Patient Administration - Army Publishing Directorate - U.S. Army

(3) Is there a procedure in place to identify and report health care services for a non-Federal employment related
injury or illness (commonly referred to as worker’s compensation) to the appropriate RJA?
(4) Are procedures in place to identify patients with concurrent TPCP and medical affirmative claims, and to notify
the appropriate RJA, in a timely manner, that a TPCP health insurance payment or denial is received on a concurrent
medical affirmative claim?
(5) Does the MTF receive a monthly report from the appropriate RJA listing medical affirmative claims closed
without recovery and claims transferred to another RJA jurisdiction?
(6) Does the MTF receive and maintain a monthly report listing the patient’s name, sponsor’s SSN, and amount(s)
deposited to the MTFs account by the RJA, or a copy of deposit voucher(s) reflecting deposits to the MTFs account by
the RJA?
(7) Are procedures in place to ensure medical affirmative claims forms are accurately completed by the MTF and
provided to the RJA, with copies of pertinent medical records, in a timely manner?
(8) Does the MTF maintain documentation supporting medical affirmative claims, including, but not limited to UB-
92 forms, encounter forms, and DD Forms 2569 after treatment or discharge as addressed in DOD 6010.15-M
regarding internal controls?
(9) Are procedures in place to ensure all requests for attorneys, insurance companies, and patients are screened for
potential or ongoing medical affirmative claims and these requests are forwarded to the RJA for release or approval for
release?
(10) Are procedures in place to ensure separation of duties, that is, that MTF personnel performing medical
affirmative claims related billing functions are not also performing medical related claims related collection/deposit
functions as addressed in DOD 6010.15-M regarding internal controls?
d. Supersession. There was no previous checklist.
e. Comments. Comments regarding this checklist should be addressed to the Commander, USAMEDCOM, ATTN:
MCHO-CL-P, 2050 Worth Road, Suite 10, Fort Sam Houston, TX 78234-6010.
C–3. Medical services account
a. Purpose. The purpose of this checklist is to assist Army MTFs in evaluating the key management controls listed
below. It is not intended to cover all controls.
b. Instructions. Answers must be based on the actual testing of key management controls (for example, document
analysis, direct observation, sampling, simulation, other). Answers which indicate deficiencies must be explained and
corrective action indicated in supporting documentation. These management controls must be evaluated at least once
every 5 years. Certification that this evaluation has been conducted must be accomplished on DA Form 11-2-R.
c. Test questions.
(1) Are rates charged eligible beneficiaries for medical, dental, and veterinary care in Army MTFs current?
(2) Is the MSAO appointed by written order of the MTF commander?
(3) Are deputy MSAO/assistant MSAOs, if required, appointed in writing by the MTF commander? Are current
procedures established for transfer of MSA accountability?
(4) Is the MSAO not accountable for another appropriated fund or other Government property?
(5) Are current SOPs established for daily operation of the MSA office?
(6) Has the MSAO designated separate accounting technicians and cashiers?
(7) Is the organizational arrangement (separation of duties of accounting technician, cashier, etc.) adequate to protect
cash receipts?
(8) Is there a separate drawer or box with a separate key for each cashier, if more than one cashier?
(9) Is the automated CHCS being used to manage accounts receivable? Is CHCS being used to maintain the invoice
and receipt (DA Form 3154) control listing? Are invoices and receipts being printed from CHCS as necessary?
(10) Are there procedures to ensure that MTF activities notify the MSAO when chargeable items are provided to the
patient and the rate to be charged?
(11) Is the original CHCS-printed copy of the invoice and receipt presented to the patient or sponsor?
(12) Are DD Forms 7 and 7A prepared monthly?
(13) Are charges for subsistence furnished to enlisted personnel inpatients billed to the Military Personnel Army
appropriation on an SF 1080?
(14) Are outpatient charges collected in advance of treatment except in case of an emergency?
(15) When outpatient charges are not collected in advance, does the MSAO approve extension of payment period?
(16) Are procedures established to collect on a cash basis at the time veterinary service is provided?
(17) Is DA Form 3154 prepared, receipted, and annotated for veterinary care?
(18) Does the MSAO report delinquent medical bills to the MTF commander for review, as required by AR 37-103?
(19) Does the MSAO have established followup procedures for collecting delinquent accounts, and are all required
collection efforts completed within the proper time limits before transferring accounts to FAO?
AR 40–400 27 January 2010
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