expectation of privacy in the use of Government networks or systems. Prior to the passage of this law on May 1, 2010, VA did not cover the cost of health care provided to dependent children, including newborns in situations where VA pays for the mothers obstetric care during the same stay. [PatientRace] tables. If a patient received care at another facility, that patient will be have a different PatientSID assigned for that facility. This Technology is currently being evaluated, reviewed, and tested in controlled environments. Bowel and bladder care for certain Veterans with SCI/D are considered supportive medical services due to the possibility of medical complications which would result in the need for hospitalization. Users of the data should keep in mind that these data represent the physical location of the entity billing for care, which may or may not be the same as the providers location. Chief Business Office. This schema contains sensitive information such as SSNs, bank accounts, and the actual name of personnel. Fee Basis data live in both SAS and SQL format. Non-VA Payment Methodology Matrix [online; VA intranet only]. Through the CCN, Veterans have access to regional networks of high-performing, licensed health care . The Department of Veterans Affairs' (VA) fee basis care spending increased from about $3.04 billion in fiscal year 2008 to about $4.48 billion in fiscal year 2012. Unscheduled trips may be reimbursed for the return mileage only. The 275 transaction process should not be utilized for the submission of any other documentation for authorized care. Researchers will have to select observations from the SQL FeeServiceProvided table in order to ensure they are only evaluating outpatient data. The PatientSID is a CDW assigned identifier that uniquely identifies a patient within a facility. Our review of the data suggests that pharmacy and ancillary claims take longer to process than inpatient or outpatient claims. VA HEALTH CARE Management and Oversight of Fee Basis Care Need. The values of Adjustment Codes 1 and 2 (ADJCD1 and ADJCD2) explain the reason for non-payment. Training - Exposure - Experience (TEE) Tournament, Observational Medical Outcomes Partnership (OMOP), Personnel & Accounting Integrated System (PAID), Decision Analysis: Decision Trees, Simulation Models, Sensitivity Analyses, Measuring the Cost of a Program or Practice: Microcosting, List of VA Economists and Researchers with Health Economic Interests. or use of this system constitutes user understanding and acceptance of these terms
Dental claims must be filed via 837 EDI transaction or using the most current. business and limited personal use under VA policy. We view the patients insurance data in the VistA file if the claim is flagged as reimbursable in VistA and encompasses the dates on the claim. Other Health Insurance (OHI) and Explanation of Benefits (EOBs), Any other document type normally sent via paper in support of a Veteran unauthorized emergency claim. The status value R stands for re-routed, meaning the claim was re-routed to the Health Administration Center (HAC). Mail to: DEPARTMENT OF VETERANS AFFAIRS. PatientIEN and PatientSID are found in the general Fee Basis tables. The quantity dispensed. Office of Information and Analytics. Q. 3. SAS has more data on inpatient diagnosis and procedure variables than do SQL data. Data Quality Program. However, in all data files, the vast majority of observations are missing values for this variable. This research was supported by the Health Services Research and Development Service, U.S. Department of Veterans Affairs (ECN 99017-1). Persons working with the SAS data should keep in mind that prior to FY 2007, the disbursed amount (DISAMT) had an implied decimal point whereas the payment amount (AMOUNT) did not. Updated September 21, 2015. Ready. A record is created only if there is a code on the invoice to be recorded. To find all care provided in a particular fiscal year requires searching by treatment date over several years of Non-VA Medical Care claims. 9. For example: services provided at a hospital anticoagulation clinic are billable for facility charges only if the anticoagulation is considered incident to physician services and certain other conditions are met.8. https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Authorized_5638.jpg, https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Unauthorized_242.jpg, https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Service_5480.jpg. Last updated validated on Tuesday, January 3, 2023 VA Palo Alto, Health Economics Resource Center; October 2013. Community Care Network Region 5 (authorized), Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, Indian Health Service/Tribal Health Program, CHAMPVA In-house Treatment Initiative (CITI), Indian Health Services/Tribal Health/Urban Indian, Spina Bifida Health Care Benefits Program, Veterans Health Information Exchange Program, Durable Medical Equipment/ Pharmacy Requirements, War Related Illness & Injury Study Center, Clinical Trainees (Academic Affiliations), Medical Document Submission Requirements for Care Coordination, Azure Rights Management Services (Azure RMS), Call TTY if you
5. Chief Business Office. VA Informatics and Computing Resource Center (VINCI). The local VA facilities put claims through a claim scrubber that checks to see if the claim was authorized and evaluates any errors or inconsistencies in the data. Using the Non-VA Medical Care data for research requires a basic understanding of laws and regulations that govern it. Per the May 5th, 2015 memorandum from the VA Chief Information Security Officer (CISO) FIPS 140-2 Validate Full Disk Encryption (FOE) for Data at Rest in Database Management Systems (DBMS) and in accordance with Federal requirements and VA policy, database management must use Federal Information Processing Standards (FIPS) 140-2 compliant encryption to protect the confidentiality and integrity of VA information at rest at the application level. A foreign key is a key that uniquely identifies a record of another table. There are five forms of patient identifiers in SQL files at CDW (including but not limited to the Fee Basis files): PatientICN, PatientSID, PatientSSN, ScrSSN, and PatientIEN. YESThis insurance is also known as: Veterans Administration. The vendor identity can be found through the VENDID or VEN13N variables in SAS. Researchers wishing to work with SAS Fee Basis data can access them at the Austin Information Technology Center (AITC). the rates paid by the United States to Medicare providers). Given the variable definitions, it is not clear whether DX1 or DXLSF is the better choice to determine primary reason for inpatient stay. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, New York/New Jersey VA Health Care Network, Call TTY if you
(Veterans may submit unauthorized claims, however, and VA has legal authority to pay them under certain conditions. If a patient saw two different providers on the same date who use the same vendor for billing, it will not be possible to distinguish the two encounters. Fact Sheet: Medical Document Submission Requirements for Care Coordination, ADA Dental Claim Form > American Dental Association website. http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf. However, not all data in the FeeServiceProvided table are outpatient data; some may pertain to inpatient stays. Both the SAS and SQL Fee Basis are housed at VINCI; the SQL data is also found at the Corporate Data Warehouse (CDW). There are no references identified for this entry. Passed in 2014 with bipartisan support in Congress, its purpose is to increase Veterans access to health care.1 The Choice Act allows Veterans to receive health care through non-VA providers in the community if they are unable to schedule an appointment at their local VA within 30 days or by a date determined by their provider (wait-time goals), if they reside over 40 miles from a VA facility, or if they face an unusual or excessive burden in travelling to a VA facility.2 Under the Choice Act, ten ($10) billion dollars has been allocated towards Non-VA Medical Care for eligible Veterans through 2017.1 The Fee Basis files contain data for care received through the Choice Act, but in this guide, we do not distinguish for care provided under the Non-VA Medical Care program and that provided under the Choice Act. Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. Then, to see which ICD procedure codes were coded for this inpatient stay, one must link to the [Dim]. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). Data are presented in Table 4. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420.
PDF Frequently Asked Questions for Providers - Logistics Health The vendor identity can be found through the FeeVendorSID or the FeeVendorIEN variables in SQL. Fee Basis data files contain information regarding both the care the Veteran received and the reimbursement of the care. Each prescription record has a fill date and a patient identifier (either PatientICN or scrambled social security number). The unique patient identifier by which to conduct SQL-based Fee Basis analyses is PatientICN. Available at: http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf.. 3. For example, if the Veteran had an Emergency Department (ED) visit and then was admitted to the hospital, this would be considered inpatient care. In both SAS and SQL, it can be difficult to determine the provider the Veteran saw for Fee Basis care. Claims processed after March 17, 2022, will be reviewed and aligned with the federal ruling which prohibits secondary payment on emergency care copayments and deductibles. FSGLI: Family Servicemembers Group Life Insurance, Schedule of Payments for Traumatic Losses, S-DVI: Service-Disabled Veterans Life Insurance, Beneficiary Financial Counseling and Online Will, Lesbian Gay, Bisexual & Transgender Veterans, Pension Management Center (PMC) that serves your state, Claims Adjudication Procedures Manual/Live Manual, Link to subscribe to receive email notice of changes to the Live Manual. For example, an interest payment of $14.21 would appear as 1421. INTAMT is part of DISAMT; it should not be added to them.
Veteran Services - TriWest Researchers evaluating care over time may want to use the DRG variable. The VA Fee Schedule is available at provider.vacommunitycare.com > Documents & Links. The dates of service are represented by the covered from/to fields of the UB-92. or acts to, The Financial Services Center (FSC) is a franchise fund (fee for service) organization in the Department of Veterans Affairs (VA).Under the authority of the Government Management Reform Act of 1994 and the Military
Eligibility and claims submission information for emergent care will be provided after notification is made to the VA. Claims for emergent care not eligible for authorization upon notification, may be eligible for consideration as Unauthorized Care. Review the Supporting Documentation section below to learn how to properly submit supporting documentation with your claim. It is the patient identifier that uniquely defines a patient across all facilities. U.S. Department of Veterans Affairs. This component provides a front end for scanning claim forms into a temporary image queue for a given patient. The majority of claims, 99%, were processed within 2 years, with the exception of pharmacy data in FY 2004 and FY2008. retrieving information only; except as otherwise explicitly authorized for official
The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. [FeeInpatInvoiceICDDiagnosis], [Dim].
Veterans Choice Program - Fee Basis Claims System in CDW VIReC Research User Guide: VHA Medical SAS Outpatient Datasets FY2006. This table also includes claims related to inpatient care and other services. Many variables in the Fee Basis files record details of invoice and check processing. Information from this system resides on and transmits through computer systems and networks funded by the VA. There may be multiple STA3Ns for a single inpatient stay. This component is a service that communicates with an outside `Adjudication Engine` which scrubs claims data and sends back scrub results to the service via a secure Pretty Good Privacy (PGP) Secure Sockets Layer (SSL) web service connection. Appendix E includes a list of SQL fields related to the type of care a patient receives. The instructions differ based on the type of submission.NOTE: For specific information on submitting claims to Optum or TriWest, please refer to their resources. 15.
Veterans Choice Program - Fee Basis Claims System in CDW - Veterans Affairs Accessed October 07, 2015. 3. . For more details, including rules for handling patients transferred during a stay, see federal regulation 38 CFR 17.55. 2. VA can waive the deductible in hardship cases. [ICDProcedure] table and a foreign key in the [Fee]. Hit enter to expand a main menu option (Health, Benefits, etc). These correspond to fields, rows and tables in a relational database. Care provided in foreign countries other than the Philippines. Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. Chapter 6 contains more information about how to access these data. Accessed October 16, 2015. [ SFeeVendor] table. NOTE: The processes outlined below are exclusive to supplying documentation for unauthorized emergent care. VA will arrange for transportation for them or will reimburse expenses on the basis of vouchers submitted. For some VEN13N, however, there is more than one MDCAREID. The Choice Act represents one of the largest shifts in the organization and financing of healthcare in the Department of Veterans Affairs (VA) in recent years. a. Some Non-VA Medical Care claims are rejected for untimeliness or lack of statutory authority. Analyses of FY 2014 data indicate approximately 50% of inpatient observations and 43% of outpatient observations are missing NPI. Thus, researchers using later years of data should be aware that files are not static and will continue to be updated. The same cannot be said for DX2-DX25, however, as additional diagnosis codes are optional. In the SAS data, the provider component of the inpatient stay is captured in the ancillary file. If you have additional questions about the form or your portal account access, please contact the Provider Services Solution (PRSS) help desk at 888-829-5373. The Medicare Ambulance Fee Schedule consists of a base rate plus mileage. Therefore, on the outpatient side as well one must aggregate multiple records to get a full picture of the outpatient encounter. Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA care. actions by all authorized VA and law enforcement personnel. Data Quality Analysis Team. MDCAREID is the Medicare OSCAR number, which is a hospital identifier. This care will be approved (or denied) by the local VA Fee Office; the Veteran is then free to seek non-VA care. VA evaluates these claims and decides how much to reimburse these providers for care. Authorized care claims must be submitted within 6 years of the date of service, service-connected emergency care claims must be submitted within 2 years of the date of service, and non-service-connected emergency care claims must be submitted within 90 days of the date of service/discharge. There are multiple methods by which community providers may electronically provide VA with the required medical documentation for care coordination purposes. These rules are subject to change by statute or regulation. Accessed October 16, 2015. Institutional Aspects of the Non-VA Medical Care System, https://www.va.gov/health-care/get-reimbursed-for-travel-pay/, http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. Box 30780 Tampa, FL 33630-3780, P2E Documentation Cover Sheet, VA Form 10-10143f. U.S. Department of Veterans Affairs. Five additional variables Financial Management System (FMS) transaction number, line number, date, batch number, and release date reflect processing of payments through the FMS. FBCS is designed to be used in the Fee Basis Departments of the Veteran Affairs Medical Centers (VAMCs). We assume here that new inpatient stays are defined by a change in vendor or a gap in treatment day more than 1 day. On March 17, 2022, The U.S. Court of Appeals for the Federal Circuit issued a ruling that changes VA's ability to reimburse as secondary payer under 38 U.S.C.1725. VAntage Point. For
INTIND and INTAMT are not always concordant. Fee Basis data are housed in both SAS and SQL format. HERC Veterans Choice Program - Fee Basis Claims System in CDW Fee Basis Claims System (FBCS) in the VA Corporate Data Warehouse All Choice claims are processed by VISN 15. Smith MW, Chow A. Non-VA Medical Care (Fee Basis) Data: A Guide for Researchers. (Anything), but would not cover any version of 7.5.x or 7.6.x on the TRM. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. Values for Fee Purpose of Visit (FPOV), HCFA Payment Type (HCFATYPE), Treatment Code (TRETYPE), Place of Service (PLSER), and Vendor Type (TYPE) appear in Appendix B. have hearing loss. In the SAS data, the patient identifier is the scrambled social security number (SCRSSN). SQL data must be linked from multiple tables in order to create an analysis dataset. We recommend researchers use the FeePurposeOfVisit codes (FPOV) codes to eliminate observations related to non-outpatient care before beginning analyses. http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. While Unauthorized care is considered a separate domain, the data pertaining to Unauthorized care are stored alongside the Authorized care data in the FeeInpatInvoice table and the FeeServiceProvided table. 2. The inpatient data will also need to be linked to the ancillary data, or the data representing the professional services provided to a patient while in the hospital, in order to determine the total cost of the inpatient stay. UB-92 box 56 (ProviderNPI) represents the providers National Provider Identifier. The vendor has verified that the VA no longer has an active contract for this technology and any instances of this software on the VA network should be removed. It is not necessarily the station at which the Veteran receives most VA care or the station which will pay for a particular Non-VA Medical Care service. 1725 or 38 U.S.C. While there is limited information about the vendor available in the SAS datasets; the most comprehensive information about the vendor can be found in the SAS VEN and SAS PHARVEN datasets. The generosity of the coverage is immaterial; if it covers any part of the providers bill, then VA may not pay anything. In VA datasets, the MDCAREID does not have an accompanying address, but one can use other non-VA datasets (e.g., Hospital Compare) and determine the address of the hospitals physical location through the common MDCAREID variable. The two tables can be joined through FeePharmacyInvoiceSID. Researchers will thus need permissions to allow the CDW data manager to obtain SCRSSN or SSN to PatientICN crosswalk to allow for the necessary data linkages. However, investigation has confirmed these are partial payments made for a single encounter or procedure. Sort data by the patient ID, STA3N, VEN13N, and the admission dates. Missingness can vary substantially by year and by file.
1. No new extracts will occur. Chapter 1 presents an overview of Fee Basis data in general; Chapter 2 presents an overview of the variables in the Fee Basis data; and Chapter 3 describes how SAS versus SQL forms of Fee Basis data differ. Electronic Data Interchange (EDI): Payer ID for medical and dental claims is VA CCN. However, previous HERC investigation confirmed these are partial payments made for a single encounter or procedure. Emergency care can also be authorized by VA in certain circumstances when the VA is notified within 72 hours. We give an example here that relates to FeeInpatInvoice table. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. 1725 (the Mill Bill) by enabling VA to pay for or reimburse Veterans enrolled in VA health care for the remaining cost of emergency care if the liability insurance only covered part of the cost. They could form part of an overall strategy to locate care provided in specialized settings, such as state homes, or of specialized services like kidney dialysis. However, there are some outliers; some claims can take up to 8 years to process. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Submit a corrected claim when you need to replace an entire claim previously submitted and processed. Inpatient care beyond the time when a patient is stabilized and can be transferred to a VA facility, except where a VA facility is not feasibly available. Private health insurance coverage through a Veteran or Veteran's spouse is insurance provided by an employer, Veteran or other non-federal source, including Medicare supplemental plans.
CLAIM.MD | Payer Information | VA Fee Basis Programs Details about the VA rules governing reimbursement can be found in Chapter 7 of this guidebook. We encourage readers to seek out the latest guidance before conducting analyses, as CDW Data Quality Analysis team may have updates to this information. The Act amends 38 U.S.C. Inpatient stays in both SAS and SQL Fee Basis data can denote hospital stays, nursing home stays, or hospice stays. privacy policies and guidelines. Providers who continue to elect to submit paper claims and paper documentation to support claims for unauthorized emergency care should be aware of the following: VHA Office of Integrated Veteran Care P.O. In this situation, a given VA medical center has a preferred hospital from which it purchases care.