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. Get Help from Our VA Disability Claim Appeals Lawyers Today. SAS data are also available in CDW, but are currently limited to those VA employees with operational access. Veterans should mail or fax correspondence pertaining to compensation claims to the below location. MDCAREID is not available in the outpatient SAS Fee Basis data, even though some outpatient services are provided in a hospital. 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. Attention A T users. However, 99% of inpatient hospital invoices were associated with a length of stay of 33 days or less. 8. Race and ethnicity are found in the [PatientEthnicity], [PatSub]. The vendor no longer supports VA installations of this technology. The values of Adjustment Codes 1 and 2 (ADJCD1 and ADJCD2) explain the reason for non-payment. Each record in the pharmacy services (PHR) file represents a single prescription, whether for a medication or a pharmacy supply (e.g., skin cleanser, bathing cloths). Several variables are available for locating care in particular settings. This act expands the non-VA care veterans were able to receive before the act was passed. Fee Basis data files contain information regarding both the care the Veteran received and the reimbursement of the care. If disbursed amount is missing (but not $0), use payment amount instead. There are nine situations in which Non-VA Medical Care is authorized. Prosthetic items. In some cases it may appear that single encounters have duplicate payments. For example, there could be many NPIs associated with a VEN13N (e.g., a hospital employing multiple providers), or many VEN13Ns for a single provider (e.g., a surgeon with privileges at multiple hospitals). There are two types of keys: primary keys and foreign keys. Unlike the inpatient data, there can be multiple records with the same invoice number. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. Attention A T users. 5. This component communicates with the FBCS MS SQL and VistA database in real time. Please switch auto forms mode to off. In addition, VA may place a Veteran in a private or state-run nursing home when a bed in a VA nursing home is unavailable or if the nursing home is distant from the patients residence. If you are in crisis or having thoughts of suicide, 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. This variable is defined as 1st Diagnosis Code. A comparison from FY 2009 to 2014 data reveals that DX1 in SAS corresponds to DX1 in SQL data, and up to 2008, DXLSF in SAS corresponds to DX1 in SQL (see Table 5). 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. Through the CCN, Veterans have access to regional networks of high-performing, licensed health care . 2. The FeeSpecialtyCodeName contains information on the specialty of the provider seen, such as oncology, chiropractic, pathology, neurosurgery, etc., but is missing much data. In the outpatient data, each record represents a different procedure, as assessed through the Current Procedural Terminology (CPT) code. VA will arrange for transportation for them or will reimburse expenses on the basis of vouchers submitted. 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. 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. 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. Of note, the relevant SQL tables for Fee Basis data are not only the [Fee]. one setting of care (inpatient or outpatient). To enter and activate the submenu links, hit the down arrow. Driving distance between a veterans residence and their closest VA facility is over 40 miles, c. The veteran must travel by boat or plane to access the VA facility closest to their home (excluding Guam, American Samoa, or the Republic of the Philippines), d. The veteran faces an excessive burden in traveling to a VA, including a body of water or geologic formation that cannot be crossed by road. There are multiple potential identifiers for provider/vendor in the SAS data: the VENDID, VEN13N, MDCAREID, SPECCODE and NPI. The definition of the DXLSF variable changes depending on the year of analysis. Each patient should have only one ICN in the entire VA, regardless of the number of facilities at which he is seen. Each VA facility has a local Fee Office to which the non-VA provider submits a claim for reimbursement. Hit enter to expand a main menu option (Health, Benefits, etc). Some missingness may indicate not applicable.. Previously, VA could reimburse Veterans or pay non-VA hospitals directly only if a Veteran has no other health insurance. Those options are: Utilize HealthShare Referral Manager (HSRM) for referrals, authorizations and documentation exchange. Matching outpatient prosthetics order records in the VA National Prosthetics Patient Database (NPPD) to health care utilization databases. [XXX] tables.9,12 Tables under the DIM schema contain attributes that describe the records in the Fee tables. Fee Basis data are housed in VA in both SAS dataset format and Microsoft SQL server tables (hereafter referred to as SQL data). 16. For EDI 837, Referral Number is Loop = 2300, Segment = REF*9F, Position = REF02 or Prior Authorization. 11. Go to CDW Home, click on CDW MetaData, then click on the link for Purchased Care. Available at: http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. In SQL, there are additional variables that will denote the type and location of the care provided along with the vendor. [FeeServiceProvided] table. Electronic Data Interchange (EDI) Interface. The FPOV variable can be found in both the SAS and SQL data. VA may be a secondary payer for unauthorized emergent claims under 38 U.S.C. VA Informatics and Computing Resource Center (VINCI). 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. Appendices G and H, copied from the Non-VA Medical Care program website, describes in detail the types of records for which each Fee Purpose of Visit (FPOV) codes are assigned. Thus, the mailing address of the vendor is not always the vendors actual location. U.S. Department of Veterans Affairs. This latter table contains a variable called InitialTreatmentDateTime. The PatientSID is a CDW assigned identifier that uniquely identifies a patient within a facility. As noted above, non-VA care may be authorized under the Non-VA Medical Care program when VA cannot offer needed care. We crosswalked the ScrSSN to allow for comparison with SAS data. Under the Veterans Choice Act, eligible veterans are able to obtain outpatient care outside the VA using their Choice Card. 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 VendorType contains information about whether the service was provided by a laboratory, radiology, physician, pharmacy, other, travel, prosthetics, federal hospital, public hospital or private hospital. Accessed October 27, 2015. PatientICN is assigned by CDW. 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. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. The vendor identity can be found through the VENDID or VEN13N variables in SAS. Hospice also appears to be billed monthly, with longest length of stay for a single hospice invoice of 31 days. In SAS, the outpatient data are housed in the MED files. 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 Payment Methodology Matrix [online; VA intranet only]. VA can make payments to non-VA health care providers under many arrangements. In order to evaluate the care received, length of stay and/or costs associated with a single inpatient stay, the user will often have to roll up multiple claims. Veterans Access, Choice, and Accountability Act of 2014 (VACAA): The Choice Program and the Choice Card [presentation]. The SQL tables [Dim]. 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. Most ED visits will be identified through FPOV values of 32 or 33. This means the data were placed in the PIT and the claim was not paid through FBCS. This component distributes fee workload to particular users using the FBCS MS SQL database and the VistA Gateway. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. to) monitoring; recording; copying; auditing; inspecting; investigating; restricting In that case, use payment amount instead. 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. Updated September 21, 2015. Mail to: DEPARTMENT OF VETERANS AFFAIRS. However, one also needs to exercise caution with DRG; there are 2 different sets of DRGs used over time. This improves claim accuracy and reduces the amount of time it takes for us to process claim determinations. Attention A T users. 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. [XXX] tables, but also the [DIM]. Please switch auto forms mode to off. Veterans Choice Program - Fee Basis Claims System in CDW Last updated validated on Tuesday, January 3, 2023 In this chapter, we discuss general aspects of Fee Basis data. Community providers should remain in contact with the referring VA Medical Center to ensure proper care coordination. 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. 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. VA payment constitutes payment in full. Researchers can read more information about accessing CDW on the VHA Data Portal (http://vaww.vhadataportal.med.va.gov/DataSources/CDW.aspx; VA intranet only). Journal of Rehabilitation Research and Development. SAS Fee Basis data can be linked to other SAS files with additional demographic data (e.g., Vital Status files, enrollment files). 6. In SAS, data are stored in variables, observations and datasets. This technology is not portable as it runs only on Windows operating systems. Chapter 1 presents an overview of Fee Basis data in general; Chapter 2 presents an overview of the variables in the Fee Basis data; and Chapter 3 describes how SAS versus SQL forms of Fee Basis data differ. or acts to, The Financial Services Center (FSC) is a franchise fund (fee for service) organization in the Department of Veterans Affairs (VA).Under the authority of the Government Management Reform Act of 1994 and the Military These correspond to fields, rows and tables in a relational database. It is the patient identifier that uniquely defines a patient across all facilities. The process of linking can be complex; analysts should take care to reduce errors during this process. For example, a technology approved with a decision for 12.6.4+ would cover any version that is greater than 12.6.4, but would not exceed the .6 decimal ie: 12.6.401 Microsoft Internet Explorer, a dependency of this technology, is in End of Life status and must no longer be used. For example, there are observations in which INTIND = 1 and INTAMT = $0. The table can be linked to the [Dim]. Use of this technology is strictly controlled and not available for use within the general population. Move on to the next patient ID, STA3N, VEN13N combination and repeat the entire process above. 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. There may be multiple vendor IDs (VENDIDs) for a single inpatient stay. Training - Exposure - Experience (TEE) Tournament. Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA care. For some years, there may be high rates of missingness of ICD-9 data in the Ancillary files. Data Quality Program. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. VA employees working on operations studies can build their own crosswalk file as they have permission to use these file. Most importantly, they do not represent all care provided during the fiscal year. Unauthorized inpatient or outpatient claims must be submitted within 90 days from the date of care. Care for dependent children, except newborns, in situations where VA pays for the mothers obstetric care during the same stay. 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. For these reasons, the program does not pay for 100% of care that was otherwise eligible. How Much Life Insurance Do You Really Need? You can use NPI to link providers in VA and Medicare. (refer to the Category tab under Runtime Dependencies), Users must ensure that Microsoft Structured Query Language (SQL) Server, Microsoft Internet Explorer (IE), and Microsoft Excel are implemented with VA-approved baselines. 1. Fee Basis Services. More than 99% of claims for inpatient, ancillary and outpatient care are processed within 2 years. These represent cases in which payment is disallowed. Prior to FY 2007, INTAMT has two implied decimal places. Additional information on accessing the AITC mainframe is available on the VHA Data Portal (VA intranet only: http://vaww.vhadataportal.med.va.gov/Home.aspx). Six additional variables indicate the setting of care and vendor or care type. VA must be capable of linking submitted supporting documentation to a corresponding claim. The funds are used to provide the best care possible to our Veterans. Appendix E includes a list of SQL fields related to the type of care a patient receives. The mileage is calculated using the fastest route. ______________________________________________________________________________. 1. However, in all data files, the vast majority of observations are missing values for this variable. There is limited information on the providers associated with Fee Basis care. FBCS supports payment of claims via VistA. Researchers should use PatientICN to link patient data within CDW. 7. However, not all dates on the claim are approved. Passed in 2014 with bipartisan support in Congress, its purpose is to increase Veterans access to health care.1 The Choice Act allows Veterans to receive health care through non-VA providers in the community if they are unable to schedule an appointment at their local VA within 30 days or by a date determined by their provider (wait-time goals), if they reside over 40 miles from a VA facility, or if they face an unusual or excessive burden in travelling to a VA facility.2 Under the Choice Act, ten ($10) billion dollars has been allocated towards Non-VA Medical Care for eligible Veterans through 2017.1 The Fee Basis files contain data for care received through the Choice Act, but in this guide, we do not distinguish for care provided under the Non-VA Medical Care program and that provided under the Choice Act. VA has adopted a policy of processing payments for certain EDI claims outside of FBCS (Choice/PCCC) by rerouting the EDI claims back to the HAC, causing them to reach terminal status in FBCS and triggering a transition to the PIT repository. SQL Fee data are available through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). 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. 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. Seven refer explicitly to Veterans alone, while the remaining two are for diagnostic services or eligibility exams, neither of which constitutes treatment. Review the Filing Electronically section above to learn how to file a claim electronically. 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. VSSC web reports are organized into nine domains: Business Operations, Capital & Planning, Clinical Care, Customer Service, Quality & Performance, Resource Management, Special Focus, Systems Redesign, and Workload. 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. PDF Frequently Asked Questions for Providers - Logistics Health PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. Table 9 lists a number of financial variables the SQL data contain. Inpatient procedures are captured by ICD-9 procedure codes (SURG9CD1-SURG9CD25) in the hospital claims file. 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. The codes for the procedures provided for a given hospital stay are kept in a separate table, a table of procedures. These tables involve payments paid only through FBCS. 4. This FPOV variable broadly categorizes the reason for the encounter, such as hospice or respite care. 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 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. Eligibility and claims submission information for emergent care will be provided after notification is made to the VA. Claims for emergent care not eligible for authorization upon notification, may be eligible for consideration as Unauthorized Care. There is no separate payment for items such as oxygen or other supplies, the number of attendants, providing an EKG during the trip, etc. There is a CPT field in the inpatient files, but this is always missing; hospitals do not use CPT codes to bill. Last updated August 21, 2017 The SQL Fee Basis data at CDW and the SAS Fee Basis data at AITC are available for VA researchers following a standard approval process. Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. The VA Fee Basis medical program provides payment authorization for eligible Veterans to obtain routine medical treatment services through non-VA health care providers. Data Quality Program. Contact the VA North Texas Health Care System. To enter and activate the submenu links, hit the down arrow. For Make sure the services provided are within the scope of the authorization. [Patient], [PatSub]. SQL tables require linking before conducting any data analyses. visit VeteransCrisisLine.net for more resources. If the Veteran received care in the community that was not pre-authorized, it is considered unauthorized by VA. 14. Veterans Health Administration. 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). National Institute of Standards and Technology (NIST) standards. Some vendors use centralized billing services located in other cities, in a few cases in other states. [FeeInpatInvoiceICDProcedure] table. VA Technical Reference Model v 23.2 DSS Fee Basis Claims Systems (FBCS) General Decision Reference Component Category Analysis General Information Technologies must be operated and maintained in accordance with Federal and Department security and privacy policies and guidelines. However, not all data in the FeeServiceProvided table are outpatient data; some may pertain to inpatient stays. Most files contain the invoice date, obligation number; check number and date, several variables pertaining to check cancellation and denials of payment, and the DHCP internal control number. Review the Where to Send Claims section below to learn where to send claims.

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