Billing

Billing Medicare

The Defense Health Agency and the Centers for Medicare and Medicaid Services have established a working relationship and have collaborated to improve billing practices between the two agencies. DHA, on behalf of their Military Treatment Facilities, has signed up as non-participating providers using the CMS election form. The below documents will assist MTFs as they submit claims to CMS.

For any questions that are specifically addressed in the above documents, please reach out to the DHA UBO Helpdesk.

Billing the USCG, NOAA, and USPHS

Established through interagency agreements, payments to the Defense Health Program (DHP) for healthcare services provided by Military Treatment Facilities (MTFs) to U.S. Coast Guard (USCG), U.S. Public Health Service (USPHS), and National Oceanic and Atmospheric Administration (NOAA) beneficiaries are managed under a prospective payment model. While the USCG has historically utilized this model, reimbursements for NOAA and USPHS beneficiaries have officially transitioned to this prospective payment approach starting in Fiscal Year (FY) 2026. Under this unified model, the sponsoring agencies reimburse the Army, Navy, Air Force, and DHA MTFs monthly, and on a prospective basis, for all inpatient and outpatient care provided to their eligible beneficiaries.

Prospective payment amounts are calculated based on historical encounter data and discounted Department of War (DoW) Medical Reimbursable Rates, which are then normalized using the appropriate medical inflation factors and force structure adjustments. These funds are distributed directly to the respective Army, Navy, Air Force, and DHA MTFs based on individual treatment Defense Medical Information System (DMIS) facility identifier calculations. For detailed operational instructions, please refer to the USCG Billing section in the DHA UBO User Guide. Please direct any questions to the DHA UBO Helpdesk.

Multi-Site/Regional Billing

Multi-site billing (sometimes referred to as regional billing) allows one facility to perform claims processing for one or more facilities. The concept of Multi-site billing has been accomplished to various degrees by the Services and NCR MD.  There are some key points, though, involved in any arrangement when a facility or agency is contracted to perform this function for another facility. At a minimum: 

  • A written agreement should be in place between the contracting and contracted facility/agency. This agreement is to be approved by the Service or NCR MD Program Managers prior to implementation to ensure it meets UBO compliance requirements. 
  • When a service is contracted out, the contracting facility/agency is ultimately responsible for assuring work is being accomplished within appropriate compliance guidelines. 
  • No military facility performing this service for another MTF should charge anything other than actual cost. The formula for determining the cost of operations is the number of claims divided by the total MEPRS EBH costs. You may need to review your EBH data to ensure it represents your costs. 
  • The facility/agency contracted to perform collections and the contracting facility must have an audit process in place to ensure record documentation supports claims developed. 
  • Accounts receivable processes must separate out claims by facility/agency against which funds were collected. 
  • The contracting facility/agency must receive reports on accounts receivable, metrics reports, and has a right to audit the process for accurate accounting and billing processes. 
  • Quarterly metrics reports data are separated out for each facility/agency for which the claims are processed. 
  • The contracting facility/agency has a right to access data from the contracted facility/agency to assess the effectiveness of third party collection operations for their patient population. These requirements should be included in the contractual agreement. 

For further information, please contact your Service or NCR MD Program Manager.