The vendor no longer supports VA installations of this technology. Menlo Park, CA. Emergency care can also be authorized by VA in certain circumstances when the VA is notified within 72 hours. Prosthetic items. Unauthorized Care is that which was not pre-authorized but was still reimbursed, such as emergency care. 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 SQL, the patient ID will be the PatientICN or PatientSID, and the admit date is the admission date.. Every one of the 700,000 health care professionals in the TriWest network has to meet VA-required quality standards to ensure that Veterans always receive the highest quality care. There are nine situations in which Non-VA Medical Care is authorized. U.S. Department of Veterans Affairs. FBCS Upload leverages LEADTOOLS Professional Optical Character Recognition (OCR) and is included in the FBCS workstation install package. Steps to collapse records into a single inpatient stay: 1. The Routing tool manages how Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims will electronically flow through the FBCS program. Non-VA Payment Methodology Matrix [online; VA intranet only]. 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). Unauthorized care can be of an inpatient or outpatient nature. VA Fee Schedule. Available at: http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. VA evaluates these claims and decides how much to reimburse these providers for care. Data Quality Program. This guide serves as an addendum to any technical documentation supplied by the healthcare clearinghouse when establishing a trading partner agreement. This is helpful in determining the location of care in inpatient claims in which MDCAREID is missing, and in outpatient claims for hospital-provided services. Paper claims and supporting documentation submitted to us are converted to Electronic Data Interchange (EDI) transactions. Patient identifiers are also different across SAS and SQL data. March 2015. 15. Fee Basis tables, however, only list PatientSID and do not list PatientICN. Payer ID for dental claims is CDCA1. At the time of this writing, the NPI number was often missing from fee basis claims. Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. This rare event most likely indicates a transfer. YESElectronic Remittance (ERA)YESICD- 1. VA is also the primary and sole payer for unauthorized emergent care approved under 38 U.S.C. Inpatient procedures are captured by ICD-9 procedure codes (SURG9CD1-SURG9CD25) in the hospital claims file. 6. This improves claim accuracy and reduces the amount of time it takes for us to process claim determinations. Smith MW, Chow A. Non-VA Medical Care (Fee Basis) Data: A Guide for Researchers. Sign up to receive the VA Provider Advisor newsletter. Data Quality Analysis Team. There are additional payments for direct medical education, capital-related costs, and other factors as appropriate. The Fee Purpose of Visit Code (FPOV) has strong guidance from VA Fee Basis Office and thus may be a more accurate way of categorizing care. 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 Updated September 21, 2015. This application is directly attached to TWAIN compliant scanners and works offline to VistA and the FBCS MS SQL databases. The OI&T Enterprise Program Management Office does not endorse nor support Class 2 and Class 3 products and does not support data usage or application programmer interfaces (APIs) between Class 1 National Software products and Class 2 or Class 3 products. There is a strong, but imperfect, concordance, between the observations housed in the SAS and SQL data. This guidebook describes characteristics of Fee Basis care data such as contents and missingness, and makes recommendations about its use for research purposes. There may be multiple CPT codes associated with a single encounter. Thus the variable INTIND (interest indicator) equals 1 if the claim is eligible for interest and 0 otherwise. 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. Plan Name or Program Name," as this is a required field. Each year represents the year in which the claim was processed, not the year in which the service was rendered. Veterans Crisis Line: Additional information appears in a federal regulation, 38 CFR 17.52. If a Veteran has only Medicare Part A then VA may consider payment for ancillary and professional services usually covered under Part B. The electronic 275 transaction process may be utilized to supply Remittance Advice documentation for timely filing purposes. The CDW SharePoint site has a document that lists the purchased care SQL tables, the fields of that they contain, and some sample SQL queries (VA intranet only: https://vaww.cdw.va.gov/metadata/Metadata%20Documents/Forms/AllItems.aspx). The DSS Fee Basis Claims System (FBCS) is a web-based claim management system. Race and ethnicity are found in the [PatientEthnicity], [PatSub]. There are also a number of other financial variables denoted in SAS (see Table 7). Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. 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. Attention A T users. Move on to the next patient ID, STA3N, VEN13N combination and repeat the entire process above. This guidebook is intended to help researchers understand and use the National Fee Basis files, which come in both SQL and SAS formats. Veterans Health Administration. The amount claimed (PAMTCL) appears in the inpatient (INPT) file alone; there is no claimed amount on the outpatient side. 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. If you are submitting a paper claim, please review the Filing Paper Claims section below for paper claim requirements. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. (1) A Veteran must be enrolled in VA health care16. VA patients who receive prescriptions from non-VA providers fill them from a VA pharmacy, often the VA Certified Mail Order Pharmacy (CMOP). Fee Basis data files contain information regarding both the care the Veteran received and the reimbursement of the care. Please switch auto forms mode to off. NPI and Medicare IDs have an M to M relationship. If disbursed amount is missing, use payment amount instead. This service communicates via native SQL Server 2005 encrypted connections through the VA Wide Area Network (WAN). 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. Submit a corrected claim when you need to replace an entire claim previously submitted and processed. The values of Adjustment Codes 1 and 2 (ADJCD1 and ADJCD2) explain the reason for non-payment. Electronic Data Interchange (EDI): Payer ID for medical claims is 12115. This variable is defined as 1st Diagnosis Code. A comparison from FY 2009 to 2014 data reveals that DX1 in SAS corresponds to DX1 in SQL data, and up to 2008, DXLSF in SAS corresponds to DX1 in SQL (see Table 5). 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. 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. Procedures are identified by CPT code (CPT1) in the non-hospital inpatient services (the ancillary file) and in the outpatient procedures file. Most ED visits will be identified through FPOV values of 32 or 33. With few exceptions these variables will be of little interest to researchers. Both ancillary and outpatient files have one record per CPT code. Review the Where to Send Claims section below to learn where to send claims. FPOV values of 32 and 33 also indicate ED visits, but are only observed in the Ancillary file. 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. Information from this system resides on and transmits through computer systems and networks funded by the VA. Then, to see which ICD procedure codes were coded for this inpatient stay, one must link to the [Dim]. Five additional variables Financial Management System (FMS) transaction number, line number, date, batch number, and release date reflect processing of payments through the FMS. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. This most likely reflects a low frequency of surgery rather than missing data. Six additional variables indicate the setting of care and vendor or care type. This report covers the audit of payments made through VA's Fee Basis Claims System (FBCS), encompassing claims paid via that payment process from November 1, 2014 through September 30, 2016. Table 3 lists their file names and gives a general description of their contents.10. 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. SAS and SQL data are very similar, but not exact copies of each other. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. Previously, VA could reimburse Veterans or pay non-VA hospitals directly only if a Veteran has no other health insurance. Business Product Management. (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). The SQL tables [Dim]. 1. [ICDProcedure] table and a foreign key in the [Fee]. Available at: http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf.. 3. Medication dosage/strength. Available at: http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. Most, if not all, of this care should be emergency care. Therefore, to make a complete assessment of the payments for inpatient cases, researchers should evaluate the outpatient files along with the inpatient and ancillary files. Each VA facility has a local Fee Office to which the non-VA provider submits a claim for reimbursement. 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. Please switch auto forms mode to off. Box 30780 Tampa, FL 33630-3780, P2E Documentation Cover Sheet, VA Form 10-10143f. Some Non-VA Medical Care claims are rejected for untimeliness or lack of statutory authority. SQL tables can be joined through linking keys. Address. privacy policies and guidelines. Yes. The base rate varies by level of ambulance service provided, locality of the Medicare carrier area, and Point of Pickup (POP) zip code classification: urban, rural, or "super rural." See 38 USC 1725 and 1728.). June 5, 2009. Previous work conducted for the HERC 2008 Fee Basis guidebook found that the cost of inpatient pharmacy was included in the inpatient records of the SAS INPT file. If the claims and records do not conform to the minimum requirements for conversion to the 837 or 275 electronic formats, they are rejected and sent back for correction. The definition of the DXLSF variable changes depending on the year of analysis. Data are presented in Table 4. 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 the SAS data, the provider component of the inpatient stay is captured in the ancillary file. By June 2017, no Choice stays are found in FBCS. We encourage readers to seek out the latest guidance before conducting analyses, as CDW Data Quality Analysis team may have updates to this information. These represent cases in which payment is disallowed. ____________________________________________________________________________. 1. 3. Persons looking to find the date of service should be advised that it will not be contained in the FeeServiceProvided table. Box 14830Albany, NY 12212. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. To enter and activate the submenu links, hit the down arrow. This component provides a front end for validation and/or correcting the data that was read from the claim via the OCR module. The Medicare hospital provider ID (MDCAREID) is entered by fee basis staff in order to calculate hospital reimbursement using the Medicare Pricer software. There are 34 Fee Basis Claims Systems (FBCS) servers, which were originally designed for episodes of care. Find out More In order to qualify for round trip mileage, an appointment must be scheduled. The SQL prescription data are housed in the [Fee]. For more information, please visit the Data Access Request Tracker (DART) Request Process page on the VHA Data Portal(VA intranet only: http://vaww.vhadataportal.med.va.gov/DataAccess/DARTRequestProcess.aspx#resources). This is a critical difference from VA utilization files, which are organized by date of service. 3. There are very limited data in both the SAS and the SQL Fee Basis data regarding the provider associated with care; the closest one can get to this information is to denote the vendor associated with the encounter (detailed more in sections 4.11 and 5.10). 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. In this table, some ancillary data are associated with an inpatient FPOV code but have an outpatient FeeProgramProvided field. Please note that this method providers an indication of the care provided to a Veteran on a single day, rather than in a single encounter, because multiple providers may use the same billing vendor. Note: Admission date is only relevant for inpatient stays; it is not relevant for outpatient visits. 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. For example, if the Veteran had an Emergency Department (ED) visit and then was admitted to the hospital, this would be considered inpatient care. To access the menus on this page please perform the following steps. We assume here that new inpatient stays are defined by a change in vendor or a gap in treatment day more than 1 day. If you are in crisis or having thoughts of suicide, All SAS prescription-related data is found in two files: the PHR file and the PHARMVEN file. SAS and SQL contain different variables to identify the provider and/or vendor associated with the care. a. URLs are not live because they are VA intranet only. If electronic capability isnot available, providers can submit claims by mail or secure fax. Fact Sheet: Medical Document Submission Requirements for Care Coordination, ADA Dental Claim Form > American Dental Association website. All information in this guidebook pertains to use of ICD-9 codes. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with. In SQL, the fields containing these data can be found in the FeeDispositionCode and FeeDispositionName Refer to Appendix C for a list of Fee Disposition Codes. Home Health Agencies billing with an OASIS Treatment number use the Prior Authorization segment for the TAC and the Referral Number segment on the 837I submission. 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 Data in any of the any S tables require Staff Real SSN access. [XXX] tables.9,12 Tables under the DIM schema contain attributes that describe the records in the Fee tables. A Non-VA Medical Care claim is defined by four elements: The remainder of section 7.4 details payment rules as of early 2015. All preauthorized claims are then processed through the Fee Basis Claims System (FBCS) at the local facility as well as sent to the payment team. This is specific to certain claims for Non-Service Connected emergency medical care under Title 38 USC 1725. It appears that starting in FY2016, Choice data is now bypassing FBCS and residing in the PIT. Veterans Crisis Line: 2010;47(8):725-37. NNPO. (Anything) - 7.(Anything). In SAS data, there is also a primary service area variable (HOMEPSA) that indicates the station to which the Veterans residence is assigned based on geography. 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. U.S. Department of Veterans Affairs. 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. 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). 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.