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

11–10. Audit and review
The MSA is subject to audit and review under AR 11-7, AR 36-2, and AR 36-5.
11–11. Physical loss of medical services accounts funds
Monies accepted from patients as payment for services are considered MSA change fund until deposited with the
supporting FAO or a designated banking facility. If physical loss of funds from the MSA change fund occurs, the
MSAO will—
a. Immediately notify the supporting DAO.
b. Notify the MTF commander, in writing, within 24 hours, of all known facts about the loss. Notify USAMED-
COM, ATTN: MCRM-F, 2050 Worth Road, Fort Sam Houston, TX 78234-6000 within 48 hours of all known facts
about the loss. If the supporting DAO/operating location is not located within commuting distance, notify the
USAMEDCOM within 24 hours.
c. Follow procedures in AR 37-103 on loss of funds.
11–12. Reports
Month-end accounting procedures for automated systems will use the output of the CHCS MSA subsystem.
11–13. Charges
Persons not authorized care in Army MTFs by law or regulation will be charged the applicable “others” rate. (See app
B and the Medical Services Account Users’ Manual.)
11–14. Application of charges
The application of charges is subject to guidance issued by the OASD(HA). This guidance allows certain operating
requirements unique to DOD MTFs. Local judgment will apply in determining whether a charge is proper. If a medical
charge is proper, it cannot be waived, suspended, compromised, or settled by the MTF commander. The DFAS has this
authority within the DOD. Such authority was given to the DFAS by the Secretary of Defense under the Federal
Claims Collection Act of 1966, 31 USC 3711. Charges of $100,000 or more require Government Accounting Office
approval and will be considered by DFAS for forwarding to Government Accounting Office.
a. Inpatient. The inpatient rates are all inclusive and are based upon guidance issued by the OASD(HA). No
additional charges will be applied.
b. Outpatient. DOD MTFs may provide health care services to some categories of non-entitled patients (for
example, DOD civilians overseas) on a reimbursable basis. Reimbursement will be calculated according to rates
established by the Under Secretary of Defense (Comptroller). All separate outpatient visits during a single day will
result in a separate charge for each visit. Failing to charge for each visit received during the same day means that the
facility will not recover the full cost of services rendered. The only exception to this rule is when a patient visits the
same clinic multiple times in the same day. In this case, they are charged for one visit at the rate for that clinic.
(1) Follow-up visits on subsequent days are chargeable unless the sole purpose of having the patient return is to
verify the success of the previous treatment and no additional treatment is provided.
(2) The following services, whether initial or follow-up visits, are not chargeable:
(a) Check-in at “sick-call” to make an appointment for a visit on a subsequent day.
(b) Prescription refills. (New prescriptions of controlled drugs obtained without the patient seeing a doctor are
considered refills.)
(c) Consultation and advice on the results of vaccinations and tests such as the tuberculosis TINE and pap smear.
(d) Physical therapy treatments.
(e) Telephone discussions. Telephone discussions which do meet the criteria of a clinic visit are not chargeable. This
does not apply to telephone consultations which are considered visits and are, therefore, chargeable.
(f) Weight checks.
(g) Blood pressure checks requested by the physician as a follow-up treatment.
(h) Check of bandages, casts, etc.
(i) Removal of sutures.
(j) Vision tests for drivers’ licenses.
(k) Verification of physical profile series.
(l) Dependent school children’s visits to public health nurses who are located at the school and who are employees
of the medical facility.
(3) When dental is available, each sitting, not each procedure, is normally a chargeable visit. Exceptions to this
policy apply when dental examinations and cleaning are performed. These procedures are normally intended to occur in
a single sitting. The fact that workload or other factors preclude performing both procedures in one sitting does not
justify an additional charge to the patient. Also, patients should not be charged for follow-up dental care which is
required solely for the following:
AR 40–400 27 January 2010
73