1. Facility charges vs. ancillary charges: There are instances when there may be claims for facility charges with no corresponding ancillary provider charge. Care provided in foreign countries other than the Philippines. 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. Given these different patient identifiers, it is difficult to conduct exact comparisons between SAS and SQL data. 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. The specific locations of the SAS payment variables and the SQL payment variables can be found in Chapters 4 and 5, respectively. 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 discussion below pertains to both SAS and SQL data. In SAS, the outpatient data are housed in the MED files. It is also possible that researchers will find a slight difference in the observations that the SAS versus SQL data contain. All Choice claims are processed by VISN 15. 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. The vendor and the provider may or may not be the same entities. For inpatient and outpatient care, in general, VA will pay the lesser of the Medicare rate (or MPFS rate) or the billed charges. Edward J. Hines, Jr. VA Hospital, Hines, Ill. 2007. Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA care. 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. The NPI is the national provider identifier, which is provider-specific but often missing in the Fee Basis data. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. While there is limited information about the vendor available in the SAS datasets; the most comprehensive information about the vendor can be found in the SAS VEN and SAS PHARVEN datasets. Bowel and bladder care for certain Veterans with SCI/D are considered supportive medical services due to the possibility of medical complications which would result in the need for hospitalization. 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. This is a critical difference from VA utilization files, which are organized by date of service. VA evaluates these claims and decides how much to reimburse these providers for care. The new temporary end date is the maximum of the discharge date of the third observation and temporary end date from Step 2. Available at:http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. DART is a workflow application that guides users through the request by collecting the appropriate documents, distributing documentation to reviewers, and assisting in communication between requestors and reviewers. 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. Last updated validated on Tuesday, January 3, 2023 This is true for both the inpatient and outpatient data. 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. The vendor identity can be found through the VENDID or VEN13N variables in SAS. The PatientSID is a CDW assigned identifier that uniquely identifies a patient within a facility. Analyses of FY 2014 data indicate approximately 50% of inpatient observations and 43% of outpatient observations are missing NPI. Operating Systems Supported by the Technology. By June 2017, no Choice stays are found in FBCS. Non-VA CareP.O. To link an authorization to a claim, use the trifecta of what VistA would consider sta3n, PatientIEN, and AuthorizationIEN. A single inpatient encounter may generate zero, one, or multiple ancillary records, depending on the number of ancillary procedures and physician services received. This rare event most likely indicates a transfer. Payment for these types of care falls under the Non-VA Medical Care program. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. The SAS files also include a patient type variable (PATTYPE). 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. VAntage Point. Facility Information Security Officers (ISOs) are often the CUPS POC. [Patient], [Spatient]. The Fee Basis files primary purpose is to record VA payments to non-VA providers. 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. In FY 2014, the longest length of stay associated with a single nursing home invoice was 31 days. Smith MW, Su P, Phibbs CS. The Act amends 38 U.S.C. For more information call 1-800-396-7929. Community providers should remain in contact with the referring VA Medical Center to ensure proper care coordination. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. TRM Proper Use Tab/Section. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. Users must ensure sensitive data is properly protected in compliance with all VA regulations. See 38 USC 1725 and 1728.). 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. Six additional variables indicate the setting of care and vendor or care type. You may use VA Form 10-583 to fulfill this requirement. These geographic variables indicate the VA station paying for the service. Hit enter to expand a main menu option (Health, Benefits, etc). Beware of VISNS 4, 15, and 23, as they have their own integrated system. 1. Each table has only one primary key field. 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. In some cases, there is a one-to-one relationship between VEN13N and MDCAREID. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. The SAS data are stored at AITC. 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). More information about can be found on their website: https://www.va.gov/communitycare/. 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. It is the patient identifier that uniquely defines a patient across all facilities. YESInstitutional/UB Claims. In SAS, ICD-9 diagnosis codes are in the Inpatient, Outpatient and Ancillary files. For these reasons, the program does not pay for 100% of care that was otherwise eligible. The travel payments data contains reimbursements for particular travel events (TVLAMT). Use of this technology is strictly controlled and not available for use within the general population. This seeming complicated arrangement is an efficient way to store data. [SpatientAddress] tables. Please visit Provider Education and Training for upcoming events. Chief Business Office. One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. 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. Table 9 lists a number of financial variables the SQL data contain. Multiple SQL tables contain these variables. (Available at the VHA Data Portal. 2. If a researcher wishes to find the Medicare hospital provider ID, one approach is to use the vendor identification variables (VEN13N, VENDID) to locate the vendors name and location in the VEN file, and then to use this information to find the Medicare provider ID using publicly available files from CMS, the agency that oversees the Medicare program. SQL tables require linking before conducting any data analyses. It is not necessarily the station at which the Veteran receives most VA care or the station which will pay for a particular Non-VA Medical Care service. Sort data by the patient ID, STA3N, VEN13N, and the admission dates. The majority of claims, 99%, were processed within 2 years, with the exception of pharmacy data in FY 2004 and FY2008. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. In some cases it may appear that single encounters have duplicate payments. Inpatient data are housed in the FeeInpatInvoice table as well as the FeeServiceProvided table, although the latter does not contain only inpatient data. Summary data are also available through the VHA Support Services Center (VSSC) website on the VA intranet. one episode of care, which can have multiple dates within the prescribed treatment, one provider, as identified by the Tax Identification Number (TIN), and. To evaluate the time it takes VA to process Fee Basis claims, we evaluated SAS data for FY2014. We gratefully acknowledge comments and contributions from Sharon Dally, Susan Schmitt and Paul Barnett. These vendors are presumably hospital chains. Chief Business Office. In some cases it may appear that single encounters have duplicate payments. In both the SAS and the SQL data, there are usually multiple observations per patient encounter. Community Care Network Region 5 (authorized), Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, Indian Health Service/Tribal Health Program, CHAMPVA In-house Treatment Initiative (CITI), Indian Health Services/Tribal Health/Urban Indian, Spina Bifida Health Care Benefits Program, Veterans Health Information Exchange Program, Durable Medical Equipment/ Pharmacy Requirements, War Related Illness & Injury Study Center, Clinical Trainees (Academic Affiliations), Medical Document Submission Requirements for Care Coordination, Azure Rights Management Services (Azure RMS), Call TTY if you If you are in crisis or having thoughts of suicide, [FeeInpatInvoiceICDProcedure] table. What documents are required by VA to process claims for. VA payment constitutes payment in full. There may be multiple CPT codes associated with a single encounter. Get Help from Our VA Disability Claim Appeals Lawyers Today. Some Fee Basis data will also appear in the non-VA medical SAS inpatient file (formerly called the Patient Treatment File). 1725 or 38 U.S.C. There is a CPT field in the inpatient files, but this is always missing; hospitals do not use CPT codes to bill. Accessed October 16, 2015. Pre-2007, DISAMT and INTAMT each have two implied decimal places a value of 1000 would indicate $10.00. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). 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. The funds are used to provide the best care possible to our Veterans. The table can be linked to the [Dim]. Appendix D contains information on the primary and foreign keys needed to link the various SQL tables.