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.. Researchers with the appropriate DART permissions can ask the studys VINCI data manager to create a crosswalk file. One can evaluate which encounters were unauthorized by joining the FeeUnauthorizedClaim table through the FeeUnauthorizedClaimSID key. - The information contained on this page is accurate as of the Decision Date (11/02/2022). SAS data are also available in CDW, but are currently limited to those VA employees with operational access. In this way, records that are missing MDCAREID can be given a MDCAREID based on the value of VEN13N and STA6A in the record. 1728. If billing electronically, please include "Other Payers Information" in Loop 2320, 2330A, 2330B, and 2430. If your claim was submitted to VA, call (877) 881-7618, If your claim was submitted to TriWest, call (877) 226-8749. Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. Veterans Choice Program (VCP) Overview [online]. YESThis insurance is also known as: Veterans Administration. This application completes the update of critical claims data into the FBCS shared MS SQL database for further processing and reporting. To enter and activate the submenu links, hit the down arrow. Request and Coordinate Care: Find more information about submitting documentation for authorized care. 7. [FeeInpatInvoiceICDDiagnosis], [Dim]. 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). Contact the VA North Texas Health Care System. Reimbursements appear in the Travel Expenses (TVL) file. Appendix G lists all available FPOV codes and classifies them as inpatient or outpatient. Researchers and analysts will have to take care to collapse observations properly if warranted, for example to determine the costs, procedures or diagnosis associated with a single stay or visit. If it cannot be located in the PTF Main file or DSS NDE for inpatient care, search other inpatient files. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. The CDW is a relational database organized into a collection of data domains implemented on the Microsoft SQL server in VINCI. Each patient should have only one ICN in the entire VA, regardless of the number of facilities at which he is seen. However, investigation has confirmed these are partial payments made for a single encounter or procedure. All analyses using this cohort should use PatientICN as indicative of a unique patient. Available at: http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. VIReC Research User Guide: VHA Medical SAS Outpatient Datasets FY2006. To learn more, please visit the Provider Training section on the MES website . This service communicates via native SQL Server 2005 encrypted connections through the VA Wide Area Network (WAN). Non-emergency care must be approved before the Veteran seeks care in the community.3 For traditional Non-VA care, a Veterans VA provider will submit a request at the local VA facility for Veteran care provided by Fee Basis. 3. VA will arrange for transportation for them or will reimburse expenses on the basis of vouchers submitted. 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. If the Veteran has insurance, VA cannot pay even when the entire claim is less than the deductible. Fee Purpose of Visit (FPOV) Document [online; VA intranet only]. 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. Fee Purpose of Visit is the recommended way to evaluate the category of the visit. 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. NPI and Medicare IDs have an M to M relationship. Medication dosage/strength. Veterans Choice Program - Fee Basis Claims System in CDW - Veterans Affairs A subsequent report will contain the results of an audit conducted to assess VA payment constitutes payment in full. Therefore, it is not possible to do an exact comparison across the datasets. Through patient identifier and travel date (TravelPaymentDate), one can link these payments to inpatient and outpatient encounters. Non-VA CareP.O. Chapter 6 provides information about how to access the Fee Basis data, while Chapter 7 provides information about the rules governing Fee Basis care. For example, if one wishes to evaluate the cost of certain diagnoses in inpatient care through SQL data, this would require the linking of multiple tables before being able to conduct any analyses such as [Fee]. VA Health Care: Management and Oversight of Fee Basis Care Need For example, DISAMT=1000 in FY06 really indicates DISAMT=10.00. [XXX] tables, but also the [DIM]. This table contains information on inpatient care. By June 2017, no Choice stays are found in FBCS. MDCAREID is not available in the outpatient SAS Fee Basis data, even though some outpatient services are provided in a hospital. This technologysupports advanced data encryption methods and role-based access control. b. http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf. actions by all authorized VA and law enforcement personnel. All information in this guidebook pertains to use of ICD-9 codes. more information please visit www.fsc.va.gov. For some years, there may be high rates of missingness of ICD-9 data in the Ancillary files. Identify Choice records by using tax ID and specialprovcat= CHOICE. 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. Get the latest updates on VA community care, including program changes, resources and more! Facility Information Security Officers (ISOs) are often the CUPS POC. 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. [FeeInpatInvoice] table, one must first link that table to the [Fee]. Include the 17 alpha-numeric (10 digits + "V" + 6 digits) VA-assigned internal control number (ICN) in the insured's I.D. It is only relevant for claims linked to VistA patients. 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. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). U.S. Department of Veterans Affairs. Review the Filing Electronically section above to learn how to file a claim electronically. It is the patient identifier that uniquely defines a patient across all facilities. Yes. 2. Available at: http://vaww.vhadataportal.med.va.gov/Portals/0/DataQualityProgram/Reports/Identifying_Veterans_in_CDW.pdf. A claim without errors or omissions is said to be clean. If VA has authority to pay the claim and the submitted documentation is sufficient then the claim is approved for payment. (1) A Veteran must be enrolled in VA health care16. Five additional variables Financial Management System (FMS) transaction number, line number, date, batch number, and release date reflect processing of payments through the FMS. SQL Fee Basis data are stored in CDW in multiple individual tables. A single inpatient encounter may generate zero, one, or multiple ancillary records, depending on the number of ancillary procedures and physician services received. In the SAS data, the provider component of the inpatient stay is captured in the ancillary file. SQL tables can be joined through linking keys. Accessed October 16, 2015. If the payment was made outside of FBCS, they wont show here. Hospice also appears to be billed monthly, with longest length of stay for a single hospice invoice of 31 days. In both the SAS and the SQL data, there are usually multiple observations per patient encounter. PDF VA Community Care - Veterans Affairs In SAS, these data can be found in the Vendor file. the rates paid by the United States to Medicare providers). DSS Fee Basis Claims Systems (FBCS) - oit.va.gov Appendix E includes a list of SQL fields related to the type of care a patient receives. Unlike the other patient identifiers in SQL such as PatientIEN or PatientSID, PatientICN is supposed to be unique to each patient across VA. 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. For example, the meaning of DRG001 is not the same in FY05 vs FY15. visit VeteransCrisisLine.net for more resources. Claims related to this care are considered authorized care. A Fee table will contain a record for an ICD-9 code, whereas a DIM table will contain the possible values of that ICD-9 code. VA must be capable of linking submitted supporting documentation to a corresponding claim. Two domains in which researchers can find reports on Non-VA Care are Resource Management and Workload. VSSC provides numerous relevant web reports, data resources, and analytics support, including summary data by facility and VISN and national summary data. This FPOV variable broadly categorizes the reason for the encounter, such as hospice or respite care. There are no references identified for this entry. Unauthorized care can be of an inpatient or outpatient nature. For inpatient and outpatient care, in general, VA will pay the lesser of the Medicare rate (or MPFS rate) or the billed charges. When a claim has reached terminal status (A, P, D, R), the field ImportedDTStamp on the UB-92/HCFA tables represents the date it was processed. 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. Provider Portal - Veterans Affairs Inpatient care, regardless of patients health status, if VA was not notified within 72 hours of admission. Through patient ID (SCRSSN) and travel date (TVLDTE) one can link these payments to inpatient and outpatient encounters. 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. (2) Additionally, a Veteran must also meet at least one of the following criteria. If you are in crisis or having thoughts of suicide, 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. 8. There is a deductible of $3 per trip up to a limit of $18 per month. Outpatient data are housed in the FeeServiceProvided table. How Much Life Insurance Do You Really Need? VA has set a goal of processing all clean claims within 30 days. Chief Business Office. Optum is a proud partner with the VA through its Community Care Network (CCN). HERC investigation of Fee Files reveals certain data anomalies of which researchers should be aware. 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. For authorized care, the referral number listed on the Billing and Other Referral Information form. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. VA is the primary and sole payer when VA issues an authorization. Attention A T users. While a researcher could theoretically conduct a Fee Basis analysis using SAS data and then upload these SAS data to CDW and pull in the relevant variables from the SQL Patient domain, this poses some logistical challenges. 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. 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. what is specified but is not to exceed or affect previous decimal places. If electronic capability isnot available, providers can submit claims by mail or secure fax. Given these different patient identifiers, it is difficult to conduct exact comparisons between SAS and SQL data. Electronic Data Interchange (EDI): Payer ID for medical claims is 12115. 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. VIReC. Such care is called Non-VA Medical Care, or Fee Basis care. If the VA Fee Schedule does not include a rate for the covered service provided, reimbursement will be made at 100% of customary charges, as defined in the provider's VA CCN Payment Appendix. PatientICN is assigned by CDW. Available at: http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf.. 3. Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. 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. National Provider Identifier: Submit all that are applicable, including, but not limited to billing, rendering/servicing, and referring. 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. There is very limited outpatient pharmacy data in the Fee files. 17. We recommend researchers use the FeePurposeOfVisit codes (FPOV) codes to eliminate observations related to non-outpatient care before beginning analyses. However, in all data files, the vast majority of observations are missing values for this variable. In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. As noted above, non-VA care may be authorized under the Non-VA Medical Care program when VA cannot offer needed care. Payer ID: 1. There are multiple methods by which community providers may electronically provide VA with the required medical documentation for care coordination purposes. The Fee Purpose of Visit (FPOV) and Health Care Financing Agency Payment Type (HCFATYPE) variables feature values pertaining to setting (inpatient, outpatient, home-based), specific items (e.g., supplies and diagnostics), and miscellaneous purposes.[1]. There are limited data available regarding the specific non-VA provider associated with a visit; much information available pertains to the vendor who is billing for the care provided. This schema contains sensitive information such as SSNs, bank accounts, and the actual name of personnel. It is also possible that researchers will find a slight difference in the observations that the SAS versus SQL data contain. 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. Researchers who have never before used CDW are encouraged to read the VA CDW First Time Users guide, available from the VIReC website (VAintranet only:http://vaww.virec.research.va.gov/CDW/Overview.htm). Please visit Provider Education and Training for upcoming events. 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. (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). 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. While Unauthorized care is considered a separate domain, the data pertaining to Unauthorized care are stored alongside the Authorized care data in the FeeInpatInvoice table and the FeeServiceProvided table. Accessed October 16, 2015. Mail to: DEPARTMENT OF VETERANS AFFAIRS. Beware of VISNS 4, 15, and 23, as they have their own integrated system. 4. 866-505-7263, Veterans Crisis Line: Electronic 837 claim and 275 supporting documentation submissions can be completed through VAs contracted clearinghouse, Change Healthcare, or through another clearinghouse of your choice. Hit enter to expand a main menu option (Health, Benefits, etc). Non-VA providers submit claims for reimbursement to VA. The Veterans Access, Choice, and Accountability Act (Veterans Choice Act), passed in 2014, expanded veterans access to non-VA care. There is no separate payment for items such as oxygen or other supplies, the number of attendants, providing an EKG during the trip, etc. If electronic capability is not available, providers can submit claims by mail or secure fax. 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. Contractor Announces Plan To Fix Non-VA Fee Basis Claims The Vendor Release table provides the known releases for the. However, in Table 4, we present some comparisons to demonstrate the different between SAS and SQL data. VA decisions for specific versions may include + symbols; which denotes that the decision for the version specified also includes versions greater than 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. Researchers with VA intranet access can access these sites by copying and pasting the URLs into their browser. Actual processing time has varied considerably over the years. 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). Sort data by the patient ID, STA3N, VEN13N, and the admission dates. 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. It can be difficult to determine the provider and the location of the Non-VA care provider. 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. Veteran's ICN can be found on the VA issued HSRM referral. We give an example here that relates to FeeInpatInvoice table. For dual pension and compensation claims, use the mailing address below for compensation claims. Please switch auto forms mode to off. However, one also needs to exercise caution with DRG; there are 2 different sets of DRGs used over time.