There are often multiple observations per inpatient stay and multiple observations per outpatient encounter. A summary of the payment guidelines can be found in Appendix I. In FY 2014, the longest length of stay associated with a single nursing home invoice was 31 days. [FeeServiceProvided], [Fee]. SAS and SQL data are organized differently and contain different variables. 9. Mail to: DEPARTMENT OF VETERANS AFFAIRS. For some vendors, there may be more than on possible hospital, for example, if the vendor is a hospital chain or an organization with a VA contract. Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. For example, accessing FY2014 data on Dec 1, 2014 will likely result in fewer observations than when accessing FY 2014 data on Dec 1, 2015. Below we describe the general types of information in both the SAS and SQL data. [FeePrescription] tables. 1. Basic demographic variables can be found in the [Patient]. The Medicare ID is missing if the payment is determined via a different mechanism (e.g., a contract). There are different ways of costing out an inpatient stay in SAS and SQL data. 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. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. [ SFeeVendor] table. Identifying Veterans in the CDW [online; VA intranet only]. For additional information or assistance regarding Section 508, please contact the Section 508 Office at Section508@va.gov. 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. We continue on this process until we find a gap greater than 1 day or we have evaluated all observations with that patient ID, STA3N and VEN13N. If you are in crisis or having thoughts of suicide, TriWest VA CCN ClaimsP.O. For example, sta3n 589A5 will be found as 589. If a patient received care at another facility, that patient will be have a different PatientSID assigned for that facility. Electronic Data Interchange (EDI): Payer ID for medical claims is 12115. 13. Actual processing time has varied considerably over the years. The same cannot be said for DX2-DX25, however, as additional diagnosis codes are optional. Inpatient care, regardless of patients health status, if VA was not notified within 72 hours of admission. 2. Chapter 8 provides references for further information about the Fee Basis program and data. Edward J. Hines, Jr. VA Hospital, Hines, Ill. 2007. Cunningham, K. VA implements the first of several Veterans Choice Program eligibility expansions. Many variables in the Fee Basis files record details of invoice and check processing. Information from this system resides on and transmits through computer systems and networks funded by the VA. Gidwani R, Hong J, Murrell S. Fee Basis Data: A Guide for Researchers. 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. The vendor represents the entity billing for the non-VA care, while the provider represents the person who was involved in care provision. This table also includes claims related to inpatient care and other services. Both the SAS and SQL Fee Basis are housed at VINCI; the SQL data is also found at the Corporate Data Warehouse (CDW). The process for filing a claim for services rendered to a Veteran in the community varies depending upon whether or not the services were referred by VA and by the entity through which the services were authorizedVA or one of the VA Third Party Administrators (TriWest Healthcare Alliance or Optum United Health Care). 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. If FIPS 140-2 encryption at the application level is not technically possible, FIPS 140-2 compliant full disk encryption (FOE) must be implemented on the hard drive where the DBMS resides. VINCI Data Description: Fee/Purchased Care [online; VA intranet only]. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. However, we conducted some comparisons for inpatient data. The National Provider Identifier (NPI) is a unique 10-digit identification number issued by the Centers for Medicare and Medicaid Services to all health care providers in the United States. These vendors are presumably hospital chains. Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. Note that the vendor may represent the hospital, a hospital chain or the entity billing on behalf of the provider. Researchers using this tactic also run the risk of not being able to properly link their cohort, as other HERC investigations have revealed an imperfect relationship between SCRSSN and ICN; some SCRSSNs do not have an accompanying PatientICN; some SCRSSNs have multiple PatientICNs. 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. NNPO. Business Product Management. How to create a secondary claims in eclinicalworks electronically; . Conversely, all stays should have at least one discharge diagnosis. U.S. Department of Veterans Affairs. field. Among non-missing observations, HERC analyses found a many-to-many relationship among NPI and VEN13N. Researchers interested in linking SQL Fee Basis data to the rich patient-level or vendor and/or provider information available in the rest of the Corporate Data Warehouse should apply for permissions to access these other datasets. 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. As noted above, non-VA care may be authorized under the Non-VA Medical Care program when VA cannot offer needed care. The Implementer of this technology has the responsibility to ensure the version deployed is 508-compliant. Providers are not required to accept VA payment in all cases. This is true for both the inpatient and the outpatient data, albeit for different reasons. 2. 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. [ICD] table, the latter of which contains a list of all possible ICD-9 codes. It is only relevant for claims linked to VistA patients. Medications dispensed in a health care facility such as a doctor's office, dialysis clinic, or hospital outpatient clinic, such as injectable medications or infusions, will be found in the outpatient data, where they will be identified by CPT code. Summary data are also available through the VHA Support Services Center (VSSC) website on the VA intranet. New values may be added over time. Prescription-related data in the PHARVEN file contain only summary payments by month. Care provided under contract is eligible for interest payments. There is also a host of non-emergency surgery provided through Fee Basis mechanisms that may be of interest to researchers. Technology must remain patched and operated in accordance with Federal and Department security policies and guidelines in order to mitigate known and future security vulnerabilities. Additionally, we found 0.94% of records were approved Choice claims (e.g., records where SPECIALPROVCAT= CHOICE and STATUS= A (approved)). SQL data are housed at CDW, which is a collection of many servers. Box 108851Florence SC29502-8851, Delta Dental of CaliforniaVA Community Care NetworkP.O. This rule applies even when the patient is incapable of making a call. A Non-VA Medical Care claim is defined by four elements: The remainder of section 7.4 details payment rules as of early 2015. MDCAREID is available in most inpatient SAS Fee Basis records. For more information call 1-800-396-7929. YESThis insurance is also known as: Veterans Administration. This component communicates with the FBCS MS SQL and VistA database in real time. You are strongly encouraged to electronically submit claims and required supporting documentation. Please switch auto forms mode to off. This means the data were placed in the PIT and the claim was not paid through FBCS. However, a 7.4.x decision Chapter 4 offers detailed information SAS Fee Basis data; Chapter 5 provides detailed information about SQL Fee Basis data. With additional permissions, researchers can also access City, Postal Code, Street Address, and Zip. Appendix D contains information on the primary and foreign keys needed to link the various SQL tables. Providers who continue to elect to submit paper claims and paper documentation to support claims for unauthorized emergency care should be aware of the following: VHA Office of Integrated Veteran Care P.O. 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. HERC investigation of Fee Files reveals certain data anomalies of which researchers should be aware. Accessed October 16, 2015. 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). ", Military service variables can be found in [PatSub],[PatientServicePeriod], [Patient]. Data Quality Program. We detail differences amongst the SAS and SQL Fee Basis data in the guidebook below. https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Authorized_5638.jpg, https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Unauthorized_242.jpg, https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Service_5480.jpg. resides on and transmits through computer systems and networks funded by the VA. [XXX] tables.9,12 Tables under the DIM schema contain attributes that describe the records in the Fee tables. Most ED visits will be identified through FPOV values of 32 or 33. 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). The codes for the procedures provided for a given hospital stay are kept in a separate table, a table of procedures. Those options are: Utilize HealthShare Referral Manager (HSRM) for referrals, authorizations and documentation exchange. The discussion below pertains to both SAS and SQL data. While all non-VA providers must submit a claim to VA in order to be reimbursed for care, the claim filing deadline depends on the type of claim. However, in all data files, the vast majority of observations are missing values for this variable. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). 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. 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. Subscribe to our E-newsletter The Service Connection Our monthly newsletter features about important and up-to-date veterans' law news, keeping you informed about the changes that matter. Several variables are available for locating care in particular settings. Researchers should use PatientICN to link patient data within CDW. Such care is called Non-VA Medical Care, or Fee Basis care. For authorized care, the referral number listed on the Billing and Other Referral Information form. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. 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. For more detailed information, researchers should visit the VHA Office of Community Care website. The generosity of the coverage is immaterial; if it covers any part of the providers bill, then VA may not pay anything. How Does VGLI Compare to Other Insurance Programs? 2. 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). It is the patient identifier that uniquely defines a patient across all facilities. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Multiple SAS datasets have VENID and VEN13N. Below are some answers to general questions about the FBCS tables. 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). In the SAS data, the provider component of the inpatient stay is captured in the ancillary file. Much Fee Basis care is pre-authorized prior to the Veteran obtaining care and is thus considered Authorized Care. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. Data Quality Analysis Team. U.S. Department of Veterans Affairs. 15. 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. Use of this technology is strictly controlled and not available for use within the general population. All information in this guidebook pertains to use of ICD-9 codes. Accessed October 16, 2015. In both SAS and SQL, it can be difficult to determine the provider the Veteran saw for Fee Basis care. Six additional variables indicate the setting of care and vendor or care type. Include the authorization number on the claim form for all non-emergent care. Most commonly, authorized care refers to medical or dental care that was approved and arranged by VA to be completed in the community. U.S. Department of Veterans Affairs. 1725 when remaining liability to the Veteran is not a copayment or similar payment. Domains represent logically or conceptually related sets of data tables. 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. 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. YESElectronic Remittance (ERA)YESICD- 1. Ready. The 2 sets of DRGs are not interchangeable. 2010;47(8):725-37. 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. The SAS PHARVEN dataset contains information only about pharmacy vendors. 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. U.S. Department of Veterans Affairs. This is in line with the way VHA Office of Productivity, Efficiency & Staffing (OPES) ascertains ED visit. However, in Table 4, we present some comparisons to demonstrate the different between SAS and SQL data. one episode of care, which can have multiple dates within the prescribed treatment, one provider, as identified by the Tax Identification Number (TIN), and. If you submit a noncompliant claim and/or record, you will receive a letter from us that includes the rejection code and reason for rejection. Each table has only one primary key field. Accessed October 16, 2015. March 2015. All instances of deployment using this technology should be reviewed to ensure compliance with. Available at: http://vaww.virec.research.va.gov/CDW/Overview.htm. Chief Business Office. VA intranet users can visit https://vaww.va.gov/communitycare/ (intranet only). Veterans Health Administration. VA systems are intended to be used by authorized VA network users for viewing and Attention A T users. Please see Section 2.1.4. for HERC advice about how to collapse multiple observations to evaluate the length and cost of a single inpatient stay. VA Fee Schedule. You can submit a corrected claim or void (cancel) a claim you have already submitted to VA for processing, either electronically or in paper. 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. SQL tables can be joined through linking keys. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. However, previous HERC investigation confirmed these are partial payments made for a single encounter or procedure. VA payment constitutes payment in full. U.S. Department of Veterans Affairs. VA employees working on research studies cannot create their own crosswalk file as they do not have permission to use these files. 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]. Hit enter to expand a main menu option (Health, Benefits, etc). more information please visit www.fsc.va.gov. One can use the FeeInitialTreatmentSID variable in the FeeServiceProvided table to link to the Fee.FeeInitialTreatment table. Domains generally indicate the application in the VistA electronic health record system from which most of the data elements come (e.g., Vital Signs or Mental Health Assessment).6. In SAS, the Patient ID will be the SCRSSN and the admit date is the treatment from date. For more details, including rules for handling patients transferred during a stay, see federal regulation 38 CFR 17.55. 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. Accessed October 16, 2015. 866-505-7263, Veterans Crisis Line: FBCS supports payment of claims via VistA. VA Palo Alto, Health Economics Resource Center; October 2013. A foreign key is a key that uniquely identifies a record of another table. visit VeteransCrisisLine.net for more resources. Prescription information: Prescribing provider's name. 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. VA CCN OptumP.O. VIReC. [FeeInpatInvoiceICDProcedure] table. As a single encounter may have more than one CPT code, users may have to aggregate multiple observations in order to evaluate the care received on a particular day. 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). 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. Data from FY1998 and FY1999 have a greater degree of discordance. Note that some physicians use the same ID number as the hospital. Once the process is exhausted for a particular patient, STA3N and VEN13N combination, we calculate length of stay as the difference between the admission date of the first record and the temporary end date.. The VA Fee Basis medical program provides payment authorization for eligible Veterans to obtain routine medical treatment services through non-VA health care providers. 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. PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. Starting in 2009, there are also a number of DXPOA variables in the SAS data, which indicate diagnoses that are present on admission. The FPOV variable can be found in both the SAS and SQL data. The data files in each fiscal year represent all claims processed in the FMS during the year. SQL tables require linking before conducting any data analyses. This component provides a front end for recognizing claim data through optical character recognition (OCR) software. Researchers with VA intranet access can access these sites by copying and pasting the URLs into their browser. If your claim was submitted to VA, call (877) 881-7618, If your claim was submitted to TriWest, call (877) 226-8749. However, the VA may pay a rate higher than the Medicare Fee Schedule rate for care provided in highly rural areas, as long as this rate is determined to be fair and reasonable by VA. One can find more information on payment rates under the Veterans Choice Act in federal regulation 17.1500. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. Important: The mailing address below only pertains to disability compensation claims. A claim void must be identical to the original claim that it is intended to cancel. (In SAS the admission date is denoted by the TREATDTF variable and the discharge date by the TREATDTO variable, in SQL the admission date is denoted by the AdmissionDate field and the discharge date is denoted by the DischargeDate field). In this chapter, we discuss general aspects of Fee Basis data. There is another category of Fee Basis care that is considered unauthorized care. At the time of writing, version 4.2 is the most current version. ______________________________________________________________________________. The SAS files also include a patient type variable (PATTYPE). Emergent care patient liabilities not tied to copayments or deductibles will continue to be considered for secondary payment by VA. For additional questions, contact VA by phone, tollfree, at (877) 881-7618. All SAS variables are denoted in capital letters, while SQL fields are denoted without spaces, in accordance with how these fields are labeled in the SQL tables. There are two important variables to consider if evaluating the cost (VA reimbursement) of Fee Basis Care: the payment amount (AMOUNT in SAS, PaidAmount in SQL) or the Financial Management System (FMS) disbursed amount (DISAMT in SAS, DisbursedAmount in SQL). If researchers wish to identify ED visits, they may want to use CPT codes or Place of Service codes, rather than FPOV. 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 FeeSpecialtyCodeName contains information on the specialty of the provider seen, such as oncology, chiropractic, pathology, neurosurgery, etc., but is missing much data. There is very limited outpatient pharmacy data in the Fee files. For example, a technology approved with a decision for 7.x would cover any version of 7. 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. - The information contained on this page is accurate as of the Decision Date (11/02/2022). Users interested in learning the rules in force at a particular point in time should contact the VHA Office of Community Care. Steps to collapse records into a single inpatient stay: 1. 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. Note: The last extract occurred in December 2020. 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 two tables can be joined through FeePharmacyInvoiceSID. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. Researchers will need to decide whether they will use the SAS or the SQL data and apply for appropriate IRB approval for use. From there, it is sent weekly to AITC in SAS format and nightly to CDW in SQL format. Thus, in SQL the total cost of an inpatient stay would be determined by evaluating the DisbursedAmount in the [Fee]. 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. 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. The conversion happens before claims and records are accepted into our claims processing system. For example, an interest payment of $14.21 would appear as 1421. INTAMT is part of DISAMT; it should not be added to them. To determine the location of care, MDCAREID will be more useful than VEN13N. 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. [FeeServiceProvided] tables. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Sort data by the patient ID, STA3N, VEN13N, and the admission dates. a. Accessed October 16, 2015. Inpatient care beyond the time when a patient is stabilized and can be transferred to a VA facility, except where a VA facility is not feasibly available. These correspond to fields, rows and tables in a relational database. The Fee Basis data contain a unique variable not found in the traditional VA inpatient and outpatient datasets: the Fee Purpose of Visit (FPOV) variable. VA decisions for specific versions may include + symbols; which denotes that the decision for the version specified also includes versions greater than 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). Dental claims must be filed via 837 EDI transaction or using the most current. This guidebook describes characteristics of Fee Basis care data such as contents and missingness, and makes recommendations about its use for research purposes. Veterans applying for and using VA medical care must provide their health insurance information, including coverage provided under policies of their spouses.
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