CHAPTER 15 HEALTHCARE ADMINISTRATION In the Medical Department, proper records administration is very important. We are charged with administering not only routine personnel records, but also clinical records that may affect the rights and benefits of patients and their dependents years beyond retirement or discharge. As a Hospital Corpsman, you could be assigned to or responsible for the administrative affairs concerning inpatients or outpatients. This chapter will provide information on the function of healthcare programs you may be involved with or responsible for. We will also discuss the legal implications in medical care, including the various aspects of consent, incident reports, and release or nonrelease of medical information under the Privacy and/or Freedom of Information Acts. Further, guidance concerning your relationship and interaction with law enforcement personnel and the legal community will also be outlined. PATIENT ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CARE LEARNING OBJECTIVE: Recognize the policies and procedures for DEERS, CHAMPUS, and TRICARE. The fact that a person seeking treatment is or was connected with the federal government does not automatically entitle him to treatment at a naval medical treatment facility. A number of factors determine eligibility for certain types of medical attention and the source and amount of remuneration for that treatment. The following section deals with eligibility verification by presentation of a valid ID card and utilization of the Defense Enrollment Eligibility System (DEERS). Further guidance can be obtained by familiarizing yourself with the following sources:  NAVMEDCOMINST 6320.3, Medical and Dental Care for Eligible Persons at Navy Medical Department Facilities  NAVMEDCOMINST 6320.18, Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) Regulation  NAVMED P-5020, Resources Management Handbook DEFENSE ENROLLMENT ELIGIBILITY REPORTING SYSTEM (DEERS) The Defense Enrollment Eligibility Reporting System (DEERS) was developed to improve distribution and control of military healthcare services. Additionally, DEERS was implemented to assist in the projection and allocation of costs for healthcare programs and to minimize fraudulent healthcare claims. Navy medicine’s eligibility for care instruction, NAVMEDCOMINST 6320.3, provides guidance as to who and under what circumstances members can receive medical and dental care at Navy Medical Department facilities; the extent and conditions under which such care may be provided; and the collection process to pay for that care. Enrollment for all seven uniformed services (i.e., Army, Air Force, Marine Corps, Navy, Coast Guard, Public Health Service, and National Oceanic and Atmospheric Administration) is accomplished through completion and submission of an Application for Uniformed Services Identification and Privilege Card, DD 1172, for a member’s dependent. When a new ID card is obtained for the dependent, the member’s DEERS data is updated online. If problems exist within a patient’s database, active duty personnel and their dependents must be referred to the sponsor’s personnel office. Refer all other beneficiaries (e.g., retired personnel and their dependents) to the nearest personnel office. Direct Care System Procedures In addition to providing authorization to standard medical care through inclusion in its membership database, DEERS now includes a dental policy based upon beneficiary information (versus the previous policy based on sponsor information). This change in policy occurred in part because of the increased accuracy of the database as well as the percentage of personnel enrolled. 15-1