Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. 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. 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. There is very limited outpatient pharmacy data in the Fee files. The VA Fee Schedule is available at provider.vacommunitycare.com > Documents & Links. VA Informatics and Computing Resource Center (VINCI). In the SAS data prior to FY 2007, the disbursed amount (DISAMT) had an implied decimal point whereas the payment amount (AMOUNT) did not. Researchers will need to decide whether they will use the SAS or the SQL data and apply for appropriate IRB approval for use. HERC: Identifying Providers in VA Administrative Data - Veterans Affairs For billing questions contact: Health Resource Center expectation of privacy in the use of Government networks or systems. 5. The quantity dispensed. In that case, use payment amount instead. If it cannot be located in the PTF Main file or DSS NDE for inpatient care, search other inpatient files. HIPAA Transaction Standard Companion Guide (275 TR3)The purpose of this companion guide is to assist in development and deployment of applications transmitting health care claim attachments intending to support health care claim payment and processing by VA community care health care programs. There is a deductible of $3 per trip up to a limit of $18 per month. 2. Values for Fee Purpose of Visit (FPOV), HCFA Payment Type (HCFATYPE), Treatment Code (TRETYPE), Place of Service (PLSER), and Vendor Type (TYPE) appear in Appendix B. The FPOV variable can be found in both the SAS and SQL data. Fee Basis providers vary in how frequently they submit an invoice for Fee Basis care. 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. This could indicate a transfer between facilities or a physician bill for an inpatient stay. The generosity of the coverage is immaterial; if it covers any part of the providers bill, then VA may not pay anything. Accessed October 16, 2015. To enter and activate the submenu links, hit the down arrow. one setting of care (inpatient or outpatient). For the inpatient data, we compared observations with the same patient identifier, based on PaidDate in SQL and TRANSDAT in SAS. With additional permissions, researchers can also access City, Postal Code, Street Address, and Zip. Missing values of PAYCAT could be imputed by finding the corresponding inpatient stay in the INPT file. One can evaluate which encounters were unauthorized by joining the FeeUnauthorizedClaim table through the FeeUnauthorizedClaimSID key. See the FBCS page (CDW Raw) on the CDW SharePoint site (VA intranet only: https://vaww.cdw.va.gov/bisl/Database/SitePages/Raw%20Extractor.aspx) for more information. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). Fee Basis data can be broadly categorized into 4 classes: inpatient care, outpatient care, pharmacy, and travel data. A record is created only if there is a code on the invoice to be recorded. SQL Fee Basis files themselves contain limited patient demographic variables, but can be linked to other SQL data. VA systems are intended to be used by authorized VA network users for viewing and retrieving information only; except as otherwise explicitly authorized for official business and limited personal use under VA policy. 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. Users interested in learning the rules in force at a particular point in time should contact the VHA Office of Community Care. Veterans Choice Program - Fee Basis Claims System in CDW The Implementer of this technology has the responsibility to ensure the version deployed is 508-compliant. Through patient ID (SCRSSN) and travel date (TVLDTE) one can link these payments to inpatient and outpatient encounters. 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. If a researcher decides to use FPOV, please note that an FPOV value of 52 indicates ED visit for persons whose care is covered under the Millennium Bill and should thus be included in evaluating ED care. Class 2 or Class 3 products must restrict their interfaces to Class 1 National Software to use of publicly-supported APIs ONLY. Unlike the inpatient data, there can be multiple records with the same invoice number. The funds are used to provide the best care possible to our Veterans. 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. [FeePrescription] tables. Researchers should use PatientICN to link patient data within CDW. Claims related to this care are considered authorized care. PatientICN is assigned by CDW. 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. No new extracts will occur. Information from this system Facility Information Security Officers (ISOs) are often the CUPS POC. Medication dosage/strength. Procedures are identified by CPT code (CPT1) in the non-hospital inpatient services (the ancillary file) and in the outpatient procedures file. Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. [FeeVendor] table. Primary keys are denoted by (PK) and foreign keys are denoted by (FK). Fee Basis data live in both SAS and SQL format. In the SAS data, the provider component of the inpatient stay is captured in the ancillary file. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. This can become complicated by the fact that not all encounters relating to the same inpatient stay will have the same admission and discharge dates. 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. One exception to this is when identifying emergency department (ED) visits. Basic demographic variables can be found in the [Patient]. [FeeInpatInvoiceICDDiagnosis] with the [Dim]. However, we conducted some comparisons for inpatient data. In SQL, the outpatient data are housed in the FeeServiceProvided table. privacy policies and guidelines. For inpatient and outpatient care, in general, VA will pay the lesser of the Medicare rate (or MPFS rate) or the billed charges. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. Data Quality Program. 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). U.S. Department of Veterans Affairs. 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. Pre-2007, DISAMT and INTAMT each have two implied decimal places a value of 1000 would indicate $10.00. 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. Office of Information and Analytics. For EDI 837, Referral Number is Loop = 2300, Segment = REF*9F, Position = REF02 or Prior Authorization. Thus, in SQL the total cost of an inpatient stay would be determined by evaluating the DisbursedAmount in the [Fee]. [Spatient], and [Spatient]. 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. Some vendors use centralized billing services located in other cities, in a few cases in other states. American Society of Health-System Pharmacy (ASHP). 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. Starting in 2009, there are also a number of DXPOA variables in the SAS data, which indicate diagnoses that are present on admission. VA Information Resource Center. 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. There are a number of different variables that denote the category of care a Veteran received through Fee Basis (see Table 2) Appendices B and H present more details about the values these variables can take. Hit enter to expand a main menu option (Health, Benefits, etc). 7. SQL Fee Basis data are stored in the form of multiple relational tables that must be linked, or in SQL parlance, joined, in order to create an analysis dataset. Unauthorized inpatient or outpatient claims must be submitted within 90 days from the date of care. 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 Nevertheless, the National Non-VA Medical Care Program Office (now the VHA Office of Community Care) has interpreted VHA Directive 2006-029 to preclude Non-VA Medical Care providers from receiving payment for prosthetics. For the purpose of this guidebook, we focus on Fee Basis files only. Much Fee Basis care is pre-authorized prior to the Veteran obtaining care and is thus considered Authorized Care. 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). 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. [FeeTravelPayment] contain information on travel type and payment. Compare the admission date of the third observation to the temporary end date from above. From there, it is sent weekly to AITC in SAS format and nightly to CDW in SQL format. Business Product Management. Contact: 1-877-353-9791; Email Customer Engagement; Customer Engagement Portal Login. We detail differences amongst the SAS and SQL Fee Basis data in the guidebook below. 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. NOTE: The processes outlined below are exclusive to supplying documentation for unauthorized emergent care. Relational Database Management Systems (RDBMS) such as Microsoft SQL server have multiple hierarchies for storing data: a domain contains many schemas, which in turn contain many tables. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. VA contracts out its hospice; therefore, the Fee Basis files contain a great deal of data related to hospice care. If disbursed amount is missing (but not $0), use payment amount instead. [FeeInpatInvoice] table, one must first link that table to the [Fee]. 1. 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. It can be difficult to determine the provider and the location of the Non-VA care provider. 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). [FeeServiceProvided] table. Electronic 837 claim and 275 supporting documentation submissions can be completed through VAs contracted clearinghouse, Change Healthcare, or through another clearinghouse of your choice. Veterans Health Administration. In this table, some ancillary data are associated with an inpatient FPOV code but have an outpatient FeeProgramProvided field. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. It can be difficult to identify the specific type of provider associated with Fee Basis care in the currently available national extracts of Fee Basis data. Important: The mailing address below only pertains to disability compensation claims. Claims should be mailed to the following address: VA Eastern Kansas Health Care System Attn: Fee Basis Office 2200 SW Gage Blvd Topeka. YESInstitutional/UB Claims. There are also variables pertaining to Veteran geographic information, particularly ZIP, HOMECNTY and HOMESTATE in the SAS data and County, Country, Province, and State in the SQL data. 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. Not all of these variables appear in every utilization file. To enter and activate the submenu links, hit the down arrow. VA intranet users can visit https://vaww.va.gov/communitycare/ (intranet only). Veterans are not responsible for the remaining balance shown as patient responsibility on the explanation of benefits from their insurance carrier. In SAS, the inpatient (INPT) file includes PAMT, the Medicare prospective payment that would apply to the stay. FBCS supports payment of claims via VistA. It is also possible that researchers will find a slight difference in the observations that the SAS versus SQL data contain. VA can waive the deductible in hardship cases. 1. While NPI is available in SQL data, it does require special permissions to access, as it is located in the [Sstaff]. If electronic capability is not available, providers can submit claims by mail or secure fax. FSGLI: Family Servicemembers Group Life Insurance, Schedule of Payments for Traumatic Losses, S-DVI: Service-Disabled Veterans Life Insurance, Beneficiary Financial Counseling and Online Will, Lesbian Gay, Bisexual & Transgender Veterans, Pension Management Center (PMC) that serves your state, Claims Adjudication Procedures Manual/Live Manual, Link to subscribe to receive email notice of changes to the Live Manual. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. Researchers will have to select observations from the SQL FeeServiceProvided table in order to ensure they are only evaluating outpatient data. [ SFeeVendor] table. [FeeServiceProvided] tables. [1] The Health Care Financing Administration (HCFA) was renamed the Centers for Medicare and Medicaid Services. There may be multiple vendor IDs (VENDIDs) for a single inpatient stay. Please note that this method providers an indication of the care provided to a Veteran on a single day, rather than in a single encounter, because multiple providers may use the same billing vendor. Note: records with status= R can have missing values for the variables vistapatkey and vistaauthkey, depending on whether or not these were linked before rejecting as a re-route to HAC. 17. Summary data are also available through the VHA Support Services Center (VSSC) website on the VA intranet. One can use the same approach as for the inpatient SQL data described above to locate the date of service. With few exceptions these variables will be of little interest to researchers. Multiple claims can be paid against a single authorization. This is a critical difference from VA utilization files, which are organized by date of service. The Act amends 38 U.S.C. Working with the Veterans Health Adminstration: A Guide for Providers [online]. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). Community providers should remain in contact with the referring VA Medical Center to ensure proper care coordination. Chapter 6 provides information about how to access the Fee Basis data, while Chapter 7 provides information about the rules governing Fee Basis care. Analyses of FY 2014 data indicate approximately 50% of inpatient observations and 43% of outpatient observations are missing NPI. Accessed October 16, 2015. This improves claim accuracy and reduces the amount of time it takes for us to process claim determinations. Payer ID for dental claims is CDCA1. 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). The temporary end date is the maximum of these two values. Contact the VA North Texas Health Care System. A foreign key is a key that uniquely identifies a record of another table. Payer ID for dental claims is 12116. Guidance can be found under "VHA Data Quality Program Reports. At the time of writing (October 2015), only operations staff will have permission to access the SAS data at VINCI. Please switch auto forms mode to off. In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. To locate the facility at which the Veteran usually receives VA care, the VA Information Resource Center (VIReC) recommends consulting the preferred facility indicator in the VHA Enrollment Database.7. This technology integrates with Veterans Information Systems and Technology Architecture (VistA) through Massachusetts General Hospital Utility Multi-Programming System (MUMPS) or a Structured Query Language (SQL) database system on the backend. As with the SAS data, it is not straightforward to determine the cost of, length of stay or care provided during a specific inpatient stay. You can use NPI to link providers in VA and Medicare. Care for dependent children, except newborns, in situations where VA pays for the mothers obstetric care during the same stay. 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. April 14, 2014. To access the menus on this page please perform the following steps. Review the Corrections and Voids page for more information. Payment for care provided under the Veterans Choice Act may not exceed the Medicare Fee Schedule (i.e. VA calculates PAMT from CMS pricer software on the basis of DRG and length of stay. The travel payments data contains reimbursements for particular travel events (TVLAMT). More than 99% of claims for inpatient, ancillary and outpatient care are processed within 2 years. Complete and accurate standard Center for Medicare & Medicaid Services (CMS) or electronic transaction containing false claims notice (such as CMS 1450, CMS 1500 or 837 EDI transaction). As part of the process, claims and supporting documentation are scanned for compliance prior to conversion to electronic format. It is not available for claims in which payment was based on a contract amount. Non-VA Medical Care data are available in SAS form at the Austin Information Technology Center (AITC) and in SAS form and SQL form through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). In general, we recommend using the disbursed amount to capture the cost of care, for two reasons. Patient residence related geographic information is available in the [Patient]. VA systems are intended to be used by authorized VA network users for viewing and Accesed October 16, 2015. We suggest using only the first 3 characters from sta3n for the merge. National Institute of Standards and Technology (NIST) standards. http://www.mssny.org/Documents/Enews/Aug%208%202014/VA%20ProvidersGuide.pdf, http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. Fee Basis: 214-857-1397 C & P. VA Claims Representation; RESOURCES. Fee Basis data are housed in both SAS and SQL format. To access the menus on this page please perform the following steps. Below are some answers to general questions about linking the UB-92 form to the FBCS data. The following information should help you understand who to submit claims to and the requirements you must follow when submitting claims. This act expands the non-VA care veterans were able to receive before the act was passed. Veterans Access, Choice, and Accountability Act of 2014 (VACAA): The Choice Program and the Choice Card [presentation]. In SAS, the outpatient data are housed in the MED files. All access or use constitutes understanding and acceptance that there is no reasonable [ModeOfTransportation] and [Fee]. 1. Researchers will thus need permissions to allow the CDW data manager to obtain SCRSSN or SSN to PatientICN crosswalk to allow for the necessary data linkages. Available at:http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. a. [FeeVendor] table. VINCI. At the time of writing, version 4.2 is the most current version. Five additional variables Financial Management System (FMS) transaction number, line number, date, batch number, and release date reflect processing of payments through the FMS. 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. VA has set a goal of processing all clean claims within 30 days. ", Military service variables can be found in [PatSub],[PatientServicePeriod], [Patient]. Appendix D contains information on the primary and foreign keys needed to link the various SQL tables. If you have additional questions about the form or your portal account access, please contact the Provider Services Solution (PRSS) help desk at 888-829-5373. b. This application reads, creates, edits authorization data in VistA, and copies critical information into the central SQL database for off-line VistA applications to consume. 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. PatientIEN and PatientSID are found in the general Fee Basis tables. The length of stay for a single hospital invoice varied greatly, with a maximum length of stay of 980 days. There is another category of Fee Basis care that is considered unauthorized care. 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. the rates paid by the United States to Medicare providers). Multiple SAS datasets have VENID and VEN13N. This application completes the update of critical claims data into the FBCS shared MS SQL database for further processing and reporting. Data Quality Analysis Team. It may duplicate the PatientIEN of another patient at another facility, and should not be used as an identifier. However, there are some outliers; some claims can take up to 8 years to process. 2010;47(8):725-37. PatientIEN is assigned by the facility. FBCS Upload leverages LEADTOOLS Professional Optical Character Recognition (OCR) and is included in the FBCS workstation install package. 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. To determine the location of care, MDCAREID will be more useful than VEN13N. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). To enter and activate the submenu links, hit the down arrow. 3. We view the patients insurance data in the VistA file if the claim is flagged as reimbursable in VistA and encompasses the dates on the claim. The codes for the procedures provided for a given hospital stay are kept in a separate table, a table of procedures. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. There are two types of keys: primary keys and foreign keys. The values of Adjustment Codes 1 and 2 (ADJCD1 and ADJCD2) explain the reason for non-payment. VA Fee Basis Programs. [XXX] tables, but also the [DIM]. The zip code accompanying the VEN13 variable denotes the zip code to which VA sent reimbursement, not the zip code where the service was rendered. For example, if one wishes to evaluate the cost of certain diagnoses in inpatient care through SQL data, this would require the linking of multiple tables before being able to conduct any analyses such as [Fee]. The VHA Office of Community Care is the contact for all VA community care programs. Under this regulation, ambulances will be reimbursed at the lesser of (a) the amount the Veteran is personally liable or (b) 70 percent of the applicable Medicare Ambulance Fee Schedule. 14. The DSS Fee Basis Claims System (FBCS) is a web-based claim management system. YESElectronic Remittance (ERA)YESICD- 1. [FeeInpatInvoiceICDProcedure] table. 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 34 Fee Basis Claims Systems (FBCS) servers, which were originally designed for episodes of care. With the exception of supplying remittance advice supporting documentation for timely filing purposes, these processes do not apply to authorized care. Payer Name: VA Fee Basis Programs - thePracticeBridge Mail to: DEPARTMENT OF VETERANS AFFAIRS. In SAS, the Patient ID will be the SCRSSN and the admit date is the treatment from date. Using SQL data will allow the researcher to link to other rich data found in CDW, such as the Health Factors data. 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. Payer ID: 1. If the Veteran has insurance, VA cannot pay even when the entire claim is less than the deductible. Claims for Non-VA Emergency Care - The information contained on this page is accurate as of the Decision Date (11/02/2022). The Department of Veterans Affairs has implemented centralized mail processing (CM) for compensation claims to reduce incoming paper handling and shipping requirements. The Routing tool manages how Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims will electronically flow through the FBCS program. In some cases it may appear that single encounters have duplicate payments. Data Quality Analysis Team. Please switch auto forms mode to off. When possible, VA will seek reimbursement for Non-VA Medical Care payments from sources such as workers compensation payments; payments resulting from motor vehicle accidents, crimes of personal violence, or torts; other agencies when the patient is a beneficiary; and third-party insurance plans. Some Fee Basis data will also appear in the non-VA medical SAS inpatient file (formerly called the Patient Treatment File). Chief Business Office. Hit enter to expand a main menu option (Health, Benefits, etc). National Non-VA Medical Care Program Office (NNPO). SAS and SQL data are very similar, but not exact copies of each other. The base rate varies by level of ambulance service provided, locality of the Medicare carrier area, and Point of Pickup (POP) zip code classification: urban, rural, or "super rural." Please visit Provider Education and Training for upcoming events. For example, DISAMT=1000 in FY06 really indicates DISAMT=10.00. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. 2. All preauthorized claims are then processed through the Fee Basis Claims System (FBCS) at the local facility as well as sent to the payment team. If a Veteran has only Medicare Part A then VA may consider payment for ancillary and professional services usually covered under Part B. 2. This rule applies even when the patient is incapable of making a call.
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