Tricare Philippines Newsletter 12010
The Double Proof of Payment Issue
The next scheduled newsletter was supposed to deal with the hospital portion of inpatient claims. However we are still waiting on a response on how beneficiaries can split the hospital portion out in the same way providers split the claim. So not to delay any longer we opted to do this newsletter pending the response.
About five years ago the DODIG, in an audit of the TRICARE Overseas Program (TOP), found that beneficiaries in Europe were sometimes allowed to not pay the provider pending processing of their claim but that some were keeping the money and not paying the provider and, because of that, some providers were no longer accepting TRICARE patients. They recommended that the TRICARE Management Activity (TMA) request proof of payment in cases where large claims were paid but without a receipt showing proof of payment.
TMA took this recommendation and applied it to the Philippines in a fashion not originally intended since they had already put in place a requirement that we must submit receipts with our claims. (Only within the last month or so has TMA extended this requirement to all of TOP.) In our case, since we had already provided the proof of payment, receipt, that the DODIG addressed, they now required of us some other form of proof. Originally the only acceptable documents were credit card receipts and cancelled checks. Given that the majority of providers did not accept credit cards or charged high fees to use them and checks are generally not used, beneficiaries were going to have a problem meeting the requirement and find their claims denied for failure to comply with the requirement. The U.S. Military Retirees of the Philippines group contested this requirement as unnecessary since proof of payment was already provided and that the intent of the DODIG was to insure beneficiaries in Europe who didn’t pay the bill in advance did pay the provider. We also pointed out the secondary or double proof of payment documents they specified we had to use was as mostly not available. It turned out TMA was unaware of how medical bills in the Philippines are paid.
While our challenge was rejected, TMA did agree to modify the list of acceptable documents a beneficiary could use for double proof of payment. TMA failed to publicize this requirement which has resulted in some claims being denied for failure to provide the double proof of payment and usually for large amounts of money.
The requirement still exists today although TMA still hasn’t published any official information on the program. However, based on input from TMA employees and Wisconsin Physicians Service (WPS) we do know when it is currently applied and some acceptable alternatives for double proof of payment.
Double proof of payment is required when a claim meets one or more of these triggers.
- An outpatient claim of $5,000 or more.
- An inpatient claim of $10,000 or more. (Combines both hospital and professional fees.)
- Claims submitted by beneficiaries on pre-payment review.
- Claims from beneficiaries where the provider is on pre-payment review.
What is pre-payment review?
TMA’s Program Integrity places Philippine beneficiaries and providers on pre-payment review for reasons that are kept secret. But we are told this happens when either one is suspected of fraud against TRICARE. Any claim that involves a beneficiary or provider on pre-payment review will trigger the double proof of payment requirement at much lower thresholds. Program Integrity likes to point to this program as their way of combating fraud in the Philippines and claims in published presentations that 82% of their total resources are dedicated to this program in the Philippines and 90% of WPS’s fraud effort is likewise dedicated to Philippine fraud while only 16% of claims come from the Philippines. Actual figures provided by TMA to Congress states that 77% of all TRICARE beneficiaries in the Philippines are on pre-payment review and 64% of all providers in the Philippines are also on pre-payment review.
In our experience with talking to many beneficiaries about their claims and assisting many others with processing their claims we haven’t come across one example of a request for double proof of payment that was triggered when the claim didn’t exceed item one and two thresholds above. So we feel these figures are greatly exaggerated and primarily for the consumption of those TMA wants to impress with their work and perhaps justify their continued special rules for the Philippines. If anyone has experienced this requirement with their claims we would like them to contact us.
What is considered acceptable double proof of payment?
The first requirement is that proof in an amount equal to or greater than the total amount of the claim was obtained from some source within a few days of the actual payments dates as shown by the previously submitted receipts.
The latest feedback we have indicates that bank withdrawal slips, credit card statements, credit card receipts and ATM receipts are acceptable. Our experience also shows that bank statements showing the withdraws, signed statements from those that loaned money so the medical bill could be paid and even statements from adult children in the states that sent money have been accepted. So our belief is that WPS will try to work with beneficiaries on this requirement.
In a published presentation from TMA’s Program Integrity that discusses the program they also list a signed letter from the providers certifying that they were paid as acceptable. However TMA has refused to respond to multiple requests asking to confirm this approach. If someone is in a situation where they have no other alternative they may want to see if this will work.
How do I prepare for this requirement?
Always consider this requirement whenever you are paying for medical expenses. Make sure you have access to one or more of these acceptable documents and maintain them with your records that support your claim. This means to always retain all withdrawal slips, ATM and credit card receipts and bank statements in the event that they may be needed. After about 30 days from the time of the transaction and where no medical expenses were paid you can discard them if not otherwise needed.
Do not send in your double proof of payment along with the normal receipts when you file the claim as they may not be considered acceptable if they later request the information.
As we indicated before we intend to address how to file a claim for the hospital portion of a hospitalization. That will depend, however, on when we get the feedback we requested some time ago.
Share this newsletter with other beneficiaries
Forward this newsletter to others you feel might benefit from them so they can sign up as well. If you represent an RAO or service organization let your members know so they can sign up. Sign up link
If you are on Facebook share this newsletter with your friends.