We suggest using only the first 3 characters from sta3n for the merge. In this way, records that are missing MDCAREID can be given a MDCAREID based on the value of VEN13N and STA6A in the record. 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. At the time of writing, SAS data at CDW are available only to those persons with VA operations access. The Medicare hospital provider ID (MDCAREID) is entered by fee basis staff in order to calculate hospital reimbursement using the Medicare Pricer software. U.S. Department of Veterans Affairs. In SQL, these variables can be found in the [Dim]. As a Class 2 or Class 3 product, it MUST NOT be assumed to having been released into production through all OI&T product release and sustainment process controls for project management; requirements, development and testing management; and configuration, change, and release management necessary to satisfy OI&T process and product compliance. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, New York/New Jersey VA Health Care Network, Call TTY if you
FBCS is an auditing system which provides instructional prompts designed to interface with the Veterans Information Systems and Technology Architecture (VistA) package to track, report, and analyze fee claim data. For example, an interest payment of $14.21 would appear as 1421. INTAMT is part of DISAMT; it should not be added to them. Several variables are available for locating care in particular settings. Some VA medical centers purchase care from only one of the hospitals in the chain. There are very limited data in both the SAS and the SQL Fee Basis data regarding the provider associated with care; the closest one can get to this information is to denote the vendor associated with the encounter (detailed more in sections 4.11 and 5.10). have hearing loss, Community Care Network Region 1 (authorized), Community Care Network Region 2 (authorized), Community Care Network Region 3 (authorized), Community Care Network Region 4 (authorized), Unauthorized Emergent Care (unauthorized). PatientIEN and PatientSID are unique to a patient within a facility, but not unique to a patient across VA facilities (e.g., a patient who had visited multiple VA facilities will have multiple PatientIENs and multiple PatientSIDs). The SAS data are stored at AITC. 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. To find all care provided in a particular fiscal year requires searching by treatment date over several years of Non-VA Medical Care claims. Providers cannot bill both VA and the patient or another insurer for the same encounter. SAS and SQL data are very similar, but not exact copies of each other. [ICDProcedure] table through the ICDProcedureSID. However, in Table 4, we present some comparisons to demonstrate the different between SAS and SQL data. How Does VGLI Compare to Other Insurance Programs? Appendix E includes a list of SQL fields related to the type of care a patient receives. Previously, VA could reimburse Veterans or pay non-VA hospitals directly only if a Veteran has no other health insurance. To enter and activate the submenu links, hit the down arrow. Persons interested in studying care provided under the Choice Act may wish to explore the VACAA tables or the FBCS tables at VA Corporate Data Warehouse (CDW). Accessed October 16, 2015. Review the Filing Electronically section above to learn how to file a claim electronically. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it. All Choice claims are processed by VISN 15. This component provides a front end for recognizing claim data through optical character recognition (OCR) software. 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. VA evaluates these claims and decides how much to reimburse these providers for care. Clinical variables in SAS format include ICD-9 diagnosis codes, ICD-9 surgical codes, CPT codes and CPT modifier codes, DRG codes and Present on Admission codes. However, previous HERC investigation confirmed these are partial payments made for a single encounter or procedure. Department of Veterans Affairs Claims Intake Center PO Box 4444 Janesville, WI 53547-4444 Or, you can fax it to: (844) 531-7818 (inside the U.S.) (248) 524-4260 (outside the U.S.) Visit your local VA regional office or Benefits Delivery at Discharge Intake Site and speak with a VA representative to assist you. [ICD9] tables. According to the Health Administration Center Internet website, the proportion of claims processed within 30 days rose from under 40% in 2007 to over 97% by the end of 2008. There is no official data dictionary for the SAS Fee Basis data. VA evaluates these claims and decides how much to reimburse these providers for care. For additional information or assistance regarding Section 508, please contact the Section 508 Office at Section508@va.gov. Include the authorization number on the claim form for all non-emergent care. When evaluating the cost of care, use the disbursed amount. Most importantly, they do not represent all care provided during the fiscal year. The veteran must wait over 30 days past their preferred appointment date or the date deemed medically necessary by their provider, b. Some Fee Basis data will also appear in the non-VA medical SAS inpatient file (formerly called the Patient Treatment File). Compare the discharge date of the first observation to the admission date of the next (second) observation. [FeePrescription] table contains rich information on the type of drug prescribed and dispensed, including the drug name, manufacturer, strength, quantity, date filled and charge and disbursed (payment) amount. Summary data are also available through the VHA Support Services Center (VSSC) website on the VA intranet. 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. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. This component communicates with the FBCS MS SQL and VistA database in real time. The unique patient identifier by which to conduct SQL-based Fee Basis analyses is PatientICN. Linking Patient Data in the CDW Update [online; VA intranet only]. In SAS, these data can be found in the Vendor file. If electronic capability isnot available, providers can submit claims by mail or secure fax. [XXX] tables.9,12 Tables under the DIM schema contain attributes that describe the records in the Fee tables. Veterans Choice Program Eligibility Details [online]. 3. As of April 2019, this guidebook is no longer being updated. Multiple SAS datasets have VENID and VEN13N. This seeming complicated arrangement is an efficient way to store data. 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. If the payment was made outside of FBCS, they wont show here. Chief Business Office. 21. We believe that payments are then made from the claim data available from the Claims Reconciliation and Auditing: Program Integrity Tool (PIT) with lump sum/expedited payments being made on a weekly basis and retrospective review, as well as recoupment efforts for overpayments/duplicates. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). Inpatient procedures are captured by ICD-9 procedure codes (SURG9CD1-SURG9CD25) in the hospital claims file. Paper claims and supporting documentation submitted to us are converted to Electronic Data Interchange (EDI) transactions. YESElectronic Remittance (ERA)YESICD- 1. Unauthorized inpatient or outpatient claims must be submitted within 90 days from the date of care. 11. The instructions differ based on the type of submission.NOTE: For specific information on submitting claims to Optum or TriWest, please refer to their resources. However, there are data available regarding the category of visit. Researchers can do this using the FeePurposeOfVisit (FPOV) code.11 We recommend this approach over using another variable, such as the Fee Program. VA calculates PAMT from CMS pricer software on the basis of DRG and length of stay. This FPOV variable broadly categorizes the reason for the encounter, such as hospice or respite care. Accessed October 16, 2015. April 14, 2014. Please visit Provider Education and Training for upcoming events. Available at: http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. VAntage Point. actions by all authorized VA and law enforcement personnel. Payer ID for dental claims is 12116. 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. 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. U.S. Department of Veterans Affairs. First, it includes both the payment amount and any interest that may apply. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. 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). These represent cases in which payment is disallowed. http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. 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. Multiple SQL tables contain these variables. In SAS, ICD-9 diagnosis codes are in the Inpatient, Outpatient and Ancillary files. 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. Health plans include private health insurance, Medicare, Medicaid, and other forms of insurance that will pay for medical treatment arising from the patients injury or illness (e.g., automobile insurance following a car accident). If the Veteran has insurance, VA cannot pay even when the entire claim is less than the deductible. The key that allows for this linkage is the FeeInpatInvoiceSID which is a primary key in the [Fee]. Payments received from a Veterans private health insurance carrier are credited towards any applicable VA copayments, reducing all or part of the Veterans out-of-pocket expenses. The diagram below (Figure 1) displays how payment is processed and sent to the non-VA provider. 2. Please switch auto forms mode to off. Other work by HERC researchers indicates that in the FY 2014 data, DXLSF and DX1 were identical 47% of the time. 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. 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. 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. A subsequent report will contain the results of an audit conducted to assess Please switch auto forms mode to off. However, Veterans may be responsible for a VA copayment depending on their assigned Priority Group. 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. Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. VA Form 10-583, Claim for Payment of Cost of Unauthorized Medical Services. 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. For authorized care, the referral number listed on the Billing and Other Referral Information form. Hit enter to expand a main menu option (Health, Benefits, etc). 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." In order to gain access to the AITC mainframe, VA system users must contact their local Customer User Provisioning System (CUPS) Points of Contact (POC) and submit a VA Form 9957 to create a Time Sharing Option (TSO) account. VSSC provides numerous relevant web reports, data resources, and analytics support, including summary data by facility and VISN and national summary data. National Non-VA Medical Care Program Office (NNPO). [FeePharmacyInvoice] and the [Fee]. Smith MW, Su P, Phibbs CS. However, there are some outliers; some claims can take up to 8 years to process. VA Information Resource Center. The process of linking can be complex; analysts should take care to reduce errors during this process. The generosity of the coverage is immaterial; if it covers any part of the providers bill, then VA may not pay anything. (1) A Veteran must be enrolled in VA health care16. In SAS, this variable is called DISTYP, or disposition type, and is located in the Inpatient and Ancillary tables. (Anything) - 7.(Anything). VA is required by law to bill private health insurance carriers for medical care, supplies and prescriptions provided for treatment of Veterans' nonservice-connected conditions. For example, a technology approved with a decision for 7.x would cover any version of 7. Electronic 837 claim and 275 supporting documentation submissions can be completed through VAs contracted clearinghouse, Change Healthcare, or through another clearinghouse of your choice. VA has established rules for timely filing of unauthorized and Mill Bill claims (i.e. 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. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. URLs are not live because they are VA intranet only. 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. Questions about care and authorization should be directed to the referring VA Medical Center. VIReC Research User Guide: VHA Medical SAS Outpatient Datasets FY2006. 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 second record would have an admission date of Jan 5, 2010 and a discharge date of Jan 5, 2010. 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. This care will be approved (or denied) by the local VA Fee Office; the Veteran is then free to seek non-VA care. 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. Accessed October 27, 2015. Defining a cohort is an activity that is different for each project and depends on the research question at hand. 3. Include the 17 alpha-numeric (10 digits + "V" + 6 digits) VA-assigned internal control number (ICN) in the insured's I.D. Attention A T users. VINCI Data Description: Dimension [online; VA intranet only]. It is the patient identifier that uniquely defines a patient across all facilities. VA evaluates these claims and decides how much to reimburse these providers for care. The funds are used to provide the best care possible to our Veterans. 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). U.S. Department of Veterans Affairs. FBCS Upload leverages LEADTOOLS Professional Optical Character Recognition (OCR) and is included in the FBCS workstation install package. 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). We give an example here that relates to FeeInpatInvoice table. 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. U.S. Department of Veterans Affairs. Last updated August 21, 2017 (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. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. Additional information appears in a federal regulation, 38 CFR 17.52. Fee Basis data are housed in both SAS and SQL format. The 2015 update to the Fee Basis Medical Care guidebook describes for the first time the SQL Fee Basis files, and contains a host of information about how SAS versus SQL Fee Basis files differ. The [Fee]. When a claim is linked to VistA, the variable Other_Hlth_ins_present is populated. In both SQL and SAS data, there is also a variable regarding the fee specialty code. 3. However, we conducted some comparisons for inpatient data. Of note, the relevant SQL tables for Fee Basis data are not only the [Fee]. _____________________________________________________________________________. There are additional payments for direct medical education, capital-related costs, and other factors as appropriate. ______________________________________________________________________________. Box 30780 Tampa, FL 33630-3780, P2E Documentation Cover Sheet, VA Form 10-10143f. 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. In SQL, there are additional variables that will denote the type and location of the care provided along with the vendor. Providers are not required to accept VA payment in all cases. Office of Information and Analytics. Missing values of PAYCAT could be imputed by finding the corresponding inpatient stay in the INPT file. There are multiple methods by which community providers may electronically provide VA with the required medical documentation for care coordination purposes. 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. Q. If electronic capability is not available, providers can submit claims by mail. There are two types of keys: primary keys and foreign keys. [FeeInpatInvoiceICDDiagnosis], [Dim]. 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. 3. Fact Sheet: Medical Document Submission Requirements for Care Coordination, ADA Dental Claim Form > American Dental Association website. For current information on Community Care data, please visit the page VA Community Care Data. Some web reports contain PHI and access to these is restricted. VA Palo Alto, Health Economics Resource Center; October 2013. PMS-DRG was effective in FY 2008; prior to this time CMS-DRGs were used. Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. 8. These variables relate to the VA station at which the Fee Basis care requests and claims are input. The following information should help you understand who to submit claims to and the requirements you must follow when submitting claims. At the time of this writing, the NPI number was often missing from fee basis claims. You can further refine by selecting records on or after November 4, 2014, when Choice was first enacted. There is a lack of publicly available technical documentation and support may be limited to specific forums. Customer Call Center: 877-881-76188:05 a.m. to 6:45 p.m. Eastern TimeMondayFriday, Sign up for the Provider Advisor newsletter, Veterans Crisis Line:
Medical specialty type (SPECCODE) is a provider-specific variable and indicates the specialty type of the provider rendering the service. In FY05, DRG001 means CRANIOTOMY- >17 W CC, compared to HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC for DRG001 in FY15 DRG001. This means the data were placed in the PIT and the claim was not paid through FBCS. [Patient], [SPatient]. [ModeOfTransportation] and [Fee]. The payment category (PAYCAT) is missing for all records in the inpatient services (ANCIL) file. The SQL tables [Dim]. visit VeteransCrisisLine.net for more resources. 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. Veterans Crisis Line:
Fee Basis Services. (refer to the Category tab under Runtime Dependencies), Users must ensure that Microsoft Structured Query Language (SQL) Server is implemented with VA-approved baselines. To access the menus on this page please perform the following steps. Electronic Data Interchange (EDI): Payer ID for medical and dental claims is VA CCN. If you are in crisis or having thoughts of suicide,
Ready. To access the menus on this page please perform the following steps. While a researcher could theoretically conduct a Fee Basis analysis using SAS data and then upload these SAS data to CDW and pull in the relevant variables from the SQL Patient domain, this poses some logistical challenges. 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. There are up to 25 ICD-9 diagnosis codes and 25 ICD-9 surgical procedure codes in the inpatient data. 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/.