8384 Physical Therapy services delivered during such a program/encounter must be itemized and each service reviewed to determine if it was delivered by an authorized individual professional provider, if it is a TRICARE covered benefit, and whether it is medically necessary and appropriate. ABORTION AS A TRICARE COVERED SERVICE UNDER CERTAIN CIRCUMSTANCES: According to the TRICARE Policy Manual, Chapter 4, Section 18.3, abortions are now considered a TRICARE covered procedure when the following circumstances are met (and documented):  In a case in which the pregnancy is the result of an act of rape or incest.  When the life of the mother would be endangered if the fetus were carried to term. To ensure that TRICARE reimburses the claim, the following G7 modifiers and medical condition codes must be included on the CMS 1500 or UB-04 Claim Forms:  AA: Abortion performed due to rape  AB: Abortion performed due to incest  AD: Abortion performed due to life threatening physical condition A medical care brief on this topic will be available on www.tricareoverseas.com Visit the Providers section of this website for more information or contact your TOP Regional Call Center and press Option #5 to speak with a member of the TOP Provider Support Services team. Latin America & Canada +1-215-942-8393 Puerto Rico +1-877-867-1091 CERVICAL CANCER SCREENING UPDATES & GUIDELINES: New evidence-based recommendations for Cervical Cancer Screening were published in 2012 by:  United States Preventative Services Task Force (USPSTF);  American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP);  American Congress of Obstetricians and Gynecologists (ACOG) These evidence-based recommendations include:  Begin cervical cancer screening at age 21  Women ages 21-29 years should be screened with cytology alone every 3 years  Women ages 30-65 years should be screened with cytology and HPV testing (‘‘cotesting’’) every 5 years (preferred) or cytology alone every 3 years (acceptable)  Women over 65 years of age with evidence of adequate negative prior screening and no history of CIN2+ within the last 20 years should not be screened for cervical cancer with any modality  Women at any age following a hysterectomy with removal of the cervix who have no history of CIN2+ should not be screened for vaginal cancer using any modality (Cont.) Asia-Pacific +65-6339-2676 Australasia +61-2-9273-2710 TOP PRIME PROVIDER EDUCATIONAL SEMINAR: PUERTO RICO (APRIL 2013) International SOS recently hosted two TOP Prime Provider Educational Seminars in Puerto Rico. The events were held in Aguadilla and Ponce respectively on April 22 and April 25, 2013. Topics included:  Authorizations and Referrals  TOP Claims  TRICARE Covered Services  TOP Provider Support Services  Secure Claims Portal Registration  Frequently Asked Questions TLAC Providers who attended were able to meet International SOS Network Management Services and TOP Claims staff personally. Note: The waivers apply to claims with dates of service beginning January 1, 2013. ABOUT INTERNATIONAL SOS: The seminars were well attended by International SOS Network and TRICARE Participating Providers in the TRICARE Latin America and Canada (TLAC) area. The open exchange of information was helpful and attendees left with a better understanding of the TRICARE Overseas Program and the many educational resources available to them as they treat TRICARE beneficiaries overseas. Government personnel from several Puerto Rico Military Treatment Facilities (MTFs) attended as well and were able to meet and interact with International SOS’ Network Providers. UPDATE: PRIVATE ROOM CHARGES WAIVED IN SELECT COUNTRIES FOR ADSMS Currently, there are waivers in place authorizing the payment of private room charges for Active Duty Service Members (ADSMs) receiving inpatient care in the following countries only:  Haiti  Cuba  Venezuela  Columbia  Peru  Brazil  Guatemala City, Guatemala  Amman, Jordan According to Title 32, Code of Federal Regulations (CFR), Part 199.4(b) (5) (i) (A), a private room is defined as a room with one bed that is designated as a private room by the hospital or other authorized institutional provider. If you have any questions regarding these country-specific private room charge waivers, International SOS authorizations, or how to submit TOP Claims for these services, please contact your TOP Regional Call Center and press Option #5 to speak with a member of the TOP Provider Support Services team. International SOS Assistance, Inc. (http://www.internationalsos.com) is the world’s leading medical & security services company operating from over 700 sites in 70 countries with 10,000 employees, led by 1,100 physicians and 200 security specialists. Our global services include medical and risk planning, preventative programs, in-country expertise and emergency response for travelers, expatriates and their dependents of over 70 percent of the Fortune 500 companies. Since 1998, International SOS has supported TRICARE in ensuring that Active Duty Service Members and their families receive the highest quality care, no matter where their work or travels take them. “TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved.” Eurasia-Africa +44-20-8762-8384 Latin America & Canada +1-215-942-8393 Puerto Rico +1-877-867-1091 Asia-Pacific +65-6339-2676 Australasia +61-2-9273-2710