In order to qualify for round trip mileage, an appointment must be scheduled. The VA pays for both emergency and non-emergency care through Fee Basis mechanisms. The Fee Purpose of Visit Code (FPOV) has strong guidance from VA Fee Basis Office and thus may be a more accurate way of categorizing care. SQL inpatient data contain up to 5 diagnoses and 5 procedure codes, while SAS inpatient data contain up to 25 diagnosis codes and up to 25 procedure codes. The Non-VA Medical Care program covers the full range of medical and dental care, with these exceptions: Although VA utilization files contain many non-Veterans, Non-VA Medical Care files do not. Box 108851Florence SC29502-8851, Delta Dental of CaliforniaVA Community Care NetworkP.O. SQL Fee Basis data are stored in CDW in multiple individual tables. There are two types of keys: primary keys and foreign keys. April 14, 2014. Chapter 6 contains more information about how to access these data. 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. 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. Non-VA Medical Care consumes a significant portion of VA spending; indeed, contract costs (i.e., the cost of all things purchased from non-VA health care providers) accounted for approximately 11% of VA expenditures in fiscal year 2014. This technologysupports advanced data encryption methods and role-based access control. 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). 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. Missing values of PAYCAT could be imputed by finding the corresponding inpatient stay in the INPT file. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. 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. With few exceptions these variables will be of little interest to researchers. Health Information Governance. 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. These correspond to fields, rows and tables in a relational database. Up to FY2008 data, DXLSF is labeled as 1st Diagnosis Code. In FY2009 and on, DXLSF is labeled as the Admitting or Primary Diagnosis Code. In FY 2009 and later SAS data, there is also another variable, DX1, which is not present in SAS data prior to FY2009. Procedures are identified by CPT code (CPT1) in the non-hospital inpatient services (the ancillary file) and in the outpatient procedures file. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). When there is no available rate in the Medicare Fee Schedule, the VA will follow the payment guidelines for Non-VA Medical Care. The 2 sets of DRGs are not interchangeable. Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. VA Informatics and Computing Resource Center (VINCI). However, the VA may pay a rate higher than the Medicare Fee Schedule rate for care provided in highly rural areas, as long as this rate is determined to be fair and reasonable by VA. One can find more information on payment rates under the Veterans Choice Act in federal regulation 17.1500. Questions about non-VA care claims may be directed to the Fee Basis Unit between the hours of 8:00 a.m. Email Address Required. Attention A T users. (formerly known as VA Fee Basis or NonVA)-Community provider submits the claim and supporting documentation through their EDI provider services in . The FeeSpecialtyCodeName contains information on the specialty of the provider seen, such as oncology, chiropractic, pathology, neurosurgery, etc., but is missing much data. If the claims and records do not conform to the minimum requirements for conversion to the 837 or 275 electronic formats, they are rejected and sent back for correction. The vendor identity can be found through the FeeVendorSID or the FeeVendorIEN variables in SQL. We present here one way to collapse records into a single inpatient stay, but users may wish to develop their own method specific to the research question at hand. [FeePharmacyInvoice] table contains information on vendor, amount claimed, and amount paid. Payment guidelines for non-VA are outlined in federal regulations 17.55 and 17.56. Benefits Delivery at Discharge - Pre-Discharge - Veterans Affairs This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. The Act amends 38 U.S.C. 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. One can use the FeeInitialTreatmentSID variable in the FeeServiceProvided table to link to the Fee.FeeInitialTreatment table. It may duplicate the PatientIEN of another patient at another facility, and should not be used as an identifier. Fee Basis data are housed in both SAS and SQL format. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with. Inpatient data are housed in the FeeInpatInvoice table as well as the FeeServiceProvided table, although the latter does not contain only inpatient data. VA Health Care: Management and Oversight of Fee Basis Care Need Table 3 lists their file names and gives a general description of their contents.10. ", Military service variables can be found in [PatSub],[PatientServicePeriod], [Patient]. Contact the VA North Texas Health Care System. Review the Where to Send Claims section below to learn where to send claims. The temporary end date is the maximum of these two values. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). 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. Steps to collapse records into a single inpatient stay: 1. 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. Use Azure Rights Management Services (Azure RMS) for encrypted email. Accessed October 16, 2015. For dual pension and compensation claims, use the mailing address below for compensation claims. [Patient], [PatSub]. 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. Actual processing time has varied considerably over the years. If you are in crisis or having thoughts of suicide, The Fee Basis schema data can be found at the CDW SharePoint portal at the links below (VA intranet only). FPOV values of 32 and 33 also indicate ED visits, but are only observed in the Ancillary file. With the exception of supplying remittance advice supporting documentation for timely filing purposes, these processes do not apply to authorized care. [ SFeeVendor] table. On March 17, 2022, The U.S. Court of Appeals for the Federal Circuit issued a ruling that changes VAs ability to reimburse as secondary payer under 38 U.S.C.1725. For more details, including rules for handling patients transferred during a stay, see federal regulation 38 CFR 17.55. Thus, researchers using later years of data should be aware that files are not static and will continue to be updated. For example, a technology approved with a decision for 7.x would cover any version of 7. 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. VIReC. 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. Available at: http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. Through patient ID (SCRSSN) and travel date (TVLDTE) one can link these payments to inpatient and outpatient encounters. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Veterans Choice Program Eligibility Details [online]. 3. 7. Documentation in support of a claim may include: *NOTE: Documentation not required includes flowsheets and medication administration. The Department of Veterans Affairs' (VA) fee basis care spending increased from about $3.04 billion in fiscal year 2008 to about $4.48 billion in fiscal year 2012. Other work by HERC researchers indicates that in the FY 2014 data, DXLSF and DX1 were identical 47% of the time. Optum is a proud partner with the VA through its Community Care Network (CCN). Inpatient care beyond the time when a patient is stabilized and can be transferred to a VA facility, except where a VA facility is not feasibly available. YESThis insurance is also known as: Veterans Administration. Each VA facility has a local Fee Office to which the non-VA provider submits a claim for reimbursement. Domains generally indicate the application in the VistA electronic health record system from which most of the data elements come (e.g., Vital Signs or Mental Health Assessment).6. When a key field is missing, SQL indicates this with a value of -1. The Medicare Ambulance Fee Schedule consists of a base rate plus mileage. VSSC provides numerous relevant web reports, data resources, and analytics support, including summary data by facility and VISN and national summary data. PDF Office of Inspector General - Oversight.gov VA is also the primary and sole payer for unauthorized emergent care approved under 38 U.S.C. 17. Those with access to the VA intranet can find a list of SQL fields on the CDW MetaData site. SQL Fee Basis files themselves contain limited patient demographic variables, but can be linked to other SQL data. To understand what procedures were performed during an inpatient stay in the [Fee]. Information from this system Payment for care provided under the Veterans Choice Act may not exceed the Medicare Fee Schedule (i.e. As of April 2019, this guidebook is no longer being updated. 2. - The information contained on this page is accurate as of the Decision Date (11/02/2022). 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. [SpatientAddress] tables. Get the latest updates on VA community care, including program changes, resources and more! Make sure the services provided are within the scope of the authorization. [SPatient] and[PatSub] tables. If using payment amount, one would overestimate the cost of care. However, there are data available regarding the category of visit. Review the Supporting Documentation section below to learn how to properly submit supporting documentation with your claim. For more information call 1-800-396-7929.Claims for Non-VA Emergency CareVeterans need to make sure any bills for non-VA emergency care of non-service connected conditions are submitted to the VA Medical Centers NVCC Office within 90 days. Researchers should pay special attention to reducing duplicates in the pre-2008 data. This research was supported by the Health Services Research and Development Service, U.S. Department of Veterans Affairs (ECN 99017-1). Veterans who have private health insurance should consider a number of important factors before canceling their health insurance, such as: If you cancel your Medicare Part B Coverage, you need to know that you cannot be reinstated until January of the following year, and you may be penalized for reinstatement. The Fee Card (VET) file contains only summary payment figures by month, although researchers can match the records to other data by SCRSSN and other identifiers. Move on to the next patient ID, STA3N, VEN13N combination and repeat the entire process above. Attention A T users. If disbursed amount is missing, use payment amount instead. Here, ICDProcedureSID is a primary key in the [Dim]. Available at: http://www.mssny.org/Documents/Enews/Aug%208%202014/VA%20ProvidersGuide.pdf, 6. In SQL, there are multiple patient identifiers, with the most useful being the PatientICN. URLs are not live because they are VA intranet only. Electronic Data Interchange (EDI): Payer ID for medical claims is 12115. 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. This application reads/creates/edits fee payment data in VistA and copies critical information into the central SQL database for off-line VistA applications to consume, and now includes Unauthorized payments. Each patient should have only one ICN in the entire VA, regardless of the number of facilities at which he is seen. Hospice also appears to be billed monthly, with longest length of stay for a single hospice invoice of 31 days. 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. Veterans Choice Program - Fee Basis Claims System in CDW - Veterans Affairs NOTE: The processes outlined below are exclusive to supplying documentation for unauthorized emergent care. TRM Proper Use Tab/Section. The key field indicates which invoice they appeared on. Non-VA Payment Methodology Matrix [online; VA intranet only]. This table also includes claims related to inpatient care and other services. For example, the meaning of DRG001 is not the same in FY05 vs FY15. You can further refine by selecting records on or after November 4, 2014, when Choice was first enacted. The Non-VA Payment Methodology Matrix, prepared by the National Non-VA Medical Care Program Office (now the VHA Office of Community Care), presents guidelines for preauthorized care and emergency care for service and non-service connected conditions for both inpatient and outpatient care.17 VA will reimburse the same non-VA provider a different rate depending on whether the Veteran received: a) pre-authorized care; b) emergency care for a service-connected condition; or c) emergency care for non-service connected conditions and non-service connected Veterans. There is limited information on the providers associated with Fee Basis care. One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. Yes. Prescription-related data in the PHARVEN file contain only summary payments by month. (Available at the VHA Data Portal. Electronic Data Interchange (EDI): Payer ID for medical claims is TWVACCN. 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. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. 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. You will have to pay this penalty for as long as you have Part B. resides on and transmits through computer systems and networks funded by the VA. 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. There is a lack of publicly available technical documentation and support may be limited to specific forums. These variables relate to the VA station at which the Fee Basis care requests and claims are input. 988 (Press 1). VA employees working on operations studies can build their own crosswalk file as they have permission to use these file. Several variables are available for locating care in particular settings. Second, there are some cases where the disbursed amount is $0, while the payment amount is greater than $0; these are cases in which the payment was cancelled and the true cost of care is thus $0. Of note, the FBCS was not in place nationwide prior to FY 2008. Note: Admission date is only relevant for inpatient stays; it is not relevant for outpatient visits. This service communicates via native SQL Server 2005 encrypted connections through the VA Wide Area Network (WAN). To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. When a claim has reached terminal status (A, P, D, R), the field ImportedDTStamp on the UB-92/HCFA tables represents the date it was processed. Fee Basis Services. VA regulations 38 CFR 17.1000-17.1008. Veterans Health Administration. DART is a workflow application that guides users through the request by collecting the appropriate documents, distributing documentation to reviewers, and assisting in communication between requestors and reviewers. This section describes two elements of the program: the range of services covered and the payment rules used to determine the amount that VA will pay (DISAMT). 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. There may be multiple STA3Ns for a single inpatient stay. [FeeInpatInvoice] table, one must first link that table to the [Fee]. Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. Appendix G lists all available FPOV codes and classifies them as inpatient or outpatient. Payment for these types of care falls under the Non-VA Medical Care program. (In SAS the admission date is denoted by the TREATDTF variable and the discharge date by the TREATDTO variable, in SQL the admission date is denoted by the AdmissionDate field and the discharge date is denoted by the DischargeDate field). At the time of this writing, the NPI number was often missing from fee basis claims. If electronic capability is not available, providers can submit claims by mail. This act expands the non-VA care veterans were able to receive before the act was passed. The NPI is the national provider identifier, which is provider-specific but often missing in the Fee Basis data. There may be multiple CPT codes associated with a single encounter. The table can be linked to the [Dim]. Care for dependent children, except newborns, in situations where VA pays for the mothers obstetric care during the same stay. Attention A T users. 3. The UB-92 equivalent variables would be: facility (after merging in facility name from the FBCS_Facilities table), vistapatkey, and vistaauthkey, respectively. This technology has not been assessed by the Section 508 Office. The FPOV variable can be found in both the SAS and SQL data. The inpatient data will also need to be linked to the ancillary data, or the data representing the professional services provided to a patient while in the hospital, in order to determine the total cost of the inpatient stay. VA intranet users can visit https://vaww.va.gov/communitycare/ (intranet only). We therefore use the PROC CONTENTS to describe SAS variables, found in Appendix A. SAS data use patient scrambled social security number (SCRSSN) as the patient identifier. Reimbursements appear in the Travel Expenses (TVL) file. Researchers must consider whether a missing value means not applicable. For example, many inpatient (INPT) records lack a value for any of the surgery codes (SURG9CD1-SURG9CD5). Internal use only. 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. One can use the same approach as for the inpatient SQL data described above to locate the date of service. [FeeServiceProvided], [Fee]. 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. The Veterans Emergency Care Fairness Act (Public Law 111-137), signed February 1, 2010, authorizes VA as a secondary payer to third party liability insurance not related to health insurance. VA Form 10-583, Claim for Payment of Cost of Unauthorized Medical Services. Data are presented in Table 4. In SAS, data are stored in variables, observations and datasets. Institutional Aspects of the Non-VA Medical Care System, https://www.va.gov/health-care/get-reimbursed-for-travel-pay/, http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. Emergent care patient liabilities not tied to copayments or deductibles will continue to be considered for secondary payment by VA. For additional questions, contact VA by phone, tollfree, at (877) 881-7618. Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. If you are in crisis or having thoughts of suicide, Contractor Announces Plan To Fix Non-VA Fee Basis Claims Available at: http://vaww.vhadataportal.med.va.gov/Portals/0/DataQualityProgram/Reports/Identifying_Veterans_in_CDW.pdf. Data Quality Program. HERC: Fee Basis Data: A Guide for Researchers - Veterans Affairs Five additional variables Financial Management System (FMS) transaction number, line number, date, batch number, and release date reflect processing of payments through the FMS. Office of Media and Public Relations. This is true for both the inpatient and the outpatient data, albeit for different reasons. VA decisions for specific versions may include + symbols; which denotes that the decision for the version specified also includes versions greater than You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. However, in all data files, the vast majority of observations are missing values for this variable. This guide serves as an addendum to any technical documentation supplied by the healthcare clearinghouse when establishing a trading partner agreement. VA payment constitutes payment in full. Please switch auto forms mode to off. There are no references identified for this entry. 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. 11. To access the menus on this page please perform the following steps. Using the Non-VA Medical Care data for research requires a basic understanding of laws and regulations that govern it. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, New York/New Jersey VA Health Care Network, Call TTY if you In general, persons on active duty in the U.S. military are excluded even if they are transitioning to VA care. Veterans Choice Program (VCP) Overview [online]. 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. Of note, SQL and SAS data contain similar, but not exactly the same, information. SQL Fee data are available through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). Community Care Network Region 5 (authorized), Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, Indian Health Service/Tribal Health Program, CHAMPVA In-house Treatment Initiative (CITI), Indian Health Services/Tribal Health/Urban Indian, Spina Bifida Health Care Benefits Program, Veterans Health Information Exchange Program, Durable Medical Equipment/ Pharmacy Requirements, War Related Illness & Injury Study Center, Clinical Trainees (Academic Affiliations), Medical Document Submission Requirements for Care Coordination, Azure Rights Management Services (Azure RMS), Call TTY if you Please switch auto forms mode to off. 2010;47(8):725-37. [FeeInpatInvoiceICDProcedure] table. Most ED visits will be identified through FPOV values of 32 or 33. Defining a cohort is an activity that is different for each project and depends on the research question at hand. The length of stay for a single hospital invoice varied greatly, with a maximum length of stay of 980 days. When evaluating the cost of care, use the disbursed amount. PatientIEN is assigned by the facility. 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. The diagram below (Figure 1) displays how payment is processed and sent to the non-VA provider. There are also a number of other financial variables denoted in SAS (see Table 7). Community providers should remain in contact with the referring VA Medical Center to ensure proper care coordination. Private health insurance coverage through a Veteran or Veteran's spouse is insurance provided by an employer, Veteran or other non-federal source, including Medicare supplemental plans. CLAIM.MD | Payer Information | VA Fee Basis Programs Gidwani R, Hong J, Murrell S. Fee Basis Data: A Guide for Researchers. To learn more, please visit the Provider Training section on the MES website . The clinic of jurisdiction, or medical facility, authorizes such care under the fee-basis program .