There are nine situations in which Non-VA Medical Care is authorized. If the Veteran received care in the community that was not pre-authorized, it is considered unauthorized by VA. Thus the variable INTIND (interest indicator) equals 1 if the claim is eligible for interest and 0 otherwise. 2. Payer ID: 1. VIReC. If the VA Fee Schedule does not include a rate for the covered service provided, reimbursement will be made at 100% of customary charges, as defined in the provider's VA CCN Payment Appendix. (refer to the Category tab under Runtime Dependencies), Users must ensure that Microsoft Structured Query Language (SQL) Server is implemented with VA-approved baselines. _________________________________________________________________. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Quality of Life and Veterans Affairs Appropriations Act of 2006 (Public Law 109-114),the FSC offers a wide range of financial and accounting products and services to both the VA and Other Government Agencies (OGA). SQL data must be linked from multiple tables in order to create an analysis dataset. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). As with the SAS data, the important variables in the SQL data are the AmountPaid and the DisbursedAmount. Appropriate access enforcement and physical security control must also be implemented. Through the CCN, Veterans have access to regional networks of high-performing, licensed health care . Our review of the data suggests that pharmacy and ancillary claims take longer to process than inpatient or outpatient claims. VA Fee Basis Programs. 7. In SQL, there are multiple patient identifiers, with the most useful being the PatientICN. The SAS files also include a patient type variable (PATTYPE). All instances of deployment using this technology should be reviewed by the local ISSO (Information System Security Officer) to ensure compliance with. All analyses using this cohort should use PatientICN as indicative of a unique patient. 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. Up to FY2008 data, DXLSF is labeled as 1st Diagnosis Code. In FY2009 and on, DXLSF is labeled as the Admitting or Primary Diagnosis Code. In FY 2009 and later SAS data, there is also another variable, DX1, which is not present in SAS data prior to FY2009. [FeeTravelPayment] contain information on travel type and payment. NPI is available within the VA CDW SStaff table. 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. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. This rare event most likely indicates a transfer. U.S. Department of Veterans Affairs. NNPO. However, a 7.4.x decision 2. 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. Contact the VA North Texas Health Care System. 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 . Make sure you have received an official authorization to provide care or that the care is of an emergent nature. PMS-DRG was effective in FY 2008; prior to this time CMS-DRGs were used. Appendix G lists all available FPOV codes and classifies them as inpatient or outpatient. Microsoft Internet Explorer, a dependency of this technology, is in End of Life status and must no longer be used. We assume here that new inpatient stays are defined by a change in vendor or a gap in treatment day more than 1 day. Below we describe the general types of information in both the SAS and SQL data. 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. 6. For example: services provided at a hospital anticoagulation clinic are billable for facility charges only if the anticoagulation is considered incident to physician services and certain other conditions are met.8. Some Fee Basis data will also appear in the non-VA medical SAS inpatient file (formerly called the Patient Treatment File). A foreign key is a key that uniquely identifies a record of another table. This seeming complicated arrangement is an efficient way to store data. 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. For example, DISAMT=1000 in FY06 really indicates DISAMT=10.00. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). 1. SAS data also contain an additional diagnosis variable that is not present in the SQL data -- DXLSF. When MDCAREID is not available, it is possible to assign MCCAREID based on the relationship between VEN13N and STA6A. VINCI Data Description: Dimension [online; VA intranet only]. Patient identifiers are also different across SAS and SQL data. [FeePharmacyInvoice] table contains information on vendor, amount claimed, and amount paid. The new temporary end date is the maximum of the discharge date of the third observation and temporary end date from Step 2. 5. 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). 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. 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. The status value R stands for re-routed, meaning the claim was re-routed to the Health Administration Center (HAC). 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). In FY 2014, the longest length of stay associated with a single nursing home invoice was 31 days. Use of this technology is strictly controlled and not available for use within the general population. This guide was published in October 2015; the same month the United States switched from ICD-9 to ICD-10. VA CCN OptumP.O. 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. VA Palo Alto, Health Economics Resource Center; October 2013. Most importantly, they do not represent all care provided during the fiscal year. 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 With additional permissions, researchers can also access City, Postal Code, Street Address, and Zip. Therefore, to get an understanding of the total cost of this care, one would have to link the Fee Basis data to VA utilization datasets. Six additional variables indicate the setting of care and vendor or care type. Using the Non-VA Medical Care data for research requires a basic understanding of laws and regulations that govern it. Table 1 in the Data Quality Analysis teams guide Linking Patient Data in the CDW Updateprovides a brief summary for each identifier (Available atthe VHA Data Portal. See 38 USC 1725 and 1728.). 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. 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. The variable DTStamp represent the date the claim was received. All tablesmentioned in the Fee Basis guidebookare storedin an Excel file. In SQL, the outpatient data are housed in the FeeServiceProvided table. Reimbursement for Pharmacists Services in a Hospital-based, Pharmacist-managed Anticoagulation Clinic. 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]. Accessed October 16, 2015. 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. [FeePharmacyInvoice] and the [Fee]. However, not all dates on the claim are approved. The vendor no longer supports VA installations of this technology. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. 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. Veterans Health Administration. Prior to FY 2007, INTAMT has two implied decimal places. In general, persons on active duty in the U.S. military are excluded even if they are transitioning to VA care. 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. We are grateful for their cogent work. Several variables are available for locating care in particular settings. To evaluate the time it takes VA to process Fee Basis claims, we evaluated SAS data for FY2014. This technology can integrate with and alter database technologies. In the outpatient data, one observation represents a single CPT code. The CDW is a relational database organized into a collection of data domains implemented on the Microsoft SQL server in VINCI. 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. 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. U.S. Department of Veterans Affairs. Multiple SAS datasets have VENID and VEN13N. (Available at the VHA Data Portal. In the SAS data, the provider component of the inpatient stay is captured in the ancillary file. With few exceptions these variables will be of little interest to researchers. Detailed information about accessing each of these data sources is available at the VHA Data Portal (VA intranet only: http://vaww.vhadataportal.med.va.gov).See Table 10 for a summary of the data sources. The definition of the DXLSF variable changes depending on the year of analysis. As part of the process, claims and supporting documentation are scanned for compliance prior to conversion to electronic format. You will have to pay this penalty for as long as you have Part B. In that case, use payment amount instead. Unscheduled trips may be reimbursed for the return mileage only. Payer ID for dental claims is 12116. In the outpatient data, each record represents a different procedure, as assessed through the Current Procedural Terminology (CPT) code. If electronic capability is not available, providers can submit claims by mail. All Choice claims are processed by VISN 15. Accessed October 16, 2015. To enter and activate the submenu links, hit the down arrow. This component is a service that communicates with the Program Integrity Tool (PIT) which scores claims and sends results to FBCS. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). VA is the primary and sole payer when VA issues an authorization. Additional information appears in a federal regulation, 38 CFR 17.52. After a claim is submitted electronically it must be entered manually into a Non-VA Medical Care approval system. The status value A stands for accepted, meaning the claim was paid. Box 108851Florence SC29502-8851, Delta Dental of CaliforniaVA Community Care NetworkP.O. You can further refine by selecting records on or after November 4, 2014, when Choice was first enacted. 2. Download the tables here. This component provides a front end for validation and/or correcting the data that was read from the claim via the OCR module. Persons looking to find the date of service should be advised that it will not be contained in the FeeServiceProvided table. 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. Details about the VA rules governing reimbursement can be found in Chapter 7 of this guidebook. 13. In the SQL files, there is no separate ancillary file; rather, data regarding the physician cost of the inpatient stay is denoted in the [Fee]. These correspond to fields, rows and tables in a relational database. Missing values of PAYCAT could be imputed by finding the corresponding inpatient stay in the INPT file. This application is directly attached to TWAIN compliant scanners and works offline to VistA and the FBCS MS SQL databases. Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. [FeeServiceProvided], [Fee]. The disbursed amount should be used to calculate the cost of care, except in the case where disbursed amount is missing. 1. 9. The Florida Department of Veterans' Affairs has Claims Examiners co-located with the VA Regional Office in Bay Pines, each VA Medical Center and many VA Outpatient Clinics. 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. This technology has not been assessed by the Section 508 Office. We crosswalked the ScrSSN to allow for comparison with SAS data. The DSS Fee Basis Claims System (FBCS) is a web-based claim management system. The PatientSID is a CDW assigned identifier that uniquely identifies a patient within a facility. The mileage fee varies by type of ambulance service: ground, fixed wing, or rotary wing, POP zip code classification, and loaded mileage. The electronic 275 transaction process may be utilized to supply Remittance Advice documentation for timely filing purposes. 3. b. Home Health Agencies billing with an OASIS Treatment number use the Prior Authorization segment for the TAC and the Referral Number segment on the 837I submission. Paper claims and supporting documentation submitted to us are converted to Electronic Data Interchange (EDI) transactions. To access the menus on this page please perform the following steps. This improves claim accuracy and reduces the amount of time it takes for us to process claim determinations. 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). 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). [FeeInpatInvoice], [Fee]. Office of Information and Analytics. 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. PatientIEN and PatientSID are found in the general Fee Basis tables. Care for dependent children, except newborns, in situations where VA pays for the mothers obstetric care during the same stay. Visit the VHA Data Portal for further information on accessing restricted VSSC web reports. Technologies must be operated and maintained in accordance with Federal and Department security and 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. Documentation, including data contents, field frequencies, and record counts, is also available on VIReCs CDW Data Documentation page (VA intranet only: http://vaww.virec.research.va.gov/CDW/Documentation.htm). Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. As noted in Chapter 2, the important variables capturing cost of care are AMOUNT and DISAMT. The procedure code table has just as many records as there were procedures on the invoice. Another approach is to search other fee claims submitted by the same vendor to see if a Medicare hospital ID was assigned to those claims. While NPI is available in SQL data, it does require special permissions to access, as it is located in the [Sstaff]. The Fee Purpose of Visit (FPOV) and Health Care Financing Agency Payment Type (HCFATYPE) variables feature values pertaining to setting (inpatient, outpatient, home-based), specific items (e.g., supplies and diagnostics), and miscellaneous purposes.[1]. [FeeInpatInvoice], and a foreign key in the [Fee].[FeeInpatInvoiceICDProcedure]. The Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law 111-163) authorizes VA to provide post-delivery and routine care to a newborn child of qualifying women Veterans receiving VA maternity care for up to seven days following the birth. There is very limited outpatient pharmacy data in the Fee files. 2. For the inpatient data, we compared observations with the same patient identifier, based on PaidDate in SQL and TRANSDAT in SAS. There are five forms of patient identifiers in SQL files at CDW (including but not limited to the Fee Basis files): PatientICN, PatientSID, PatientSSN, ScrSSN, and PatientIEN. VSSC provides numerous relevant web reports, data resources, and analytics support, including summary data by facility and VISN and national summary data. [FeeVendor] table. Missingness can vary substantially by year and by file. 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. SQL tables can be joined through linking keys. Move on to the next patient ID, STA3N, VEN13N combination and repeat the entire process above. There is limited information on the providers associated with Fee Basis care. Unlike the other patient identifiers in SQL such as PatientIEN or PatientSID, PatientICN is supposed to be unique to each patient across VA. The majority of claims, 99%, were processed within 2 years, with the exception of pharmacy data in FY 2004 and FY2008. The Department of Veterans Affairs' (VA) fee basis care spending increased from about $3.04 billion in fiscal year 2008 to about $4.48 billion in fiscal year 2012. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. 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. [XXX] tables.9,12 Tables under the DIM schema contain attributes that describe the records in the Fee tables. Institutional Aspects of the Non-VA Medical Care System, https://www.va.gov/health-care/get-reimbursed-for-travel-pay/, http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. The Veteran's full 9-digit social security number (SSN) may be used if the ICN is not available. It is available in the PHARVEN and VEN files, albeit with a high degree of missingness. Access; upload; download; change; or delete information on this system; Otherwise misuse this system are strictly prohibited. In most cases, if you don't sign up for Part B when you are first eligible, you'll have to pay a late enrollment penalty. The Act amends 38 U.S.C. At the time of this writing, the NPI number was often missing from fee basis claims. SAS Fee Basis data can be linked to other SAS files with additional demographic data (e.g., Vital Status files, enrollment files). In some cases, there is a one-to-one relationship between VEN13N and MDCAREID. 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. The SQL prescription data are housed in the [Fee]. Inpatient procedures are captured by ICD-9 procedure codes (SURG9CD1-SURG9CD25) in the hospital claims file. VA employees working on research studies cannot create their own crosswalk file as they do not have permission to use these files. The SAS Fee Basis data are organized by fiscal year. To access the menus on this page please perform the following steps. This application reads/creates/edits fee payment data in VistA and copies critical information into the central SQL database for off-line VistA applications to consume, and now includes Unauthorized payments. Sign up to receive the VA Provider Advisor newsletter. VAntage Point. Dental claims must be filed via 837 EDI transaction or using the most current. Non-VA providers submit claims for reimbursement to VA. 8. 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. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/.
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