(Anything) - 7.(Anything). 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. http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf. Claims should be mailed to the following address: VA Eastern Kansas Health Care System Attn: Fee Basis Office 2200 SW Gage Blvd Topeka. 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). [ SFeeVendor] table. The Medicare ID is missing if the payment is determined via a different mechanism (e.g., a contract). Last updated validated on Tuesday, January 3, 2023 Get the latest updates on VA community care, including program changes, resources and more! (refer to the Category tab under Runtime Dependencies), Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. 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. VA Claims Representation; RESOURCES. ______________________________________________________________________________. More information about provider reimbursement can be found in the document Working with the Veterans Health Administration: A Guide for Providers (available on the VHA Office of Community Care website, on the Provider Resources page).5. 1. The UB-92 equivalent variables would be: facility (after merging in facility name from the FBCS_Facilities table), vistapatkey, and vistaauthkey, respectively. This rare event most likely indicates a transfer. Operating Systems Supported by the Technology. For more detailed information, researchers should visit the VHA Office of Community Care website. The FPOV variable can be found in both the SAS and SQL data. VA employees working on operations studies can build their own crosswalk file as they have permission to use these file. By store procedure codes as records in another table, the SQL relational database uses the minimum amount of storable space. Hospice also appears to be billed monthly, with longest length of stay for a single hospice invoice of 31 days. FPOV values of 32 and 33 also indicate ED visits, but are only observed in the Ancillary file. The Fee Purpose of Visit (FPOV) and Health Care Financing Agency Payment Type (HCFATYPE) variables feature values pertaining to setting (inpatient, outpatient, home-based), specific items (e.g., supplies and diagnostics), and miscellaneous purposes.[1]. However, not all data in the FeeServiceProvided table are outpatient data; some may pertain to inpatient stays. 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. To enter and activate the submenu links, hit the down arrow. Available at:http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. Therefore, to get an understanding of the total cost of this care, one would have to link the Fee Basis data to VA utilization datasets. 3. This application completes the update of critical claims data into the FBCS shared MS SQL database for further processing and reporting. To access the menus on this page please perform the following steps. Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. A subsequent report will contain the results of an audit conducted to assess VA Palo Alto, Health Economics Resource Center;November 2015. In SQL, these variables can be found in the [Dim]. Fee Basis tables, however, only list PatientSID and do not list PatientICN. [FeePrescription] tables. Patient type can take one of seven values: surgical; medical; home nursing; psych contract; psychiatric, neuro contract; or neurological. Most importantly, they do not represent all care provided during the fiscal year. In the Fee Basis inpatient data, each record represents a separate claim; these separate claims must be aggregated to capture the totality of the inpatient stay. As noted above, in SAS, the patient identifier is the SCRSSN; this is unique to each patient across the entire VA. The Fee Basis files are stored in two formats: SAS and SQL. In both SQL and SAS data, there is also a variable regarding the fee specialty code.
Veterans Choice Program - Fee Basis Claims System in CDW - Veterans Affairs Use Azure Rights Management Services (Azure RMS) for encrypted email. Lump sum payments are not paid via FBCS. HERC did not investigate use of NPI for this guidebook. For authorized care, the referral number listed on the Billing and Other Referral Information form. Sort data by the patient ID, STA3N, VEN13N, and the admission dates. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). From 1998 to 2014, approximately 50% of claims were paid within 30 days of VA receiving the invoice, and 95% of claims are paid in 200 days or less. [SpatientAddress] tables. Attention A T users. 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. 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). If electronic capability isnot available, providers can submit claims by mail or secure fax. The VA Fee Basis medical program provides payment authorization for eligible Veterans to obtain routine medical treatment services through non-VA health care providers. Veteran's ICN can be found on the VA issued HSRM referral. However, there is one situation in which the payment amount will be more accurate than the disbursed amount: when the disbursed amount is missing, and the payment was not cancelled, one should use the payment amount to capture the cost of care. There are 34 Fee Basis Claims Systems (FBCS) servers, which were originally designed for episodes of care. Note: The last extract occurred in December 2020. 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. Payment for care provided under the Veterans Choice Act may not exceed the Medicare Fee Schedule (i.e. There are two types of keys: primary keys and foreign keys. VA Palo Alto, Health Economics Resource Center; October 2013. Non-VA providers submit claims for reimbursement to VA. As noted in Chapter 2, the important variables capturing cost of care are AMOUNT and DISAMT. VINCI. One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. 3. Assistance with claims is free and covers all state and federal veterans' programs. 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. This latter table contains a variable called InitialTreatmentDateTime. You can find more information about eligibility on the VHA Office of Community Care website. Missingness can vary substantially by year and by file. (Anything), but would not cover any version of 7.5.x or 7.6.x on the TRM. Some missingness may indicate not applicable.. 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. We detail differences amongst the SAS and SQL Fee Basis data in the guidebook below. FBCS is where weve spent the bulk of our time investigating. In the outpatient data, each record represents a different procedure, as assessed through the Current Procedural Terminology (CPT) code. This is a critical difference from VA utilization files, which are organized by date of service. - The information contained on this page is accurate as of the Decision Date (11/02/2022). Note that the vendor may represent the hospital, a hospital chain or the entity billing on behalf of the provider. This table also includes claims related to inpatient care and other services. The funds are used to provide the best care possible to our Veterans. This guidebook describes characteristics of Fee Basis care data such as contents and missingness, and makes recommendations about its use for research purposes. Access; upload; download; change; or delete information on this system; Otherwise misuse this system are strictly prohibited. 4. As noted earlier, there are often multiple records that indicate a single inpatient stay each record pertains to a unique invoice number. [FeeInpatInvoice], and a foreign key in the [Fee].[FeeInpatInvoiceICDProcedure]. When a key field is missing, SQL indicates this with a value of -1.
[FeeInpatInvoiceICDDiagnosis], [Dim]. http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. 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. At the time of this writing, the NPI number was often missing from fee basis claims.
HERC: Fee Basis Data: A Guide for Researchers - Veterans Affairs However, investigation has confirmed these are partial payments made for a single encounter or procedure. Electronic Data Interchange (EDI) Interface.
Veteran Services - TriWest We suggest using only the first 3 characters from sta3n for the merge. This guidebook is intended to help researchers understand and use the National Fee Basis files, which come in both SQL and SAS formats. Accessed October 16, 2015. A valid receipt showing the amount paid for the prescription. 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. VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. In that case, use payment amount instead. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. If the Veteran received care in the community that was not pre-authorized, it is considered unauthorized by VA. The FMS disbursed amount is the payment amount plus any interest payment. Given the variable definitions, it is not clear whether DX1 or DXLSF is the better choice to determine primary reason for inpatient stay.
Fee Basis Services - VetsFirst In this way, records that are missing MDCAREID can be given a MDCAREID based on the value of VEN13N and STA6A in the record. If a claim is filed for an eligible episode of care, VA must pay the whole amount according to the payment rules noted above. Each prescription record has a fill date and a patient identifier (either PatientICN or scrambled social security number).
PDF Frequently Asked Questions for Providers - Logistics Health [Patient], [Spatient]. If the patient is transferred from a non-VA to a VA hospital, the non-VA component of this care will be captured through Fee Basis, while the VA component of this care will be in the VA inpatient datasets. Treatment date correlates to covered from/to. Accessed October 16, 2015. Claims for Non-VA Emergency Care 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. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with. In SQL, there are multiple patient identifiers, with the most useful being the PatientICN. There are delays in the processing of Fee Basis claims. 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. 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. Chapter 4 offers detailed information SAS Fee Basis data; Chapter 5 provides detailed information about SQL Fee Basis data. New values may be added over time. Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. Available at: http://vaww.vhadataportal.med.va.gov/Portals/0/DataQualityProgram/Reports/Identifying_Veterans_in_CDW.pdf. VAntage Point. NOTE: The processes outlined below are exclusive to supplying documentation for unauthorized emergent care. 7. Every one of the 700,000 health care professionals in the TriWest network has to meet VA-required quality standards to ensure that Veterans always receive the highest quality care. The procedure code table has just as many records as there were procedures on the invoice. Data Quality Analysis Team. 1. would cover any version of 7.4. There are substantial differences in quantity of inpatient diagnosis and procedure data available in SAS versus SQL. Not all of these variables appear in every utilization file. U.S. Department of Veterans Affairs. SAS data are housed in 8 ready-to-use datasets per fiscal year. Appendix G lists all available FPOV codes and classifies them as inpatient or outpatient. VA may reconsider and provide retroactive reimbursements for emergency treatment that was provided prior to the date of enactment (July 19, 2001), if documentation sufficiently demonstrates the original denial was because the Veteran received partial third party payment. Appropriate access enforcement and physical security control must also be implemented. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, New York/New Jersey VA Health Care Network, Call TTY if you
Information from this system resides on and transmits through computer systems and networks funded by the VA. Documentation in support of a claim may include: *NOTE: Documentation not required includes flowsheets and medication administration. In SQL, there are additional variables that will denote the type and location of the care provided along with the vendor.
File a Claim for Veteran Care - Community Care - Veterans Affairs In general, we recommend using the disbursed amount to capture the cost of care, for two reasons. The outpatient pharmacy data includes medications dispensed in a pharmacy. For inpatient and outpatient care, in general, VA will pay the lesser of the Medicare rate (or MPFS rate) or the billed charges. 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. HERC investigation of Fee Files reveals certain data anomalies of which researchers should be aware. The VA pays for both emergency and non-emergency care through Fee Basis mechanisms. Each year represents the year in which the claim was processed, not the year in which the service was rendered. Box 30780 Tampa, FL 33630-3780, P2E Documentation Cover Sheet, VA Form 10-10143f. 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). 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. Defining a cohort is an activity that is different for each project and depends on the research question at hand. Researchers can do this using the FeePurposeOfVisit (FPOV) code.11 We recommend this approach over using another variable, such as the Fee Program. The Veterans Access, Choice, and Accountability Act (Veterans Choice Act), passed in 2014, expanded veterans access to non-VA care. SQL Fee Basis files themselves contain limited patient demographic variables, but can be linked to other SQL data. This schema contains sensitive information such as SSNs, bank accounts, and the actual name of personnel. 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. This Technology is currently being evaluated, reviewed, and tested in controlled environments. In SQL, the fields containing these data can be found in the FeeDispositionCode and FeeDispositionName Refer to Appendix C for a list of Fee Disposition Codes. what is specified but is not to exceed or affect previous decimal places. Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA care. [FeeInpatInvoiceICDProcedure] table. These inpatient tables have to be linked to FeeInpatInvoiceICDDiagnosis, FeeInpatInvoiceICDProcedure, FeeInitialTreatment and the appropriate DIM tables in order to understand the specific diagnoses and procedures associated with the inpatient observations in these tables. This application is directly attached to TWAIN compliant scanners and works offline to VistA and the FBCS MS SQL databases. Federal law puts prosthetics into a special payment category that mandates full financial support from VA. As implemented in VA policy, it requires that VA facilities provide all necessary prosthetics, orthotics, and assistive devices (prosthetics) needed by patients. One exception to this is when identifying emergency department (ED) visits. Steps to collapse records into a single inpatient stay: 1. 3. . The length of stay for a single hospital invoice varied greatly, with a maximum length of stay of 980 days. VINCI Data Description: Fee/Purchased Care [online; VA intranet only]. Include the claim, or a copy of the claim, on top of the supporting documentation that is mailed to the following address: Include a completed cover sheet with the supporting documentation that is mailed to the above address. Payer ID for dental claims is 12116. 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. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. [FeeInpatInvoice], [Fee]. All access
All Fee Basis care will be found in the Fee files. Veterans Crisis Line:
For these reasons, the program does not pay for 100% of care that was otherwise eligible. INTIND and INTAMT are not always concordant. Non-VA Payment Methodology Matrix [online; VA intranet only]. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. ____________________________________________________________________________. U.S. Department of Veterans Affairs. 16. Detailed instructions and documentation required for DART data requests can be found on the VHA Data Portal intranet website at http://vaww.vhadataportal.med.va.gov/DataAccess/DARTRequestProcess.aspx. U.S. Department of Veterans Affairs. 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. VIReC. U.S. Department of Veterans Affairs. Basic demographic variables can be found in the [Patient]. Include the 17 alpha-numeric (10 digits + "V" + 6 digits) VA-assigned internal control number (ICN) in the insured's I.D. This is in line with the way VHA Office of Productivity, Efficiency & Staffing (OPES) ascertains ED visit. Some vendors use centralized billing services located in other cities, in a few cases in other states. Thus, the mailing address of the vendor is not always the vendors actual location. SQL Fee Basis data are stored in CDW in multiple individual tables. The PatientSID is a CDW assigned identifier that uniquely identifies a patient within a facility. 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. Current Decision Matrix (10/21/2022) Researchers will have to select observations from the SQL FeeServiceProvided table in order to ensure they are only evaluating outpatient data. In FY 2014, the longest length of stay associated with a single nursing home invoice was 31 days. There are multiple methods by which community providers may electronically provide VA with the required medical documentation for care coordination purposes. 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. For current information on Community Care data, please visit the page VA Community Care Data. The VHA Office of Community Care is the contact for all VA community care programs. 2. Veterans who meet certain criteria may be eligible for mileage reimbursement for travel to and from VA or Non-VA care. The same concept (such as fiscal year, state, or county) may be represented by several variables, sometimes in differing formats. However, we conducted some comparisons for inpatient data. These geographic variables indicate the VA station paying for the service. The values of Adjustment Codes 1 and 2 (ADJCD1 and ADJCD2) explain the reason for non-payment. The specific locations of the SAS payment variables and the SQL payment variables can be found in Chapters 4 and 5, respectively. Researchers with VA intranet access can access these sites by copying and pasting the URLs into their browser. 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. Contact the VA North Texas Health Care System. Business Product Management. Again, date of service is not available in the FeeServiceProvided table. Once the VA system user has a TSO account, s/he may connect to the AITC mainframe through the Attachmate Reflection File Transfer Protocol (FTP). [ICD] table, the latter of which contains a list of all possible ICD-9 codes. Given these different patient identifiers, it is difficult to conduct exact comparisons between SAS and SQL data. Outpatient prescriptions beyond a 10-day supply. In the SAS data, the provider component of the inpatient stay is captured in the ancillary file. business and limited personal use under VA policy. 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. have hearing loss. The Department of Veterans Affairs has implemented centralized mail processing (CM) for compensation claims to reduce incoming paper handling and shipping requirements.
Contractor Announces Plan To Fix Non-VA Fee Basis Claims 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. All observations for this particular patient ID, STA3N and VEN13N where the admission date comes on or after the admission date of the first record AND the discharge date comes on or before the temporary end date are considered to be part of the same inpatient stay. Working with the Veterans Health Adminstration: A Guide for Providers [online]. Thus, in SQL the total cost of an inpatient stay would be determined by evaluating the DisbursedAmount in the [Fee]. 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. Linking Patient Data in the CDW Update [online; VA intranet only]. It is available in the PHARVEN and VEN files, albeit with a high degree of missingness. Research requests for data from CDW/VINCI must be submitted via the Data Access Request Tracker (DART) application. There are different ways of costing out an inpatient stay in SAS and SQL data. Fee Basis data can be broadly categorized into 4 classes: inpatient care, outpatient care, pharmacy, and travel data. Persons working with SPatient or Patient data are also recommended to refer to the CDW guidance about how to delete test observations. 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). Veterans Health Administration. March 2018: Due to the transition of the National Non-VA Medical Care Program Office to the VHA Office of Community Care and updates to the VINCI website, some documents may no longer be available. 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? To enter and activate the submenu links, hit the down arrow. Additional information appears in a federal regulation, 38 CFR 17.52. When evaluating the cost of care, use the disbursed amount. Facility charges vs. ancillary charges: There are instances when there may be claims for facility charges with no corresponding ancillary provider charge. In SAS data, there is also a primary service area variable (HOMEPSA) that indicates the station to which the Veterans residence is assigned based on geography.