Payment guidelines for non-VA are outlined in federal regulations 17.55 and 17.56. As noted above, there are differences in the patient identifier and the date variables in the SAS versus SQL data; both data sources do not contain the same variables regarding patient identifier or date the claim was paid. Starting in 2009, there are also a number of DXPOA variables in the SAS data, which indicate diagnoses that are present on admission. There are up to 25 ICD-9 diagnosis codes and 25 ICD-9 surgical procedure codes in the inpatient data. The SQL tables [Dim]. The zip code accompanying the VEN13 variable denotes the zip code to which VA sent reimbursement, not the zip code where the service was rendered. SAS data are also available in CDW, but are currently limited to those VA employees with operational access. This act expands the non-VA care veterans were able to receive before the act was passed. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. VA systems are intended to be used by authorized VA network users for viewing and If FIPS 140-2 encryption at the application level is not technically possible, FIPS 140-2 compliant full disk encryption (FOE) must be implemented on the hard drive where the DBMS resides. This technology has not been assessed by the Section 508 Office. the rates paid by the United States to Medicare providers). The unique patient identifier by which to conduct SQL-based Fee Basis analyses is PatientICN. VA can also pay for hospice care for Veterans when the VA facility is unable to provide the needed care; this happens frequently, as VA provides only inpatient-based hospice care and many Veterans may wish to receive hospice at home or in the community. You can submit a corrected claim or void (cancel) a claim you have already submitted to VA for processing, either electronically or in paper. Below we describe the general types of information in both the SAS and SQL data. April 14, 2014. For additional information or assistance regarding Section 508, please contact the Section 508 Office at Section508@va.gov. Our review of the data suggests that pharmacy and ancillary claims take longer to process than inpatient or outpatient claims. The slight decrease in fiscal year 2012 spending from the fiscal year 2011 level was due to VA's adoption of Medicare rates as its primary payment method for fee basis providers. 400, Wittman Drive Grand Rapids Itasca County MN - 55744 United States. Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. Of note, SQL and SAS data contain similar, but not exactly the same, information. The deadline for claims submission is dependent upon which program the care has been authorized through or which program the emergency care will be considered under. Missingness can vary substantially by year and by file. As part of the process, claims and supporting documentation are scanned for compliance prior to conversion to electronic format. If the patient was transported to a VA hospital after stabilization (as indicated by the DISTYP, or disposition type, variable), the record of the VA stay should appear in VA utilization databases. Table 8 denotes on which CDW servers Fee Basis data are housed. Defining a cohort is an activity that is different for each project and depends on the research question at hand. Again, date of service is not available in the FeeServiceProvided table. Electronic 837 claim and 275 supporting documentation submissions can be completed through VAs contracted clearinghouse, Change Healthcare, or through another clearinghouse of your choice. Researchers wishing to work with SAS Fee Basis data can access them at the Austin Information Technology Center (AITC). 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. 8. Veterans who meet certain criteria may be eligible for mileage reimbursement for travel to and from VA or Non-VA care. Under this regulation, ambulances will be reimbursed at the lesser of (a) the amount the Veteran is personally liable or (b) 70 percent of the applicable Medicare Ambulance Fee Schedule. Accessed October 16, 2015. Researchers can read more information about accessing CDW on the VHA Data Portal (http://vaww.vhadataportal.med.va.gov/DataSources/CDW.aspx; VA intranet only). This is helpful in determining the location of care in inpatient claims in which MDCAREID is missing, and in outpatient claims for hospital-provided services. In the SAS data prior to FY 2007, the disbursed amount (DISAMT) had an implied decimal point whereas the payment amount (AMOUNT) did not. [Patient], [Spatient]. This guidebook describes characteristics of Fee Basis care data such as contents and missingness, and makes recommendations about its use for research purposes. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. The travel payments data contains reimbursements for particular travel events (TVLAMT). The key that allows for this linkage is the FeeInpatInvoiceSID which is a primary key in the [Fee]. A description of the Patient and SPatient schema is available on the VIReC CDW Documentation webpage: http://vaww.virec.research.va.gov/CDW/Documentation.htm (intranet only). Hit enter to expand a main menu option (Health, Benefits, etc). VA Directive 6402, Modifications to Standardized National Software, Document Storage Systems (DSS) DocManager, Microsoft Structured Query Language (SQL) Server, Optical Character Recognition (OCR) Module, Fidelity National Information Service (FIS) Compass. Available at: http://www.mssny.org/Documents/Enews/Aug%208%202014/VA%20ProvidersGuide.pdf, 6. National Institute of Standards and Technology (NIST) standards. Review the Filing Electronically section above to learn how to file a claim electronically. You will have to pay this penalty for as long as you have Part B. The alternative, putting the procedure code fields in the invoice table, would not be as efficient. 3. [ICD9] tables. FBCS is moving to a centralized system in the near future, where there will be centralized rules and national policies with 3 distinct groups: CCN (network), CCRA (authorization), and CCRS (reimbursement system; an IBM product). Some web reports contain PHI and access to these is restricted. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. There are nine situations in which Non-VA Medical Care is authorized. VINCI. The Fee Basis program or Non-VA Care is health care provided outside VA. NVCC Office coordinates services and payments for Veterans receiving non-VA care for emergent and non-emergent medical care. The data regarding the clinical encounter as well as the charge and payment for that encounter are populated into the VA Health Information Systems and Technology Architecture (VistA). Some important DIM tables that will be useful in analyzing Fee Basis data are FeePurposeOfVisit, FeeSpecialtyCode, FeeVendor, ICD, ICDProcedure Code, DRG, CPT, and CPT Category. Treatment date correlates to covered from/to. 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. Available at: http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. The Florida Department of Veterans' Affairs has Claims Examiners co-located with the VA Regional Office in Bay Pines, each VA Medical Center and many VA Outpatient Clinics. The table can be linked to the [Dim]. MDCAREID is not available in the outpatient SAS Fee Basis data, even though some outpatient services are provided in a hospital. Non-VA Medical Care data are available in SAS form at the Austin Information Technology Center (AITC) and in SAS form and SQL form through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). 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. For inpatient and outpatient care, in general, VA will pay the lesser of the Medicare rate (or MPFS rate) or the billed charges. Other work by HERC researchers indicates that in the FY 2014 data, DXLSF and DX1 were identical 47% of the time. Chief Business Office. To access the menus on this page please perform the following steps. VA's fee basis care program. (Veterans may submit unauthorized claims, however, and VA has legal authority to pay them under certain conditions. The Veteran's full 9-digit social security number (SSN) may be used if the ICN is not available. If, however, VA is authorized to pay for only certain days in an inpatient stay, then the provider may bill the patient for the remaining days. YESThis insurance is also known as: Veterans Administration. If researchers wish to identify ED visits, they may want to use CPT codes or Place of Service codes, rather than FPOV. National Non-VA Medical Care Program Office (NNPO). It will often times not be possible to determine the reason for an outpatient visit, as there will be multiple observations/CPT codes that denote a single visit. Search VA Fee Basis Programs PayerID 12115 and find the complete info about VA Fee Basis Programs Insurance Type, LOB, ENR, RTE, RTS, ERA, SEC, Customer Service Number and more . Patient identifiers are also different across SAS and SQL data. If the gap is 0 or 1, it is part of the same hospital stay and we then want to assess its discharge date. what is specified but is not to exceed or affect previous decimal places. The generosity of the coverage is immaterial; if it covers any part of the providers bill, then VA may not pay anything. Note: Admission date is only relevant for inpatient stays; it is not relevant for outpatient visits. Address. The Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law 111-163) authorizes VA to provide post-delivery and routine care to a newborn child of qualifying women Veterans receiving VA maternity care for up to seven days following the birth. Each VA facility has a local Fee Office to which the non-VA provider submits a claim for reimbursement. The Department of Veterans Affairs has implemented centralized mail processing (CM) for compensation claims to reduce incoming paper handling and shipping requirements. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. The potential exists to store Personally Identifiable Information (PII), Protected Health Information (PHI) and/or VA Sensitive data and proper security standards must be followed in these cases. The VHA Office of Community Care is the contact for all VA community care programs. VA payment constitutes payment in full. In this way, records that are missing MDCAREID can be given a MDCAREID based on the value of VEN13N and STA6A in the record. The following information should help you understand who to submit claims to and the requirements you must follow when submitting claims. 15. In some cases it may appear that single encounters have duplicate payments. A single inpatient encounter may generate zero, one, or multiple ancillary records, depending on the number of ancillary procedures and physician services received. If it cannot be located in the PTF Main file or DSS NDE for inpatient care, search other inpatient files. The Veteran files contain the richest patient demographic information in the SAS data; these include the Veterans date of birth, sex, prisoner of war status and war code. The Fee Basis data contain a unique variable not found in the traditional VA inpatient and outpatient datasets: the Fee Purpose of Visit (FPOV) variable. [ICD] table, the latter of which contains a list of all possible ICD-9 codes. In SQL, there are additional variables that will denote the type and location of the care provided along with the vendor. Many veterans now have access to Non-VA medical care through the new Veterans Access, Choice, and Accountability Act (VACAA, or Choice Act). 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. 9. Paper claims and supporting documentation submitted to us are converted to Electronic Data Interchange (EDI) transactions. The majority of claims, 99%, were processed within 2 years, with the exception of pharmacy data in FY 2004 and FY2008. 2. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. If the payment was made outside of FBCS, they wont show here. http://www.mssny.org/Documents/Enews/Aug%208%202014/VA%20ProvidersGuide.pdf, http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. Hit enter to expand a main menu option (Health, Benefits, etc). The key field indicates which invoice they appeared on. Research requests for data from CDW/VINCI must be submitted via the Data Access Request Tracker (DART) application. (formerly known as VA Fee Basis or NonVA)-Community provider submits the claim and supporting documentation through their EDI provider services in . If that analyst examines VEN13N and STA6A (in inpatient Fee Basis data, this field represents the VA hospital arranging care), there is often only one MDCAREID. [1] The Health Care Financing Administration (HCFA) was renamed the Centers for Medicare and Medicaid Services. Fact Sheet: Medical Document Submission Requirements for Care Coordination, ADA Dental Claim Form > American Dental Association website. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. In general, we recommend using the disbursed amount to capture the cost of care, for two reasons. We found SPECIALPROVCAT was missing in 93% of records. U.S. Department of Veterans Affairs. Electronic Services Available (EDI): Professional/1. In both SAS and SQL data, outpatient data are organized in long format, with one record per CPT code. Six additional variables indicate the setting of care and vendor or care type. VA evaluates these claims and decides how much to reimburse these providers for care. Accessed October 16, 2015. VA Form 10-583, Claim for Payment of Cost of Unauthorized Medical Services. Outpatient data are housed in the FeeServiceProvided table. Unauthorized inpatient or outpatient claims must be submitted within 90 days from the date of care. U.S. Department of Veterans Affairs. SQL data contain the following vendor information: NPI, FeeVendorSID, FeeVendorIEN, NPI, VendorType and FeeSpecialtyCodeName. Appendices G and H, copied from the Non-VA Medical Care program website, describes in detail the types of records for which each Fee Purpose of Visit (FPOV) codes are assigned. VENDID is the vendor ID. The FMS disbursed amount is the payment amount plus any interest payment. To enter and activate the submenu links, hit the down arrow. Identifying Veterans in the CDW [online; VA intranet only]. Electronic Data Interchange (EDI): Payer ID for medical claims is TWVACCN. Of note, the FBCS was not in place nationwide prior to FY 2008. In most cases, if you don't sign up for Part B when you are first eligible, you'll have to pay a late enrollment penalty. All persons working with these data should review this information before conducting any analyses. Documentation, including data contents, field frequencies, and record counts, is also available on VIReCs CDW Data Documentation page (VA intranet only: http://vaww.virec.research.va.gov/CDW/Documentation.htm). Such care is called Non-VA Medical Care, or Fee Basis care. Customer Call Center: 877-881-76188:05 a.m. to 6:45 p.m. Eastern TimeMondayFriday, Sign up for the Provider Advisor newsletter, Veterans Crisis Line: 1725 or 38 U.S.C. Please switch auto forms mode to off. The NPI is the national provider identifier, which is provider-specific but often missing in the Fee Basis data. All analyses using this cohort should use PatientICN as indicative of a unique patient. Each observation in the SAS and SQL data has an accompanying vendor ID. access; blocking; tracking; disclosing to authorized personnel; or any other authorized There is a deductible of $3 per trip up to a limit of $18 per month. Plan Name or Program Name," as this is a required field. The Implementer of this technology has the responsibility to ensure the version deployed is 508-compliant. By June 2017, no Choice stays are found in FBCS. 7. resides on and transmits through computer systems and networks funded by the VA. Given these delays in processing claims, we recommend that analyses use Fee Basis data from 2 years prior to the current date to ensure almost complete capture of inpatient, ancillary and outpatient data. Each record in the pharmacy services (PHR) file represents a single prescription, whether for a medication or a pharmacy supply (e.g., skin cleanser, bathing cloths). ______________________________________________________________________________. Training - Exposure - Experience (TEE) Tournament. 17. . For billing questions contact: Health Resource Center This can become complicated by the fact that not all encounters relating to the same inpatient stay will have the same admission and discharge dates. NNPO. In the outpatient data, one observation represents a single CPT code. Some encounters have multiple procedures that are paid as a single encounter; other encounters have multiple procedures and there are separate payments for each procedure. [PatientRace] tables. Attention A T users. Go to CDW Home, click on CDW MetaData, then click on the link for Purchased Care. To access the menus on this page please perform the following steps. When there is no available rate in the Medicare Fee Schedule, the VA will follow the payment guidelines for Non-VA Medical Care. Fee Basis data can be broadly categorized into 4 classes: inpatient care, outpatient care, pharmacy, and travel data. Veteran's ICN can be found on the VA issued HSRM referral. One way to do this is to concatenate the vendor identifier, the patient identifier, and the visit date. In order to gain access to the AITC mainframe, VA system users must contact their local Customer User Provisioning System (CUPS) Points of Contact (POC) and submit a VA Form 9957 to create a Time Sharing Option (TSO) account. Hospice also appears to be billed monthly, with longest length of stay for a single hospice invoice of 31 days. It is only relevant for claims linked to VistA patients. [FeePrescription] table contains rich information on the type of drug prescribed and dispensed, including the drug name, manufacturer, strength, quantity, date filled and charge and disbursed (payment) amount. If there are multiple providers using the same entity to bill their claims, it will not be possible to disaggregate what type of provider the patient saw (e.g., an internal medicine physician or an infectious disease specialist). For more information, please visit the Data Access Request Tracker (DART) Request Process page on the VHA Data Portal(VA intranet only: http://vaww.vhadataportal.med.va.gov/DataAccess/DARTRequestProcess.aspx#resources). As noted earlier, there are often multiple records that indicate a single inpatient stay each record pertains to a unique invoice number. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, New York/New Jersey VA Health Care Network, Call TTY if you Table 3 lists their file names and gives a general description of their contents.10. [FeeInpatInvoiceICDProcedure] table. For a list of VA acronyms, please visit the VA AcronymLookup on the VA intranet at http://vaww.va.gov/Acronyms/fulllist.cfm. Review the Where to Send Claims section below to learn where to send claims. If a researcher decides to use FPOV, please note that an FPOV value of 52 indicates ED visit for persons whose care is covered under the Millennium Bill and should thus be included in evaluating ED care. actions by all authorized VA and law enforcement personnel. Government contractor DSS Inc a new plan to fix VA's failing non-VA fee basis claims processing and management system with certain software updates - self-funded - to improve the system. We continue on this process until we find a gap greater than 1 day or we have evaluated all observations with that patient ID, STA3N and VEN13N. Five additional variables Financial Management System (FMS) transaction number, line number, date, batch number, and release date reflect processing of payments through the FMS. Smith MW, Chow A. Non-VA Medical Care (Fee Basis) Data: A Guide for Researchers. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). If electronic capability isnot available, providers can submit claims by mail or secure fax. More than 99% of claims for inpatient, ancillary and outpatient care are processed within 2 years. As of April 2019, this guidebook is no longer being updated. Veterans applying for and using VA medical care must provide their health insurance information, including coverage provided under policies of their spouses. 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. Mail to: DEPARTMENT OF VETERANS AFFAIRS. 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.

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