va fee basis program claims address

Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. Working with the Veterans Health Adminstration: A Guide for Providers [online]. For some vendors, there may be more than on possible hospital, for example, if the vendor is a hospital chain or an organization with a VA contract. Subscribe to our E-newsletter The Service Connection Our monthly newsletter features about important and up-to-date veterans' law news, keeping you informed about the changes that matter. Va Fee Basis Program Claims Address - pijonajalin.weebly.com For some years, there may be high rates of missingness of ICD-9 data in the Ancillary files. Please switch auto forms mode to off. To learn more, please visit the Provider Training section on the MES website . [ICDProcedure] table and a foreign key in the [Fee]. Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. The VendorType contains information about whether the service was provided by a laboratory, radiology, physician, pharmacy, other, travel, prosthetics, federal hospital, public hospital or private hospital. PO BOX 4444. The mileage fee varies by type of ambulance service: ground, fixed wing, or rotary wing, POP zip code classification, and loaded mileage. The definition of the DXLSF variable changes depending on the year of analysis. Veterans Choice Program Eligibility Details [online]. 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). [FeeInpatInvoiceICDProcedure] table. Analyses of FY 2014 data indicate approximately 50% of inpatient observations and 43% of outpatient observations are missing NPI. 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. For billing questions contact: Health Resource Center Box 30780, Tampa FL 33630-3780. 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. There is another category of Fee Basis care that is considered unauthorized care. VA is required by law to bill private health insurance carriers for medical care, supplies and prescriptions provided for treatment of Veterans' nonservice-connected conditions. Thus, in SQL the total cost of an inpatient stay would be determined by evaluating the DisbursedAmount in the [Fee]. A single inpatient encounter may generate zero, one, or multiple ancillary records, depending on the number of ancillary procedures and physician services received. VA Palo Alto, Health Economics Resource Center;November 2015. Fee Basis data can be broadly categorized into 4 classes: inpatient care, outpatient care, pharmacy, and travel data. The zip code accompanying the VEN13 variable denotes the zip code to which VA sent reimbursement, not the zip code where the service was rendered. 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. 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. Business Product Management. - The information contained on this page is accurate as of the Decision Date (11/02/2022). As of April 2019, this guidebook is no longer being updated. Most importantly, they do not represent all care provided during the fiscal year. 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). This guidebook is intended to help researchers understand and use the National Fee Basis files, which come in both SQL and SAS formats. The SQL tables [Dim]. Given the stronger guidance from the Fee Office regarding use of the FPOV code, we recommend using the FPOV code to discern which observations are ancillary care, as the FeeProgram may not be as reliable. Those with access to the VA intranet can find a list of SQL fields on the CDW MetaData site. When a key field is missing, SQL indicates this with a value of -1. SAS and SQL contain different variables to identify the provider and/or vendor associated with the care. Defining a cohort is an activity that is different for each project and depends on the research question at hand. Hit enter to expand a main menu option (Health, Benefits, etc). 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. There are delays in the processing of Fee Basis claims. Accessed October 07, 2015. The SAS data are stored at AITC. Attention A T users. Questions about care and authorization should be directed to the referring VA Medical Center. Payment for care provided under the Veterans Choice Act may not exceed the Medicare Fee Schedule (i.e. This component provides a front end for recognizing claim data through optical character recognition (OCR) software. The funds are used to provide the best care possible to our Veterans. [FeeInpatInvoice] and [Fee]. Persons working with SPatient or Patient data are also recommended to refer to the CDW guidance about how to delete test observations. There is no separate payment for items such as oxygen or other supplies, the number of attendants, providing an EKG during the trip, etc. 1. This component is a service that communicates with the Program Integrity Tool (PIT) which scores claims and sends results to FBCS. The Routing tool manages how Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims will electronically flow through the FBCS program. 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. Non-VA Payment Methodology Matrix [online; VA intranet only]. If, however, VA is authorized to pay for only certain days in an inpatient stay, then the provider may bill the patient for the remaining days. MDCAREID is the Medicare OSCAR number, which is a hospital identifier. FBCS is designed to be used in the Fee Basis Departments of the Veteran Affairs Medical Centers (VAMCs). Each VA facility has a local Fee Office to which the non-VA provider submits a claim for reimbursement. 1. 1728. Payments received from a Veterans private health insurance carrier are credited towards any applicable VA copayments, reducing all or part of the Veterans out-of-pocket expenses. There are also a number of other financial variables denoted in SAS (see Table 7). Claims Assistance | Veterans' Affairs - South Carolina [SpatientAddress] tables. Identify Choice records by using tax ID and specialprovcat= CHOICE. Then, to see which ICD procedure codes were coded for this inpatient stay, one must link to the [Dim]. U.S. Department of Veterans Affairs. Researchers wishing to work with SAS Fee Basis data can access them at the Austin Information Technology Center (AITC). For example, a hospital stay may last from Jan 1, 2010 to Jan 10, 2010, and have another claim for treatment provided on Jan 5, 2010. The two tables can be joined through FeePharmacyInvoiceSID. However, not all dates on the claim are approved. In that case, use payment amount instead. 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). is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not. To access the menus on this page please perform the following steps. It is the patient identifier that uniquely defines a patient across all facilities. The data that is not available is the data element that indicates if it was generated by FBCS or manually entered by the user in FBCS. Providers are not required to accept VA payment in all cases. If you submit a noncompliant claim and/or record, you will receive a letter from us that includes the rejection code and reason for rejection. ______________________________________________________________________________. One can use the same approach as for the inpatient SQL data described above to locate the date of service. CDW Data Quality Analysis Team has particular recommendations for excluding observations before beginning analyses on your cohort.13 Corporate Data Warehouse (CDW) contains dummy data as well as test patients that will need to be removed from tables before conducting analyses. If your claim was submitted to VA, call (877) 881-7618, If your claim was submitted to TriWest, call (877) 226-8749. SQL Fee data are available through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). If electronic capability isnot available, providers can submit claims by mail or secure fax. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. 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. FBCS Upload leverages LEADTOOLS Professional Optical Character Recognition (OCR) and is included in the FBCS workstation install package. The Act amends 38 U.S.C. 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. [FeeServiceProvided] tables. Conversely, all stays should have at least one discharge diagnosis. 15. A claims scrubber software program is run to ensure completeness and to locate possible errors. Fee Basis Services - VetsFirst However, not all data in the FeeServiceProvided table are outpatient data; some may pertain to inpatient stays. 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]. 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. Non-VA providers submit claims for reimbursement to VA. If it still cannot be found, then the stay may have ended on the day the person stabilized. For a list of VA acronyms, please visit the VA AcronymLookup on the VA intranet at http://vaww.va.gov/Acronyms/fulllist.cfm. Search VA Fee Basis Programs PayerID 12115 and find the complete info about VA Fee Basis Programs Insurance Type, LOB, ENR, RTE, RTS, ERA, SEC, Customer Service Number and more . The UB-92 equivalent variables would be: facility (after merging in facility name from the FBCS_Facilities table), vistapatkey, and vistaauthkey, respectively. In general, we recommend using the disbursed amount to capture the cost of care, for two reasons. Additionally, our health care providers make certain that Veterans' VA medical records remain updated by returning information about Veteran care and treatment to VA. The data files in each fiscal year represent all claims processed in the FMS during the year. VA Informatics and Computing Resource Center (VINCI). For more details, including rules for handling patients transferred during a stay, see federal regulation 38 CFR 17.55. [FeeInpatInvoiceICDDiagnosis], [Dim]. There may be multiple CPT codes associated with a single encounter. If the Veteran went to the ED and was not admitted to the hospital, this would be considered outpatient care. It is available in the PHARVEN and VEN files, albeit with a high degree of missingness. 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. one episode of care, which can have multiple dates within the prescribed treatment, one provider, as identified by the Tax Identification Number (TIN), and. Detailed information about accessing each of these data sources is available at the VHA Data Portal (VA intranet only: http://vaww.vhadataportal.med.va.gov).See Table 10 for a summary of the data sources. To access the menus on this page please perform the following steps. Therefore, on the outpatient side as well one must aggregate multiple records to get a full picture of the outpatient encounter. To enter and activate the submenu links, hit the down arrow. Missingness can vary substantially by year and by file. The Fee Basis data contain a unique variable not found in the traditional VA inpatient and outpatient datasets: the Fee Purpose of Visit (FPOV) variable. Operating Systems Supported by the Technology. Payer ID for dental claims is 12116. If electronic capability is not available, providers can submit claims by mail or secure fax. Chief Business Office. This means the data were placed in the PIT and the claim was not paid through FBCS. There are often multiple observations per inpatient stay and multiple observations per outpatient encounter. New values may be added over time. Researchers should pay special attention to reducing duplicates in the pre-2008 data. What documents are required by VA to process claims for. The local VA facilities put claims through a claim scrubber that checks to see if the claim was authorized and evaluates any errors or inconsistencies in the data. Prior to FY 2007, INTAMT has two implied decimal places. This act expands the non-VA care veterans were able to receive before the act was passed. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. The second record would have an admission date of Jan 5, 2010 and a discharge date of Jan 5, 2010. 4. However, there is one situation in which the payment amount will be more accurate than the disbursed amount: when the disbursed amount is missing, and the payment was not cancelled, one should use the payment amount to capture the cost of care. SQL Fee Basis data are stored in CDW in multiple individual tables. 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. Of note, the relevant SQL tables for Fee Basis data are not only the [Fee]. 5. 6. Race and ethnicity are found in the [PatientEthnicity], [PatSub]. (Available at the VHA Data Portal. The NPI is the national provider identifier, which is provider-specific but often missing in the Fee Basis data. 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). If the provider declines VA payment then it may be able to charge the patient a greater total amount. We are grateful for their cogent work. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). 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. If a patient received care at another facility, that patient will be have a different PatientSID assigned for that facility. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. There may be many providers that use the same vendor for billing. Through patient identifier and travel date (TravelPaymentDate), one can link these payments to inpatient and outpatient encounters. Many private health insurance companies will apply VA health care charges towards satisfying a Veteran's annual deductible and maximum out of pocket expnse. [Patient], [SPatient]. Hospice also appears to be billed monthly, with longest length of stay for a single hospice invoice of 31 days. Chapter 1 presents an overview of Fee Basis data in general; Chapter 2 presents an overview of the variables in the Fee Basis data; and Chapter 3 describes how SAS versus SQL forms of Fee Basis data differ. 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. Box 537007Sacramento CA 95853-7007, CCN Region 5(Kodiak, Alaska, only)Submit to TriWest. privacy policies and guidelines. You can further refine by selecting records on or after November 4, 2014, when Choice was first enacted. A record is created only if there is a code on the invoice to be recorded. Veterans Crisis Line: Veterans Choice Program - Fee Basis Claims System in CDW - Veterans Affairs Below are some answers to general questions about the FBCS tables. [FeeTravelPayment] contain information on travel type and payment. Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). For authorized care, the referral number listed on the Billing and Other Referral Information form. While many Veterans qualify for free health care services based on a VA compensable service-connected condition or other qualifying factor, most Veterans are asked to complete an annual financial assessment, to determine if they qualify for free services. There may be multiple vendor IDs (VENDIDs) for a single inpatient stay. The payment category (PAYCAT) is missing for all records in the inpatient services (ANCIL) file. The [Fee]. Submit a claim void when you need to cancel a claim already submitted and processed. visit VeteransCrisisLine.net for more resources. Attention A T users. These rules are subject to change by statute or regulation. In SAS, the outpatient data are housed in the MED files. The dates of service are represented by the covered from/to fields of the UB-92. 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]. This service communicates via native SQL Server 2005 encrypted connections through the VA Wide Area Network (WAN). If the gap is 0 or 1, evaluate the discharge date of the first and second observation. 12. This component distributes fee workload to particular users using the FBCS MS SQL database and the VistA Gateway. If researchers wish to identify ED visits, they may want to use CPT codes or Place of Service codes, rather than FPOV. VINCI. Outpatient data are housed in the FeeServiceProvided table. If a Veteran has only Medicare Part A then VA may consider payment for ancillary and professional services usually covered under Part B. Users must ensure that Microsoft .NET Framework, Microsoft Structured Query Language (SQL) Server, and Microsoft Excel are implemented with VA-approved baselines. Prescription-related data in the PHARVEN file contain only summary payments by month. However, in all data files, the vast majority of observations are missing values for this variable.