A Study to Determine the Tripler Army Medical Center Urology Clinic's FY 2001 Outpatient Service Charges to the Veterans Administration

The objective of this study was to determine the Tripler Army Medical Center (TAMC) Urology clinic's outpatient service charges to the Veterans Administration (VA) for fiscal year 2001. A sensitivity analysis was conducted using a six-month sample of TAMC Urology clinic VA beneficiary (VAB) encounters (509 clinic and ambulatory procedure visits) and six federal and civilian outpatient billing methodologies in order to determine fair and reasonable TAMC Urology clinic outpatient charges to the VA. The six outpatient billing rates used in this study were the full and relevant Medical Expense and Performance Reporting System (MEPRS), full federal third-party and Interagency, local Hawaiian usual, customary, and reasonable (UCR), and Medicare's Outpatient Prospective Payment System (OPPS). The Medicare OPPS, though projected to initially reimburse 40 percent less than the current TAMC outpatient billing methodology (relevant MEPRS), adheres to current joint VA/DoD outpatient billing guidelines, is competitive with local healthcare market rates, and it satisfies the 2000 National Defense Authorization Act directive to implement an itemized CPT outpatient billing methodology (by 2002) similar to civilian industry standards. Based on the results of this study, a recommendation was made to implement Medicare OPPS billing rates for the TAMC Urology clinic for FY2001.