SAS and SQL contain different variables to identify the provider and/or vendor associated with the care. Make sure the services provided are within the scope of the authorization. YESInstitutional/UB Claims. A description of the Patient and SPatient schema is available on the VIReC CDW Documentation webpage: http://vaww.virec.research.va.gov/CDW/Documentation.htm (intranet only). The Fee Basis files primary purpose is to record VA payments to non-VA providers. Therefore, it is not possible to do an exact comparison across the datasets. Fee Basis providers vary in how frequently they submit an invoice for Fee Basis care. 13. VA patients who receive prescriptions from non-VA providers fill them from a VA pharmacy, often the VA Certified Mail Order Pharmacy (CMOP). VA can also pay for hospice care for Veterans when the VA facility is unable to provide the needed care; this happens frequently, as VA provides only inpatient-based hospice care and many Veterans may wish to receive hospice at home or in the community. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. For example, an interest payment of $14.21 would appear as 1421. INTAMT is part of DISAMT; it should not be added to them. Any variable that has an S prefix indicates secure data and requires special permission to access; researchers should be aware of this when submitting their IRB applications and their CDW DART data access requests. Providers are not required to accept VA payment in all cases. Hit enter to expand a main menu option (Health, Benefits, etc). U.S. Department of Veterans Affairs. The Act amends 38 U.S.C. Additionally, we found 0.94% of records were approved Choice claims (e.g., records where SPECIALPROVCAT= CHOICE and STATUS= A (approved)). Many veterans now have access to Non-VA medical care through the new Veterans Access, Choice, and Accountability Act (VACAA, or Choice Act). 9. Through patient identifier and travel date (TravelPaymentDate), one can link these payments to inpatient and outpatient encounters. 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. The Customer Engagement Portal is a reporting tool for VA Medical providers to verify the status of claims as well as run payment reconciliation reports. [ SFeeVendor] table.
HERC: Fee Basis Data: A Guide for Researchers - Veterans Affairs Veterans whose income exceed the established VA Income Thresholds as well as those who choose not to complete the financial assessment must agree to pay required copays to become eligible for VA health care services. 2. Lump sum payments are not paid via FBCS. We view the patients insurance data in the VistA file if the claim is flagged as reimbursable in VistA and encompasses the dates on the claim. U.S. Department of Veterans Affairs. Using SQL data will allow the researcher to link to other rich data found in CDW, such as the Health Factors data. The procedure code table has just as many records as there were procedures on the invoice. New values may be added over time. Fee Purpose of Visit is the recommended way to evaluate the category of the visit. Race and ethnicity are found in the [PatientEthnicity], [PatSub]. Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. Box 30780, Tampa FL 33630-3780. Section 508 compliance may be reviewed by the Section 508 Office and appropriate remedial action required if necessary. Researchers must consider whether a missing value means not applicable. For example, many inpatient (INPT) records lack a value for any of the surgery codes (SURG9CD1-SURG9CD5). The vendor represents the entity billing for the non-VA care, while the provider represents the person who was involved in care provision. 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. Austin Information Technology Center (AITC) is one of the VAs five national data centers. Missing values of PAYCAT could be imputed by finding the corresponding inpatient stay in the INPT file. To access the menus on this page please perform the following steps. The VEN13N is the vendor ID with a suffix; VEN13N is more detailed than VENDID and is thus recommended for use. This is true for both the inpatient and the outpatient data, albeit for different reasons. One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. All Fee Basis care will be found in the Fee files. one setting of care (inpatient or outpatient). The PatientSID is a CDW assigned identifier that uniquely identifies a patient within a facility.
Provider Portal - Veterans Affairs VA Informatics and Computing Resource Center (VINCI). It is the patient identifier that uniquely defines a patient across all facilities. If the payment was made outside of FBCS, they wont show here. They could form part of an overall strategy to locate care provided in specialized settings, such as state homes, or of specialized services like kidney dialysis. It will often times not be possible to determine the reason for an outpatient visit, as there will be multiple observations/CPT codes that denote a single visit. When possible, VA will seek reimbursement for Non-VA Medical Care payments from sources such as workers compensation payments; payments resulting from motor vehicle accidents, crimes of personal violence, or torts; other agencies when the patient is a beneficiary; and third-party insurance plans. Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. 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. 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. Medical specialty type (SPECCODE) is a provider-specific variable and indicates the specialty type of the provider rendering the service. Cunningham, K. VA implements the first of several Veterans Choice Program eligibility expansions. Optum is a proud partner with the VA through its Community Care Network (CCN). 1. These include Fee purpose of visit (FPOV), place of service (PLSER), type of treatment (TRETYPE), HCFA payment type (HCFATYPE), and record type (TYPE). 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. 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 will need to decide whether they will use the SAS or the SQL data and apply for appropriate IRB approval for use.
PDF Office of Inspector General - Oversight.gov 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. 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. All SAS prescription-related data is found in two files: the PHR file and the PHARMVEN file. Fee Basis data are housed in VA in both SAS dataset format and Microsoft SQL server tables (hereafter referred to as SQL data). To enter and activate the submenu links, hit the down arrow. Per the May 5th, 2015 memorandum from the VA Chief Information Security Officer (CISO) FIPS 140-2 Validate Full Disk Encryption (FOE) for Data at Rest in Database Management Systems (DBMS) and in accordance with Federal requirements and VA policy, database management must use Federal Information Processing Standards (FIPS) 140-2 compliant encryption to protect the confidentiality and integrity of VA information at rest at the application level. Please review the Where To Send Claims and the Where To Send Documentation sections below for mailing addresses and Electronic Data Interchange (EDI) details. The Veterans Access, Choice, and Accountability Act (Veterans Choice Act), passed in 2014, expanded veterans access to non-VA care. [FeeInpatInvoice], and a foreign key in the [Fee].[FeeInpatInvoiceICDProcedure]. Data are presented in Table 4. However, investigation has confirmed these are partial payments made for a single encounter or procedure. Unauthorized care can be of an inpatient or outpatient nature. VA Technical Reference Model v 23.1 DSS Fee Basis Claims Systems (FBCS) General Decision Reference Component Category Analysis Vendor Release Information The Vendor Release table provides the known releases for the TRM Technology, obtained from the vendor (or from the release source). Current Decision Matrix (10/21/2022) Box 537007Sacramento CA 95853-7007, CCN Region 5(Kodiak, Alaska, only)Submit to TriWest. In some cases it may appear that single encounters have duplicate payments. 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. There are additional payments for direct medical education, capital-related costs, and other factors as appropriate. 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). privacy policies and guidelines. Veterans are not responsible for the remaining balance shown as patient responsibility on the explanation of benefits from their insurance carrier. VENDID is the vendor ID. 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. For EDI 837, Referral Number is Loop = 2300, Segment = REF*9F, Position = REF02 or Prior Authorization. Note: A Veterans insurance coverage or lack of insurance coverage does not determine their eligibility for treatment at a VA health care facility. For home loan matters, contact a Regional Loan Center and for Veteran Readiness and Employment matters, contact your local regional office at their physical address. The discussion below pertains to both SAS and SQL data. To find all care provided in a particular fiscal year requires searching by treatment date over several years of Non-VA Medical Care claims. 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. - The information contained on this page is accurate as of the Decision Date (11/02/2022).
Fee Basis Services - VetsFirst There are exceptions. Veterans Health Administration. Our review of the data suggests that pharmacy and ancillary claims take longer to process than inpatient or outpatient claims. 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.
Customer Engagement Portal - Veterans Affairs Veterans Choice Program Eligibility Details [online]. The Routing tool manages how Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims will electronically flow through the FBCS program. Some Non-VA Medical Care claims are rejected for untimeliness or lack of statutory authority. To access the menus on this page please perform the following steps. 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. Prescription information: Prescribing provider's name. Basic demographic variables can be found in the [Patient]. In general, we recommend using the disbursed amount to capture the cost of care, for two reasons. In SAS, ICD-9 diagnosis codes are in the Inpatient, Outpatient and Ancillary files. This rule applies even when the patient is incapable of making a call. VA can waive the deductible in hardship cases. Claims related to this care are considered authorized care. [ICDProcedure] table through the ICDProcedureSID. The FeeSpecialtyCodeName contains information on the specialty of the provider seen, such as oncology, chiropractic, pathology, neurosurgery, etc., but is missing much data. YESElectronic Remittance (ERA)YESICD- 1. October 1, 2015. FBCS supports payment of claims via VistA. Electronic Data Interchange (EDI) Interface. There is a CPT field in the inpatient files, but this is always missing; hospitals do not use CPT codes to bill. Analyses of FY 2014 data indicate approximately 50% of inpatient observations and 43% of outpatient observations are missing NPI. This guide serves as an addendum to any technical documentation supplied by the healthcare clearinghouse when establishing a trading partner agreement. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). 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. The Fee Basis program or Non-VA Care is health care provided outside VA. NVCC Office coordinates services and payments for Veterans receiving non-VA care for emergent and non-emergent medical care. In SQL, the patient ID will be the PatientICN or PatientSID, and the admit date is the admission date.. U.S. Department of Veterans Affairs. 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. This is in line with the way VHA Office of Productivity, Efficiency & Staffing (OPES) ascertains ED visit. [FeeTravelPayment] contain information on travel type and payment. Plan Name or Program Name," as this is a required field. Outpatient prescriptions beyond a 10-day supply. 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. (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. If it cannot be located in the PTF Main file or DSS NDE for inpatient care, search other inpatient files. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. 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. Veterans Health Administration. To understand what procedures were performed during an inpatient stay in the [Fee]. or acts to, The Financial Services Center (FSC) is a franchise fund (fee for service) organization in the Department of Veterans Affairs (VA).Under the authority of the Government Management Reform Act of 1994 and the Military
For these reasons, the program does not pay for 100% of care that was otherwise eligible. It can be difficult to identify the specific type of provider associated with Fee Basis care in the currently available national extracts of Fee Basis data. The FMS disbursed amount is the payment amount plus any interest payment. Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. Payment for care provided under the Veterans Choice Act may not exceed the Medicare Fee Schedule (i.e. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. U.S. Department of Veterans Affairs. 1. NPI is available within the VA CDW SStaff table. ____________________________________________________________________________. Prior to the passage of this law on May 1, 2010, VA did not cover the cost of health care provided to dependent children, including newborns in situations where VA pays for the mothers obstetric care during the same stay. One way to do this is to concatenate the vendor identifier, the patient identifier, and the visit date. Detailed instructions and documentation required for DART data requests can be found on the VHA Data Portal intranet website at http://vaww.vhadataportal.med.va.gov/DataAccess/DARTRequestProcess.aspx. The same cannot be said for DX2-DX25, however, as additional diagnosis codes are optional. 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. SAS and SQL data are organized differently and contain different variables. FBCS Upload leverages LEADTOOLS Professional Optical Character Recognition (OCR) and is included in the FBCS workstation install package. Through the CCN, Veterans have access to regional networks of high-performing, licensed health care . Both the SAS and SQL Fee Basis are housed at VINCI; the SQL data is also found at the Corporate Data Warehouse (CDW). For example, the meaning of DRG001 is not the same in FY05 vs FY15. Reimbursement for Pharmacists Services in a Hospital-based, Pharmacist-managed Anticoagulation Clinic. 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. 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. The Fee Basis files are stored in two formats: SAS and SQL. 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. As with inpatient data, researchers will need to collapse multiple observations in order to get a complete picture of the outpatient care provided on a single day. 3. If you are in crisis or having thoughts of suicide,
At the time of writing, version 4.2 is the most current version. Training - Exposure - Experience (TEE) Tournament. Attention A T users. In SAS, the Patient ID will be the SCRSSN and the admit date is the treatment from date. Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. Both ancillary and outpatient files have one record per CPT code. 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. Coverage will start July 1 of that year. We present here one way to collapse records into a single inpatient stay, but users may wish to develop their own method specific to the research question at hand. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, New York/New Jersey VA Health Care Network, Call TTY if you
Below are some answers to general questions about the FBCS tables. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. 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. . It is available in the PHARVEN and VEN files, albeit with a high degree of missingness. VA Palo Alto, Health Economics Resource Center; October 2013. March 2018: Due to the transition of the National Non-VA Medical Care Program Office to the VHA Office of Community Care and updates to the VINCI website, some documents may no longer be available. Note that some physicians use the same ID number as the hospital. The disbursed amount should be used to calculate the cost of care, except in the case where disbursed amount is missing. This technology has not been assessed by the Section 508 Office. 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. 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).
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. Available at: http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf.. 3. Appendix G lists all available FPOV codes and classifies them as inpatient or outpatient. The FPOV variable can be found in both the SAS and SQL data. Submit a claim void when you need to cancel a claim already submitted and processed. The unique patient identifier by which to conduct SQL-based Fee Basis analyses is PatientICN. 15. HERC did not investigate use of NPI for this guidebook. b. [Patient], [PatSub]. While NPI is available in SQL data, it does require special permissions to access, as it is located in the [Sstaff]. Other work by HERC researchers indicates that in the FY 2014 data, DXLSF and DX1 were identical 47% of the time. Fee Basis data can be broadly categorized into 4 classes: inpatient care, outpatient care, pharmacy, and travel data. 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. These data indicate the specialty code associated with the vendor, such as orthopedic surgery, cardiology, family practice, etc. VA evaluates these claims and decides how much to reimburse these providers for care. When a key field is missing, SQL indicates this with a value of -1. If the provider declines VA payment then it may be able to charge the patient a greater total amount. They do not represent all claims received during the year. 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.