Available at: http://vaww.virec.research.va.gov/CDW/Overview.htm. Accessed October 16, 2015. 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. Guidance can be found under "VHA Data Quality Program Reports. To enter and activate the submenu links, hit the down arrow. (Anything), but would not cover any version of 7.5.x or 7.6.x on the TRM. 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. All analyses using this cohort should use PatientICN as indicative of a unique patient. VHA Office of FinanceP.O. 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. 21. Pre-2007, DISAMT and INTAMT each have two implied decimal places a value of 1000 would indicate $10.00. 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. Not all of these variables appear in every utilization file. Community providers should remain in contact with the referring VA Medical Center to ensure proper care coordination. Payer ID for dental claims is 12116. 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. There are three routes for filing claims for authorized care which depend on your status in VAs network and how the care was authorized: All non-urgent and non-emergent care requires authorization from VA in advance. For these reasons, VA strongly encourages Veterans to consider important factors, risks and benefits before making any changes to their private health insurance. All Choice claims are processed by VISN 15. Unauthorized user attempts Review the Where to Send Claims section below to learn where to send claims. In VA datasets, the MDCAREID does not have an accompanying address, but one can use other non-VA datasets (e.g., Hospital Compare) and determine the address of the hospitals physical location through the common MDCAREID variable. Using the Non-VA Medical Care data for research requires a basic understanding of laws and regulations that govern it. 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. Go to CDW Home, click on CDW MetaData, then click on the link for Purchased Care. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. You can use NPI to link providers in VA and Medicare. (Available at the VHA Data Portal. Last updated August 21, 2017 There may be many providers that use the same vendor for billing. SQL Fee Basis data are stored in CDW in multiple individual tables. 1. VA contracts out its hospice; therefore, the Fee Basis files contain a great deal of data related to hospice care. In the outpatient data, each record represents a different procedure, as assessed through the Current Procedural Terminology (CPT) code. Thus, our recommendation is as follows: Use disbursed amount to calculate the cost of care, except in the case where disbursed amount is missing and the payment was not cancelled. Working with the Veterans Health Adminstration: A Guide for Providers [online]. VAntage Point. TRM Proper Use Tab/Section. Electronic Data Interchange (EDI): Payer ID for medical claims is 12115. This component is a service that communicates directly with the High Availability Controller (HAC) SQL database for syncing critical fee data back into the local FBCS MS SQL database. To access the menus on this page please perform the following steps. PDF Office of Inspector General - Oversight.gov VIReC. Office of Information and Analytics. The Department of Veterans Affairs has implemented centralized mail processing (CM) for compensation claims to reduce incoming paper handling and shipping requirements. The Medicare Ambulance Fee Schedule consists of a base rate plus mileage. For the purpose of this guidebook, we focus on Fee Basis files only. It would seem logical to use the vendors location, found in the vendor files PHARVEN and VEN, to associate care with a particular station, but this should be approached with caution. If the Veteran went to the ED and was not admitted to the hospital, this would be considered outpatient care. 2. If the patient is transferred from a non-VA to a VA hospital, the non-VA component of this care will be captured through Fee Basis, while the VA component of this care will be in the VA inpatient datasets. There is a CPT field in the inpatient files, but this is always missing; hospitals do not use CPT codes to bill. 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. However, not all dates on the claim are approved. Thus, the mailing address of the vendor is not always the vendors actual location. Of note, the FBCS was not in place nationwide prior to FY 2008. For more details, including rules for handling patients transferred during a stay, see federal regulation 38 CFR 17.55. For some VEN13N, however, there is more than one MDCAREID. There are exceptions. PatientIEN and PatientSID are found in the general Fee Basis tables. Claims for Non-VA Emergency Care The VA Fee Schedule is available at provider.vacommunitycare.com > Documents & Links. As noted earlier, there are often multiple records that indicate a single inpatient stay each record pertains to a unique invoice number. 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. It is not available for claims in which payment was based on a contract amount. There are additional payments for direct medical education, capital-related costs, and other factors as appropriate. These data indicate the specialty code associated with the vendor, such as orthopedic surgery, cardiology, family practice, etc. 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. Before this time, data were entered by hand, and there was no easy way to tell whether the claim being entered was a duplicate one. visit VeteransCrisisLine.net for more resources. Persons looking to classify patients Veterans by race and ethnicity are encouraged to read VHA guidance available on the Data Reports page of the VHA Data Portal (available on the intranet at http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). For authorized care, the referral number listed on the Billing and Other Referral Information form. Accessed October 07, 2015. If the payment was made outside of FBCS, they wont show here. For example, a hospital stay may last from Jan 1, 2010 to Jan 10, 2010, and have another claim for treatment provided on Jan 5, 2010. In summary, in order to create a research cohort, one must first identify the cohort based on PatientSID, then request the CDW data manager to link the PatientSIDs in her cohort to unique PatientICNs, and finally remove test/dummy/unnecessary PatientSIDs and PatientICNs. However, in all data files, the vast majority of observations are missing values for this variable. Class 2 or Class 3 products must restrict their interfaces to Class 1 National Software to use of publicly-supported APIs ONLY. There are no references identified for this entry. Of note, SQL and SAS data contain similar, but not exactly the same, information. [FeeInpatInvoice] and [Fee]. When evaluating the cost of care, use the disbursed amount. These correspond to fields, rows and tables in a relational database. Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA care. The Veterans Access, Choice, and Accountability Act (Veterans Choice Act), passed in 2014, expanded veterans access to non-VA care. Billing & Insurance - New York/New Jersey VA Health Care Network Please switch auto forms mode to off. In general, persons on active duty in the U.S. military are excluded even if they are transitioning to VA care. [LocalDrug] table through LocalDrugSID to see whether there was the generic equivalent found in the VA drug file that was dispensed to the patient. Coverage will start July 1 of that year. 866-505-7263, Veterans Crisis Line: The VA pays for both emergency and non-emergency care through Fee Basis mechanisms. VA systems are intended to be used by authorized VA network users for viewing and There may be multiple vendor IDs (VENDIDs) for a single inpatient stay. 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 . U.S. Department of Veterans Affairs. VA evaluates these claims and decides how much to reimburse these providers for care. 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. 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. Customer Engagement Portal - Veterans Affairs This means the data were placed in the PIT and the claim was not paid through FBCS. As of July 2015, the current mileage reimbursement rate is 41.5 cents per mile. For example, to understand the ICD-9 codes associated with a particular inpatient encounter, one would have to link the [Fee]. Providers cannot bill both VA and the patient or another insurer for the same encounter. As of April 2019, this guidebook is no longer being updated. Prescription-related data in the PHARVEN file contain only summary payments by month. You can submit a corrected claim or void (cancel) a claim you have already submitted to VA for processing, either electronically or in paper. Care provided under contract is eligible for interest payments. SAS and SQL data are organized differently and contain different variables. To access the menus on this page please perform the following steps. The second record would have an admission date of Jan 5, 2010 and a discharge date of Jan 5, 2010. Through patient identifier and travel date (TravelPaymentDate), one can link these payments to inpatient and outpatient encounters. Appendix G lists all available FPOV codes and classifies them as inpatient or outpatient. Move on to the next patient ID, STA3N, VEN13N combination and repeat the entire process above. Some missingness may indicate not applicable.. By June 2017, no Choice stays are found in FBCS. Each observation in the SAS and SQL data has an accompanying vendor ID. Care provided to persons associated with a particular VA station can be found by selecting records by STA3N. Several variables are available for locating care in particular settings. This technology can use a VA-preferred database. There is also a host of non-emergency surgery provided through Fee Basis mechanisms that may be of interest to researchers. The status value A stands for accepted, meaning the claim was paid. The Fee Basis schema data can be found at the CDW SharePoint portal at the links below (VA intranet only). The Medicare hospital provider ID (MDCAREID) is entered by fee basis staff in order to calculate hospital reimbursement using the Medicare Pricer software. File a Claim for Veteran Care - Community Care - Veterans Affairs Veterans who meet certain criteria may be eligible for mileage reimbursement for travel to and from VA or Non-VA care. MDCAREID is not available in the outpatient SAS Fee Basis data, even though some outpatient services are provided in a hospital. As with the SAS data, the important variables in the SQL data are the AmountPaid and the DisbursedAmount. There are delays in the processing of Fee Basis claims. 3. U.S. Department of Veterans Affairs. Hit enter to expand a main menu option (Health, Benefits, etc). 2. Please switch auto forms mode to off. It is only relevant for claims linked to VistA patients. If this is the case, then it can be assumed that any care provided by the vendor with that VEN13N is actually a hospital with that MDCAREID. Users must ensure that Microsoft .NET Framework, Microsoft Structured Query Language (SQL) Server, and Microsoft Excel are implemented with VA-approved baselines. Smith MW, Su P, Phibbs CS. In SAS, ICD-9 diagnosis codes are in the Inpatient, Outpatient and Ancillary files. Each table has only one primary key field. 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. New values may be added over time. 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). There is no official data dictionary for the SAS Fee Basis data. 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). CDW Data Quality Analysis Team has particular recommendations for excluding observations before beginning analyses on your cohort.13 Corporate Data Warehouse (CDW) contains dummy data as well as test patients that will need to be removed from tables before conducting analyses. In the SAS data, the provider component of the inpatient stay is captured in the ancillary file. MDCAREID is the Medicare OSCAR number, which is a hospital identifier. This care will be approved (or denied) by the local VA Fee Office; the Veteran is then free to seek non-VA care. YESInstitutional/UB Claims. Veterans are not responsible for the remaining balance shown as patient responsibility on the explanation of benefits from their insurance carrier. Hit enter to expand a main menu option (Health, Benefits, etc). These data records cannot be linked to particular patient identifiers or encounters. 5. 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. 3. . We assume here that new inpatient stays are defined by a change in vendor or a gap in treatment day more than 1 day. 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 vendor identity can be found through the VENDID or VEN13N variables in SAS. Appropriate access enforcement and physical security control must also be implemented. INTIND and INTAMT are not always concordant. Most of these fields would be empty. [FeeInpatInvoice] table, one must first link that table to the [Fee]. In SQL, there are additional variables that will denote the type and location of the care provided along with the vendor. Therefore, it is not possible to do an exact comparison across the datasets. In both SAS and SQL, it can be difficult to determine the provider the Veteran saw for Fee Basis care. This component communicates with the FBCS MS SQL and VistA database in real time. However, a 7.4.x decision Prescription information: Prescribing provider's name. The prescription must be for a service-connected condition or must otherwise have specific approval. U.S. Department of Veterans Affairs. The SQL prescription data are housed in the [Fee]. 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. 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. Domains represent logically or conceptually related sets of data tables. The SAS Fee Basis data are organized by fiscal year. 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. Data Quality Analysis Team. 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. Many veterans now have access to Non-VA medical care through the new Veterans Access, Choice, and Accountability Act (VACAA, or Choice Act). To enter and activate the submenu links, hit the down arrow. For more information, please visit the Data Access Request Tracker (DART) Request Process page on the VHA Data Portal(VA intranet only: http://vaww.vhadataportal.med.va.gov/DataAccess/DARTRequestProcess.aspx#resources). The NPI is the national provider identifier, which is provider-specific but often missing in the Fee Basis data. If it cannot be located in the PTF Main file or DSS NDE for inpatient care, search other inpatient files. Cunningham, K. VA implements the first of several Veterans Choice Program eligibility expansions. Menlo Park, CA. Veterans Health Administration. Then, to see which ICD procedure codes were coded for this inpatient stay, one must link to the [Dim]. Provider Portal - Veterans Affairs VA HEALTH CARE Management and Oversight of Fee Basis Care Need. [ICDProcedure] table and a foreign key in the [Fee]. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Health - Veterans Affairs The FMS disbursed amount is the payment amount plus any interest payment. Other Health Insurance (OHI) and Explanation of Benefits (EOBs), Any other document type normally sent via paper in support of a Veteran unauthorized emergency claim. The FeeSpecialtyCodeName contains information on the specialty of the provider seen, such as oncology, chiropractic, pathology, neurosurgery, etc., but is missing much data. 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. 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. Missingness can vary substantially by year and by file. The electronic 275 transaction process may be utilized to supply Remittance Advice documentation for timely filing purposes. April 14, 2014.
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