We gratefully acknowledge comments and contributions from Sharon Dally, Susan Schmitt and Paul Barnett. Include the 17 alpha-numeric (10 digits + "V" + 6 digits) VA-assigned internal control number (ICN) in the insured's I.D. Care provided under contract is eligible for interest payments. 1. The amount claimed (PAMTCL) appears in the inpatient (INPT) file alone; there is no claimed amount on the outpatient side. 1. In SQL, there are multiple patient identifiers, with the most useful being the PatientICN. To access the menus on this page please perform the following steps. Many URLs are not live because they are VA intranet only. Hit enter to expand a main menu option (Health, Benefits, etc). Electronic 837 claim and 275 supporting documentation submissions can be completed through VAs contracted clearinghouse, Change Healthcare, or through another clearinghouse of your choice. 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. Access; upload; download; change; or delete information on this system; Otherwise misuse this system are strictly prohibited. DSS Fee Basis Claims Systems (FBCS) - oit.va.gov There are limited data available regarding the specific non-VA provider associated with a visit; much information available pertains to the vendor who is billing for the care provided. VA has set a goal of processing all clean claims within 30 days. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. However, a 7.4.x decision *From the date the Veteran was discharged from the facility that furnished the emergency treatment; the date of death, but only if the death occurred during transportation to a facility for emergency treatment or if the death occurred during the stay in the facility that included the provision of the emergency treatment; or the date the Veteran exhausted, without success, action to obtain payment or reimbursement for treatment from a third party. If this is the case, then it can be assumed that any care provided by the vendor with that VEN13N is actually a hospital with that MDCAREID. The FeeSpecialtyCodeName contains information on the specialty of the provider seen, such as oncology, chiropractic, pathology, neurosurgery, etc., but is missing much data. Emergency claims covered under the Veterans Millennium Care and Benefits Act, Public Law 106-117); see 29 CFR 17.120 and 38 CFR 17.1004. PDF VA Community Care - Veterans Affairs All tablesmentioned in the Fee Basis guidebookare storedin an Excel file. U.S. Department of Veterans Affairs. The vendor identity can be found through the FeeVendorSID or the FeeVendorIEN variables in SQL. For example, there are observations in which INTIND = 1 and INTAMT = $0. The values of Adjustment Codes 1 and 2 (ADJCD1 and ADJCD2) explain the reason for non-payment. [SPatient] and[PatSub] tables. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. (Veterans may submit unauthorized claims, however, and VA has legal authority to pay them under certain conditions. Claims Assistance | Veterans' Affairs - South Carolina Summary Fee Basis expenditure data are also available through the VHA Support Services Center (VSSC) intranet site, further information about accessing these summary data can be found in Chapter 6. Patient type can take one of seven values: surgical; medical; home nursing; psych contract; psychiatric, neuro contract; or neurological. VA is the primary and sole payer when VA issues an authorization. The quantity dispensed. VA HEALTH CARE Management and Oversight of Fee Basis Care Need. 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, 7. March 2015. In SAS, the Patient ID will be the SCRSSN and the admit date is the treatment from date. SAS data are also available in CDW, but are currently limited to those VA employees with operational access. By store procedure codes as records in another table, the SQL relational database uses the minimum amount of storable space. In both SQL and SAS data, there is also a variable regarding the fee specialty code. 4. VA evaluates these claims and decides how much to reimburse these providers for care. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. This most likely reflects a low frequency of surgery rather than missing data. The Department of Veterans Affairs (VA) often pays providers in the community to provide care to Veterans when it is unable to provide such care itself (e.g., due to a lack of resources or delays in providing care), or when it is infeasible to do so (e.g., emergency care). 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. SAS versus SQL data differ in three main ways: Appendix A lists all variables in the SAS files. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it. Note that the vendor may represent the hospital, a hospital chain or the entity billing on behalf of the provider. 2. Persons looking to classify patients Veterans by race and ethnicity are encouraged to read VHA guidance available on the Data Reports page of the VHA Data Portal (available on the intranet at http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). There are 34 Fee Basis Claims Systems (FBCS) servers, which were originally designed for episodes of care. 400, Wittman Drive Grand Rapids Itasca County MN - 55744 United States. After a claim is submitted electronically it must be entered manually into a Non-VA Medical Care approval system. This application queues critical claims data into the FBCS shared MS SQL database for further processing and reporting. Thus, our recommendation is as follows: Use disbursed amount to calculate the cost of care, except in the case where disbursed amount is missing and the payment was not cancelled. Veterans Health Administration. First, it includes both the payment amount and any interest that may apply. This is a critical difference from VA utilization files, which are organized by date of service. visit VeteransCrisisLine.net for more resources. Training - Exposure - Experience (TEE) Tournament. FBCS is an auditing system which provides instructional prompts designed to interface with the Veterans Information Systems and Technology Architecture (VistA) package to track, report, and analyze fee claim data. The key field indicates which invoice they appeared on. There are nine situations in which Non-VA Medical Care is authorized. 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). You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. We assume here that new inpatient stays are defined by a change in vendor or a gap in treatment day more than 1 day. Data are presented in Table 4. The PHR file contains information on the cost-related data associated with the prescription, while the PHARMVEN file contains information on the vendor associated with the prescription. One way to do this is to concatenate the vendor identifier, the patient identifier, and the visit date. All information in this guidebook pertains to use of ICD-9 codes. Payer ID for dental claims is CDCA1. 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. If you submit a noncompliant claim and/or record, you will receive a letter from us that includes the rejection code and reason for rejection. The SAS data are stored at AITC. 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 . A record is created only if there is a code on the invoice to be recorded. There are exceptions. 15. VA medical centers may purchase prosthetics and related items, such as clothing specialized for prosthetic limbs, and then dispense them through VA facilities. No new extracts will occur. The dates of service are represented by the covered from/to fields of the UB-92. Billing & Insurance - New York/New Jersey VA Health Care Network VENDID is the vendor ID. The VHA Office of Community Care is the contact for all VA community care programs. This technologysupports advanced data encryption methods and role-based access control. U.S. Department of Veterans Affairs. 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. For additional information or assistance regarding Section 508, please contact the Section 508 Office at Section508@va.gov. 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. FBCS Upload leverages LEADTOOLS Professional Optical Character Recognition (OCR) and is included in the FBCS workstation install package. When there is no available rate in the Medicare Fee Schedule, the VA will follow the payment guidelines for Non-VA Medical Care. VINCI. [XXX] tables.9,12 Tables under the DIM schema contain attributes that describe the records in the Fee tables. The base rate varies by level of ambulance service provided, locality of the Medicare carrier area, and Point of Pickup (POP) zip code classification: urban, rural, or "super rural." [PatientRace] tables. To access the menus on this page please perform the following steps. VA Health Care: Management and Oversight of Fee Basis Care Need At the time of writing, SAS data at CDW are available only to those persons with VA operations access. Seven refer explicitly to Veterans alone, while the remaining two are for diagnostic services or eligibility exams, neither of which constitutes treatment. In both SAS and SQL, it can be difficult to determine the provider the Veteran saw for Fee Basis care. This table also includes claims related to inpatient care and other services. Research requests for data from CDW/VINCI must be submitted via the Data Access Request Tracker (DART) application. There are 3 categories of geographic data: veteran-related information, vendor-related information and VA-station related information. Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. Both ancillary and outpatient files have one record per CPT code. HIPAA Transaction Standard Companion Guide (275 TR3)The purpose of this companion guide is to assist in development and deployment of applications transmitting health care claim attachments intending to support health care claim payment and processing by VA community care health care programs. There are two important variables to consider if evaluating the cost (VA reimbursement) of Fee Basis Care: the payment amount (AMOUNT in SAS, PaidAmount in SQL) or the Financial Management System (FMS) disbursed amount (DISAMT in SAS, DisbursedAmount in SQL). Providers cannot bill both VA and the patient or another insurer for the same encounter. Accessed October 16, 2015. SAS and SQL also have several geographic fields related to the vendor providing the non-VA care, such as the vendors city, county, state and zip code. 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. As part of the process, claims and supporting documentation are scanned for compliance prior to conversion to electronic format. Relational Database Management Systems (RDBMS) such as Microsoft SQL server have multiple hierarchies for storing data: a domain contains many schemas, which in turn contain many tables. While NPI is available in SQL data, it does require special permissions to access, as it is located in the [Sstaff]. Technology must remain patched and operated in accordance with Federal and Department security policies and guidelines in order to mitigate known and future security vulnerabilities. This FPOV variable broadly categorizes the reason for the encounter, such as hospice or respite care. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). Paper claims and supporting documentation submitted to us are converted to Electronic Data Interchange (EDI) transactions. Updated August 26, 2015. 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. In the SAS data, the patient identifier is the scrambled social security number (SCRSSN). For example, sta3n 589A5 will be found as 589. While a researcher could theoretically conduct a Fee Basis analysis using SAS data and then upload these SAS data to CDW and pull in the relevant variables from the SQL Patient domain, this poses some logistical challenges. The status value A stands for accepted, meaning the claim was paid. UB-92 box 56 (ProviderNPI) represents the providers National Provider Identifier. You can further refine by selecting records on or after November 4, 2014, when Choice was first enacted. Nevertheless, the National Non-VA Medical Care Program Office (now the VHA Office of Community Care) has interpreted VHA Directive 2006-029 to preclude Non-VA Medical Care providers from receiving payment for prosthetics. Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. Please switch auto forms mode to off. Below we describe the general types of information in both the SAS and SQL data. We are the third-party administrator for the VA CCN for Regions 1, 2 and 3, encompassing 36 states, Puerto Rico, the U.S. Virgin Islands and the District of Columbia. 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. 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. While VA always encourages providers to submit claims electronically, on and after May 1, 2020, it is important that all documentation submitted in support of a claim comply with one of the two paper submission processes described. CLAIM.MD | Payer Information | VA Fee Basis Programs Payer Information VA Fee Basis Programs Payer ID: 12115 This insurance is also known as: Veterans Administration Need to submit transactions to this insurance carrier? 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. Business Product Management. These rules are subject to change by statute or regulation. Again, date of service is not available in the FeeServiceProvided table. Persons looking to find the date of service should be advised that it will not be contained in the FeeServiceProvided table. Table 1 in the Data Quality Analysis teams guide Linking Patient Data in the CDW Updateprovides a brief summary for each identifier (Available atthe VHA Data Portal. Fee Basis Services - VetsFirst Chief Business Office. Guidance can be found under "VHA Data Quality Program Reports. For example, accessing FY2014 data on Dec 1, 2014 will likely result in fewer observations than when accessing FY 2014 data on Dec 1, 2015. For the purpose of this guidebook, we focus on Fee Basis files only. Here, ICDProcedureSID is a primary key in the [Dim]. Many private health insurance companies will apply VA health care charges towards satisfying a Veteran's annual deductible and maximum out of pocket expnse. The SAS PHARVEN dataset contains information only about pharmacy vendors. The Vendor Release table provides the known releases for the. Q. Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). When possible, VA will seek reimbursement for Non-VA Medical Care payments from sources such as workers compensation payments; payments resulting from motor vehicle accidents, crimes of personal violence, or torts; other agencies when the patient is a beneficiary; and third-party insurance plans. VA Informatics and Computing Resource Center (VINCI). Data Quality Analysis Team. In both SAS and SQL data, outpatient data are organized in long format, with one record per CPT code. HERC did not investigate use of NPI for this guidebook. The impact on inpatient and emergent care is unclear, however, as the definition of prosthetic in VA is so broad as to include items placed inside the body, such as internal fixation devices, coronary stents, and cardioverter defibrillators. U.S. Department of Veterans Affairs. Below are some answers to general questions about linking the UB-92 form to the FBCS data. In SAS, the outpatient data are housed in the MED files. In FY05, DRG001 means CRANIOTOMY- >17 W CC, compared to HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC for DRG001 in FY15 DRG001. As with inpatient data, researchers will need to collapse multiple observations in order to get a complete picture of the outpatient care provided on a single day. The Fee Basis files primary purpose is to record VA payments to non-VA providers. Basic demographic variables can be found in the [Patient]. _____________________________________________________________________________. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). If notification was not made to VA and you wish to have claims considered for payment, please submit claims and supporting documentation to VA as listed in the "Where to Send Claims" dropdown below. 1. To enter and activate the submenu links, hit the down arrow. This is true for both the inpatient and the outpatient data, albeit for different reasons. The Department of Veterans Affairs has implemented centralized mail processing (CM) for compensation claims to reduce incoming paper handling and shipping requirements. Researchers with VA intranet access can access these sites by copying and pasting the URLs into their browser. Fee Basis data will be most useful for studying conditions where contract care is common, such as home-based care and nursing care, and for determining typical non-VA charges for health care services (both charges and payments are reported) and comparing those to VA costs. Claims should be mailed to the following address: VA Eastern Kansas Health Care System Attn: Fee Basis Office 2200 SW Gage Blvd Topeka. Class 2 or Class 3 products must restrict their interfaces to Class 1 National Software to use of publicly-supported APIs ONLY. FBCS is where weve spent the bulk of our time investigating. SAS data are housed in 8 ready-to-use datasets per fiscal year. You may use VA Form 10-583 to fulfill this requirement. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). 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. 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. VA Technical Reference Model - DigitalVA Box 30780, Tampa FL 33630-3780. 17. [FeeInpatInvoiceICDDiagnosis] with the [Dim]. 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. Multiple claims may be submitted for each inpatient stay and the various claims do not have a common identifier indicating they are all part of the same inpatient stay. 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. As noted in Chapter 2, the important variables capturing cost of care are AMOUNT and DISAMT. Researchers should use PatientICN to link patient data within CDW. Non-VA providers submit claims for reimbursement to VA. 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. [FeeInpatInvoice], [Fee]. The VA pays for both emergency and non-emergency care through Fee Basis mechanisms. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. Medications dispensed in a health care facility such as a doctor's office, dialysis clinic, or hospital outpatient clinic, such as injectable medications or infusions, will be found in the outpatient data, where they will be identified by CPT code.
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