However, not all data in the FeeServiceProvided table are outpatient data; some may pertain to inpatient stays. U.S. Department of Veterans Affairs. For more detailed information, researchers should visit the VHA Office of Community Care website. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. 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. One way to do this is to concatenate the vendor identifier, the patient identifier, and the visit date. Using SQL data will allow the researcher to link to other rich data found in CDW, such as the Health Factors data. These rules are subject to change by statute or regulation. 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. 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). Q. If you are in crisis or having thoughts of suicide,
URLs are not live because they are VA intranet only. Identify Choice records by using tax ID and specialprovcat= CHOICE. Again, date of service is not available in the FeeServiceProvided table. Training - Exposure - Experience (TEE) Tournament, Observational Medical Outcomes Partnership (OMOP), Personnel & Accounting Integrated System (PAID), Decision Analysis: Decision Trees, Simulation Models, Sensitivity Analyses, Measuring the Cost of a Program or Practice: Microcosting, List of VA Economists and Researchers with Health Economic Interests, 7. 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. Users interested in learning the rules in force at a particular point in time should contact the VHA Office of Community Care. If disbursed amount is missing, use payment amount instead. 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. SAS and SQL also have several geographic fields related to the vendor providing the non-VA care, such as the vendors city, county, state and zip code. SAS Fee Basis data can be linked to other SAS files with additional demographic data (e.g., Vital Status files, enrollment files). 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. In SAS, this variable is called DISTYP, or disposition type, and is located in the Inpatient and Ancillary tables. 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. Each observation in the SAS and SQL data has an accompanying vendor ID. Some VA medical centers purchase care from only one of the hospitals in the chain. In the Fee Basis inpatient data, each record represents a separate claim; these separate claims must be aggregated to capture the totality of the inpatient stay. 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. Claims related to this care are considered authorized care. Basic demographic variables can be found in the [Patient]. VA Fee Basis Programs. However, Veterans may be responsible for a VA copayment depending on their assigned Priority Group. Get the latest updates on VA community care, including program changes, resources and more! Because coding varies by station, users are encouraged to employ multiple variables in an effort to find all care associated with a particular setting or service type. April 08, 2014. This rule applies even when the patient is incapable of making a call. Accessed October 07, 2015. Table 3 lists their file names and gives a general description of their contents.10. The values of Adjustment Codes 1 and 2 (ADJCD1 and ADJCD2) explain the reason for non-payment. Second, there are some cases where the disbursed amount is $0, while the payment amount is greater than $0; these are cases in which the payment was cancelled and the true cost of care is thus $0. To access the menus on this page please perform the following steps. 400, Wittman Drive Grand Rapids Itasca County MN - 55744 United States. As part of the process, claims and supporting documentation are scanned for compliance prior to conversion to electronic format. American Society of Health-System Pharmacy (ASHP). Note: A Veterans insurance coverage or lack of insurance coverage does not determine their eligibility for treatment at a VA health care facility. Please switch auto forms mode to off. The Department of Veterans Affairs (VA) often pays providers in the community to provide care to Veterans when it is unable to provide such care itself (e.g., due to a lack of resources or delays in providing care), or when it is infeasible to do so (e.g., emergency care). 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). This component provides a front end for validation and/or correcting the data that was read from the claim via the OCR module. 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. These inpatient tables have to be linked to FeeInpatInvoiceICDDiagnosis, FeeInpatInvoiceICDProcedure, FeeInitialTreatment and the appropriate DIM tables in order to understand the specific diagnoses and procedures associated with the inpatient observations in these tables. Missingness can vary substantially by year and by file. Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. YESElectronic Remittance (ERA)YESICD- 1. UB-92 box 56 (ProviderNPI) represents the providers National Provider Identifier. Veterans Access, Choice, and Accountability Act of 2014 (VACAA): The Choice Program and the Choice Card [presentation]. The vendor represents the entity billing for the non-VA care, while the provider represents the person who was involved in care provision. Non-VA Payment Methodology Matrix [online; VA intranet only]. The Choice Act represents one of the largest shifts in the organization and financing of healthcare in the Department of Veterans Affairs (VA) in recent years. Menlo Park, CA. Use of this technology is strictly controlled and not available for use within the general population. *From the date the Veteran was discharged from the facility that furnished the emergency treatment; the date of death, but only if the death occurred during transportation to a facility for emergency treatment or if the death occurred during the stay in the facility that included the provision of the emergency treatment; or the date the Veteran exhausted, without success, action to obtain payment or reimbursement for treatment from a third party. 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. Patient residence related geographic information is available in the [Patient]. 4. 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. The impact on inpatient and emergent care is unclear, however, as the definition of prosthetic in VA is so broad as to include items placed inside the body, such as internal fixation devices, coronary stents, and cardioverter defibrillators. VA evaluates these claims and decides how much to reimburse these providers for care. U.S. Department of Veterans Affairs. Pre-2007, DISAMT and INTAMT each have two implied decimal places a value of 1000 would indicate $10.00. Providers are not required to accept VA payment in all cases. VA has adopted a policy of processing payments for certain EDI claims outside of FBCS (Choice/PCCC) by rerouting the EDI claims back to the HAC, causing them to reach terminal status in FBCS and triggering a transition to the PIT repository. Chief Business Office. http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. Additionally, our health care providers make certain that Veterans' VA medical records remain updated by returning information about Veteran care and treatment to VA. or use of this system constitutes user understanding and acceptance of these terms
For care received under the Choice Act, Veterans will work with the third party administrators of the Choice program to find an eligible provider in their area.4. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. 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). 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. 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). When MDCAREID is not available, it is possible to assign MCCAREID based on the relationship between VEN13N and STA6A. For inpatient and outpatient care, in general, VA will pay the lesser of the Medicare rate (or MPFS rate) or the billed charges. Analyses of FY 2014 data indicate approximately 50% of inpatient observations and 43% of outpatient observations are missing NPI. 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. Download the tables here. Available at: http://vaww.virec.research.va.gov/CDW/Overview.htm. Payer ID for dental claims is 12116. Much Fee Basis care is pre-authorized prior to the Veteran obtaining care and is thus considered Authorized Care. [ICDProcedure] table and a foreign key in the [Fee]. The amount claimed (PAMTCL) appears in the inpatient (INPT) file alone; there is no claimed amount on the outpatient side. All information in this guidebook pertains to use of ICD-9 codes. Note that some physicians use the same ID number as the hospital. As noted above, in SAS, the patient identifier is the SCRSSN; this is unique to each patient across the entire VA. resides on and transmits through computer systems and networks funded by the VA.
Through patient identifier and travel date (TravelPaymentDate), one can link these payments to inpatient and outpatient encounters. For example, there are observations in which INTIND = 1 and INTAMT = $0. Federal law puts prosthetics into a special payment category that mandates full financial support from VA. As implemented in VA policy, it requires that VA facilities provide all necessary prosthetics, orthotics, and assistive devices (prosthetics) needed by patients. 3. The process of linking can be complex; analysts should take care to reduce errors during this process. a. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. 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. If a Veteran has only Medicare Part B or has both Medicare Parts A and B, no VA payment may be made. SAS and SQL data are very similar, but not exact copies of each other. All analyses using this cohort should use PatientICN as indicative of a unique patient. Information from this system resides on and transmits through computer systems and networks funded by the VA. All Fee Basis care will be found in the Fee files. INTIND and INTAMT are not always concordant. Last updated validated on Tuesday, January 3, 2023 This application reads, creates, edits authorization data in VistA, and copies critical information into the central SQL database for off-line VistA applications to consume. Claims for Non-VA Emergency Care Using the Non-VA Medical Care data for research requires a basic understanding of laws and regulations that govern it. 1. The veteran must wait over 30 days past their preferred appointment date or the date deemed medically necessary by their provider, b. VA contracts out its hospice; therefore, the Fee Basis files contain a great deal of data related to hospice care. It is also possible that researchers will find a slight difference in the observations that the SAS versus SQL data contain. Consult the latest CDW schematic diagrams to understand the tables in which your variables of interest are housed and the primary key and foreign keys needed to link each pair of tables. SQL data contain both SCRSSN and SSN, but these data reside in the SPatient table at CDW, and cannot be accessed by researchers without the CDW data manager and IRB approval. At the time of writing, SAS data at CDW are available only to those persons with VA operations access. Therefore, on the outpatient side as well one must aggregate multiple records to get a full picture of the outpatient encounter. 3. . 14. The payment category (PAYCAT) is missing for all records in the inpatient services (ANCIL) file. This component distributes fee workload to particular users using the FBCS MS SQL database and the VistA Gateway. 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. 988 (Press 1). Outpatient data are housed in the FeeServiceProvided table. Questions about care and authorization should be directed to the referring VA Medical Center. For more information call 1-800-396-7929. There are additional payments for direct medical education, capital-related costs, and other factors as appropriate. In this chapter, we discuss general aspects of Fee Basis data. You can further refine by selecting records on or after November 4, 2014, when Choice was first enacted. visit VeteransCrisisLine.net for more resources. There is a strong, but imperfect, concordance, between the observations housed in the SAS and SQL data. 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. If a researcher decides to use FPOV, please note that an FPOV value of 52 indicates ED visit for persons whose care is covered under the Millennium Bill and should thus be included in evaluating ED care. 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. U.S. Department of Veterans Affairs. This application is directly attached to TWAIN compliant scanners and works offline to VistA and the FBCS MS SQL databases. Persons working with SPatient or Patient data are also recommended to refer to the CDW guidance about how to delete test observations. 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). Government contractor DSS Inc a new plan to fix VA's failing non-VA fee basis claims processing and management system with certain software updates - self-funded - to improve the system. For some VEN13N, however, there is more than one MDCAREID. Prior to FY 2007, INTAMT has two implied decimal places. Data in any of the any S tables require Staff Real SSN access. For emergency care of service connected conditions, there is a two-year limit to submit any bills. [FeeInpatInvoiceICDDiagnosis] with the [Dim]. Internal use only. Researchers should use PatientICN to link patient data within CDW. Box 30780 Tampa, FL 33630-3780, P2E Documentation Cover Sheet, VA Form 10-10143f. 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. Persons looking to classify Veterans military service are encouraged to read the Data Quality Analysis Teams guidance on Identifying Veterans in the CDW(VA intranet only:http://vaww.vhadataportal.med.va.gov/Portals/0/DataQualityProgram/Reports/Identifying_Veterans_in_CDW.pdf).14. 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. 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. Thus, researchers using later years of data should be aware that files are not static and will continue to be updated. Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. Compare the admission date of the third observation to the temporary end date from above. Some important DIM tables that will be useful in analyzing Fee Basis data are FeePurposeOfVisit, FeeSpecialtyCode, FeeVendor, ICD, ICDProcedure Code, DRG, CPT, and CPT Category. Claims. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. Please visit Emergency Care Claims to learn more. 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). 1. SQL inpatient data contain up to 5 diagnoses and 5 procedure codes, while SAS inpatient data contain up to 25 diagnosis codes and up to 25 procedure codes. 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. 5. This component is a service that communicates with the Program Integrity Tool (PIT) which scores claims and sends results to FBCS. Some web reports contain PHI and access to these is restricted. Outpatient prescriptions beyond a 10-day supply. Those with access to the VA intranet can find a list of SQL fields on the CDW MetaData site. Paper claims and supporting documentation submitted to us are converted to Electronic Data Interchange (EDI) transactions. VA regulations 38 CFR 17.1000-17.1008. 1728. This guide serves as an addendum to any technical documentation supplied by the healthcare clearinghouse when establishing a trading partner agreement. In this table, some ancillary data are associated with an inpatient FPOV code but have an outpatient FeeProgramProvided field. Veterans Crisis Line:
The Fee Basis schema data can be found at the CDW SharePoint portal at the links below (VA intranet only). For example, the meaning of DRG001 is not the same in FY05 vs FY15. Non-VA Medical Care consumes a significant portion of VA spending; indeed, contract costs (i.e., the cost of all things purchased from non-VA health care providers) accounted for approximately 11% of VA expenditures in fiscal year 2014. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. On March 17, 2022, The U.S. Court of Appeals for the Federal Circuit issued a ruling that changes VAs ability to reimburse as secondary payer under 38 U.S.C.1725. Attention A T users. Generally, VA does not bill Medicare or Medicaid for reimbursement; however, VA does bill other types of health insurance including Medicare Supplemental plans for covered services. Sort data by the patient ID, STA3N, VEN13N, and the admission dates. We found SPECIALPROVCAT was missing in 93% of records. If you have additional questions about the form or your portal account access, please contact the Provider Services Solution (PRSS) help desk at 888-829-5373. Lump sum payments are not paid via FBCS. Seven refer explicitly to Veterans alone, while the remaining two are for diagnostic services or eligibility exams, neither of which constitutes treatment. SQL Fee data are available through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). Most importantly, they do not represent all care provided during the fiscal year. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. Some vendors use centralized billing services located in other cities, in a few cases in other states. [SPatient] and[PatSub] tables. For example, if a physician billed for a complete blood count and a venipuncture in the same day, there would be two records with the same invoice number, but different CPT codes and different claimed amounts. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. How Much Life Insurance Do You Really Need? Hit enter to expand a main menu option (Health, Benefits, etc). In some cases it may appear that single encounters have duplicate payments. The vendor identity can be found through the FeeVendorSID or the FeeVendorIEN variables in SQL. Appropriate access enforcement and physical security control must also be implemented. 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. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. FBCS is an auditing system which provides instructional prompts designed to interface with the Veterans Information Systems and Technology Architecture (VistA) package to track, report, and analyze fee claim data. privacy policies and guidelines. A summary of the payment guidelines can be found in Appendix I. [PatientRace] tables. 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 funds are used to provide the best care possible to our Veterans. Customer Call Center: 877-881-76188:05 a.m. to 6:45 p.m. Eastern TimeMondayFriday, Sign up for the Provider Advisor newsletter, Veterans Crisis Line:
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. This technology can use a VA-preferred database. 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. There are often multiple observations per inpatient stay and multiple observations per outpatient encounter. [FeeInpatInvoice] and [Fee]. Data Quality Analysis Team. Researchers should pay special attention to reducing duplicates in the pre-2008 data. This table contains information on inpatient care. There are substantial differences in quantity of inpatient diagnosis and procedure data available in SAS versus SQL. 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). would cover any version of 7.4. With few exceptions these variables will be of little interest to researchers. In SQL, these variables can be found in the [Dim]. Many classes of Veterans are eligible for travel payments. When a key field is missing, SQL indicates this with a value of -1. [FeeVendor] table. See 38 USC 1725 and 1728.). For
In general, we recommend using the disbursed amount to capture the cost of care, for two reasons. There may be multiple CPT codes associated with a single encounter. Data Quality Program. 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
Prescription information: Prescribing provider's name. Veterans are not responsible for the remaining balance shown as patient responsibility on the explanation of benefits from their insurance carrier. The second record would have an admission date of Jan 5, 2010 and a discharge date of Jan 5, 2010. Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). If it cannot be located in the PTF Main file or DSS NDE for inpatient care, search other inpatient files. Documentation in support of a claim may include: *NOTE: Documentation not required includes flowsheets and medication administration. 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 temporary end date is the maximum of these two values. All SAS prescription-related data is found in two files: the PHR file and the PHARMVEN file. U.S. Department of Veterans Affairs. Use the column 'estimated cost' and it is available in the CDW FBCS data. is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not. U.S. Department of Veterans Affairs. Data Quality Program. 8. See the FBCS page (CDW Raw) on the CDW SharePoint site (VA intranet only: https://vaww.cdw.va.gov/bisl/Database/SitePages/Raw%20Extractor.aspx) for more information. Fee Basis data can be broadly categorized into 4 classes: inpatient care, outpatient care, pharmacy, and travel data. VA calculates PAMT from CMS pricer software on the basis of DRG and length of stay. Other work by HERC researchers indicates that in the FY 2014 data, DXLSF and DX1 were identical 47% of the time. To access the menus on this page please perform the following steps. _________________________________________________________________. Patient identifiers are also different across SAS and SQL data. This research was supported by the Health Services Research and Development Service, U.S. Department of Veterans Affairs (ECN 99017-1). Please contact the referring VAMC for e-fax number. Care for dependent children, except newborns, in situations where VA pays for the mothers obstetric care during the same stay. 1725 may only be made if payment to the facility for the emergency care is authorized, or death occurred during transport. 11. To determine the location of care, MDCAREID will be more useful than VEN13N. Reimbursements appear in the Travel Expenses (TVL) file. It is not available for claims in which payment was based on a contract amount. 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. However, a 7.4.x decision
Researchers with VA intranet access can access these sites by copying and pasting the URLs into their browser.