Current Decision Matrix (10/21/2022) Each year represents the year in which the claim was processed, not the year in which the service was rendered. 17. As part of the process, claims and supporting documentation are scanned for compliance prior to conversion to electronic format. Austin Information Technology Center (AITC) is one of the VAs five national data centers. CLAIM.MD | Payer Information | VA Fee Basis Programs In both the SAS and the SQL data, there are usually multiple observations per patient encounter. Veterans Health Administration. For some VEN13N, however, there is more than one MDCAREID. PatientICN is assigned by CDW. 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. 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. VA is required by law to bill private health insurance carriers for medical care, supplies and prescriptions provided for treatment of Veterans' nonservice-connected conditions. VENDID is the vendor ID. Chapter 4 offers detailed information SAS Fee Basis data; Chapter 5 provides detailed information about SQL Fee Basis data. 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. Attention A T users. [FeeVendor] table. For authorized care, the referral number listed on the Billing and Other Referral Information form. 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. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. There may be many providers that use the same vendor for billing. The National Provider Identifier (NPI) is a unique 10 digit identifier mandated to be used in health claims under the Health Insurance Portability and Accountability Act (HIPAA). 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. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. 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. The VA Fee Schedule is available at provider.vacommunitycare.com > Documents & Links. The procedure code table has just as many records as there were procedures on the invoice. At the time of writing (October 2015), only operations staff will have permission to access the SAS data at VINCI. Non-VA providers submit claims for reimbursement to VA. VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. VA Informatics and Computing Resource Center (VINCI). You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. resides on and transmits through computer systems and networks funded by the VA. A claim without errors or omissions is said to be clean. If VA has authority to pay the claim and the submitted documentation is sufficient then the claim is approved for payment. 2. 1. Therefore, to make a complete assessment of the payments for inpatient cases, researchers should evaluate the outpatient files along with the inpatient and ancillary files. SQL tables can be joined through linking keys. Attention A T users. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). [ICD] table, the latter of which contains a list of all possible ICD-9 codes. Chapter 6 contains more information about how to access these data. 1725 or 38 U.S.C. Of note, SQL and SAS data contain similar, but not exactly the same, information. The [Fee]. However, previous HERC investigation confirmed these are partial payments made for a single encounter or procedure. Six additional variables indicate the setting of care and vendor or care type. In SAS, the cost of an inpatient stay can be determined by summing the cost from DISAMT in the inpatient files with the DISAMT from the ancillary observations that correspond to the inpatient stay; however, the inpatient and ancillary files alone may not be sufficient to account for the entire cost of care. VA Palo Alto, Health Economics Resource Center;November 2015. Office of Information and Analytics. One way to do this is to concatenate the vendor identifier, the patient identifier, and the visit date. PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. the rates paid by the United States to Medicare providers). Section 508 compliance may be reviewed by the Section 508 Office and appropriate remedial action required if necessary. In some cases, there is a one-to-one relationship between VEN13N and MDCAREID. Most, if not all, of this care should be emergency care. Technologies must be operated and maintained in accordance with Federal and Department security and Regardless of whether the care was pre-authorized or not, non-VA providers submit claims to VA if they wish to be reimbursed for care. 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. Compare the admission date of the third observation to the temporary end date from above. If the payment was made outside of FBCS, they wont show here. For some vendors, there may be more than on possible hospital, for example, if the vendor is a hospital chain or an organization with a VA contract. The unique patient identifier by which to conduct SQL-based Fee Basis analyses is PatientICN. U.S. Department of Veterans Affairs. 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. Some VA medical centers purchase care from only one of the hospitals in the chain. For example, if a physician billed for a complete blood count and a venipuncture in the same day, there would be two records with the same invoice number, but different CPT codes and different claimed amounts. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. or use of this system constitutes user understanding and acceptance of these terms With additional permissions, researchers can also access City, Postal Code, Street Address, and Zip. Please switch auto forms mode to off. There may be multiple STA3Ns for a single inpatient stay. 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). 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. These vendors are presumably hospital chains. To enter and activate the submenu links, hit the down arrow. 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. To access the menus on this page please perform the following steps. The SAS Fee Basis data are organized by fiscal year. For current information on Community Care data, please visit the page VA Community Care Data. VA Health Care: Management and Oversight of Fee Basis Care Need U.S. Department of Veterans Affairs. If using payment amount, one would overestimate the cost of care. Available at:http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. If a Veteran has only Medicare Part A then VA may consider payment for ancillary and professional services usually covered under Part B. Data Quality Program. Reimbursement for Pharmacists Services in a Hospital-based, Pharmacist-managed Anticoagulation Clinic. 988 (Press 1). [SpatientAddress] tables. The VA payment (DISAMT) is typically less than or equal to the PAMT value, although in some cases VA will pay more than Medicare would pay. While many Veterans qualify for free health care services based on a VA compensable service-connected condition or other qualifying factor, most Veterans are asked to complete an annual financial assessment, to determine if they qualify for free services. Hit enter to expand a main menu option (Health, Benefits, etc). Additionally, our health care providers make certain that Veterans' VA medical records remain updated by returning information about Veteran care and treatment to VA. Smith MW, Su P, Phibbs CS. You can find more information about eligibility on the VHA Office of Community Care website. [FeeInitialTreatment], [Fee]. Payment for care provided under the Veterans Choice Act may not exceed the Medicare Fee Schedule (i.e. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. This component is a service that communicates with the Program Integrity Tool (PIT) which scores claims and sends results to FBCS. A single inpatient encounter may generate zero, one, or multiple ancillary records, depending on the number of ancillary procedures and physician services received. There are three routes for filing claims for authorized care which depend on your status in VAs network and how the care was authorized: All non-urgent and non-emergent care requires authorization from VA in advance. Appendix G lists all available FPOV codes and classifies them as inpatient or outpatient. This report covers the audit of payments made through VA's Fee Basis Claims System (FBCS), encompassing claims paid via that payment process from November 1, 2014 through September 30, 2016. As noted earlier, there are often multiple records that indicate a single inpatient stay each record pertains to a unique invoice number. Assistance with claims is free and covers all state and federal veterans' programs. Chapter 8 provides references for further information about the Fee Basis program and data. This is the main utility that passes information back into the FBCS Payment application. When a key field is missing, SQL indicates this with a value of -1. We compared the service date (TREATDTO in inpatient and ancillary, TREATDT in outpatient, and FILLDTE in pharmacy files) to the FMS processing date (PROCDTE) (See Table 1). Identify Choice records by using tax ID and specialprovcat= CHOICE. Gidwani R, Hong J, Murrell S. Fee Basis Data: A Guide for Researchers. NNPO. For education claims, refer to the appropriate Regional Processing Office. The veteran must wait over 30 days past their preferred appointment date or the date deemed medically necessary by their provider, b. For emergency care of service connected conditions, there is a two-year limit to submit any bills. Payer Name: VA Fee Basis Programs - thePracticeBridge There is very limited outpatient pharmacy data in the Fee files. 5. This care will be approved (or denied) by the local VA Fee Office; the Veteran is then free to seek non-VA care. Hit enter to expand a main menu option (Health, Benefits, etc). Researchers with VA intranet access can access these sites by copying and pasting the URLs into their browser. Important: The mailing address below only pertains to disability compensation claims. 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. 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. [LocalDrug] table through LocalDrugSID to see whether there was the generic equivalent found in the VA drug file that was dispensed to the patient. The Veterans Access, Choice, and Accountability Act (Veterans Choice Act), passed in 2014, expanded veterans access to non-VA care. Attention A T users. In SAS, ICD-9 diagnosis codes are in the Inpatient, Outpatient and Ancillary files. VA's fee basis care program. 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. Fee Basis data can be broadly categorized into 4 classes: inpatient care, outpatient care, pharmacy, and travel data. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). As of April 2019, this guidebook is no longer being updated. As a single encounter may have more than one CPT code, users may have to aggregate multiple observations in order to evaluate the care received on a particular day. We are grateful for their cogent work. HERC: Fee Basis Data: A Guide for Researchers - Veterans Affairs Review the Corrections and Voids page for more information. Prior to use of this technology, users should check with their supervisor, Information Security Officer (ISO), Facility Chief Information Officer (CIO), or local Office of Information and Technology (OI&T) representative to ensure that all actions are consistent with current VA policies and procedures prior to implementation. A subsequent report will contain the results of an audit conducted to assess One can evaluate which encounters were unauthorized by joining the FeeUnauthorizedClaim table through the FeeUnauthorizedClaimSID key. It is only relevant for claims linked to VistA patients. 8. Chief Business Office. At the time of writing, no National Institute of Standards and Technology (NIST) vulnerabilities had been reported and no VA Cyber Security Operations Center (CSOC) bulletins had been issued for the latest versions of this technology. Please see Section 2.1.4. for HERC advice about how to collapse multiple observations to evaluate the length and cost of a single inpatient stay. Claims Assistance | Veterans' Affairs Home Claims Assistance Claims Assistance Contacting the Columbia VA Regional Office Call us at (803) 647-2488, or email VetAsst.VBACMS@va.gov, and provide your: Name Contact information and, Best time of day for contact between 8:00am and 4:00pm For example, a technology approved with a decision for 7.x would cover any version of 7. SAS data also contain an additional diagnosis variable that is not present in the SQL data -- DXLSF. Payment guidelines for non-VA are outlined in federal regulations 17.55 and 17.56. URLs are not live because they are VA intranet only. For example, to understand the ICD-9 codes associated with a particular inpatient encounter, one would have to link the [Fee]. [ SFeeVendor] table. These data records cannot be linked to particular patient identifiers or encounters. Researchers and analysts will have to take care to collapse observations properly if warranted, for example to determine the costs, procedures or diagnosis associated with a single stay or visit. [FeeInpatInvoiceICDDiagnosis], [Dim]. If disbursed amount is missing, use payment amount instead. If the provider declines VA payment then it may be able to charge the patient a greater total amount. Both ancillary and outpatient files have one record per CPT code. Some web reports contain PHI and access to these is restricted. U.S. Department of Veterans Affairs. The key field indicates which invoice they appeared on. 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. Persons looking to classify Veterans military service are encouraged to read the Data Quality Analysis Teams guidance on Identifying Veterans in the CDW(VA intranet only:http://vaww.vhadataportal.med.va.gov/Portals/0/DataQualityProgram/Reports/Identifying_Veterans_in_CDW.pdf).14. SAS data are also available in CDW, but are currently limited to those VA employees with operational access. 2. SAS data have limited patient demographic data. Health Information Governance. Health - Veterans Affairs Subscribe to our E-newsletter The Service Connection Our monthly newsletter features about important and up-to-date veterans' law news, keeping you informed about the changes that matter. This table contains information on inpatient care. The Fee Basis files primary purpose is to record VA payments to non-VA providers. This component communicates with the FBCS MS SQL database and Veterans Health Information Systems and Technology Architecture (VistA) database in real time. The 275 transaction process should not be utilized for the submission of any other documentation for authorized care. 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. Pre-2007, DISAMT and INTAMT each have two implied decimal places a value of 1000 would indicate $10.00. The disbursed amount should be used to calculate the cost of care, except in the case where disbursed amount is missing. Appendix D contains information on the primary and foreign keys needed to link the various SQL tables. In SQL, the outpatient data are housed in the FeeServiceProvided table. This application is directly attached to TWAIN compliant scanners and works offline to VistA and the FBCS MS SQL databases. U.S. Department of Veterans Affairs. Many classes of Veterans are eligible for travel payments. [FeeInpatInvoice] and [Fee]. 1725 may only be made if payment to the facility for the emergency care is authorized, or death occurred during transport. Each table has only one primary key field. privacy policies and guidelines. YESInstitutional/UB Claims. . business and limited personal use under VA policy. PatientIEN and PatientSID are found in the general Fee Basis tables. Given the stronger guidance from the Fee Office regarding use of the FPOV code, we recommend using the FPOV code to discern which observations are ancillary care, as the FeeProgram may not be as reliable. Additional information appears in a federal regulation, 38 CFR 17.52. VA HEALTH CARE Management and Oversight of Fee Basis Care Need. 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. To access the menus on this page please perform the following steps. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. Payments received from a Veterans private health insurance carrier are credited towards any applicable VA copayments, reducing all or part of the Veterans out-of-pocket expenses. Appendix H lists their current values. Fee Purpose of Visit (FPOV) Document [online; VA intranet only]. We give an example here that relates to FeeInpatInvoice table. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. The vendor identity can be found through the VENDID or VEN13N variables in SAS. SAS data are housed in 8 ready-to-use datasets per fiscal year. In the outpatient data, one observation represents a single CPT code. 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. If your claim was submitted to VA, call (877) 881-7618, If your claim was submitted to TriWest, call (877) 226-8749. The prescription must be for a service-connected condition or must otherwise have specific approval. Attention A T users. The temporary end date is the maximum of these two values. A Non-VA Medical Care claim is defined by four elements: The remainder of section 7.4 details payment rules as of early 2015. VA evaluates these claims and decides how much to reimburse these providers for care. Many veterans now have access to Non-VA medical care through the new Veterans Access, Choice, and Accountability Act (VACAA, or Choice Act). 3. U.S. Department of Veterans Affairs. more information please visit www.fsc.va.gov. VINCI Data Description: Dimension [online; VA intranet only]. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). Include the authorization number on the claim form for all non-emergent care. We crosswalked the ScrSSN to allow for comparison with SAS data. Questions about care and authorization should be directed to the referring VA Medical Center. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. have hearing loss, Community Care Network Region 1 (authorized), Community Care Network Region 2 (authorized), Community Care Network Region 3 (authorized), Community Care Network Region 4 (authorized), Unauthorized Emergent Care (unauthorized). Here, ICDProcedureSID is a primary key in the [Dim]. SQL tables require linking before conducting any data analyses. VA Form 10-583, Claim for Payment of Cost of Unauthorized Medical Services. Sort data by the patient ID, STA3N, VEN13N, and the admission dates. retrieving information only; except as otherwise explicitly authorized for official 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.

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