Non-VA Medical Care data are available in SAS form at the Austin Information Technology Center (AITC) and in SAS form and SQL form through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). 3. 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 amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. 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. Fee Basis providers vary in how frequently they submit an invoice for Fee Basis care. SQL data are housed at CDW, which is a collection of many servers. Chapter 4 offers detailed information SAS Fee Basis data; Chapter 5 provides detailed information about SQL Fee Basis data. Prior to FY 2007, INTAMT has two implied decimal places. 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. Gidwani R, Hong J, Murrell S. Fee Basis Data: A Guide for Researchers. The quantity dispensed. We compared the service date (TREATDTO in inpatient and ancillary, TREATDT in outpatient, and FILLDTE in pharmacy files) to the FMS processing date (PROCDTE) (See Table 1). Contact the VA North Texas Health Care System. 2. If it still cannot be found, then the stay may have ended on the day the person stabilized. 1. 988 (Press 1). VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. Austin Information Technology Center (AITC) is one of the VAs five national data centers. Request and Coordinate Care: Find more information about submitting documentation for authorized care. Most, if not all, of this care should be emergency care. Smith MW, Chow A. Non-VA Medical Care (Fee Basis) Data: A Guide for Researchers. This component communicates with the FBCS MS SQL database and Veterans Health Information Systems and Technology Architecture (VistA) database in real time. 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. PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. This is specific to certain claims for Non-Service Connected emergency medical care under Title 38 USC 1725. VA has set a goal of processing all clean claims within 30 days. If disbursed amount is missing, use payment amount instead. Actual processing time has varied considerably over the years. Electronic 837 claim and 275 supporting documentation submissions can be completed through VAs contracted clearinghouse, Change Healthcare, or through another clearinghouse of your choice. 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 To enter and activate the submenu links, hit the down arrow. Chapter 8 provides references for further information about the Fee Basis program and data. One exception to this is when identifying emergency department (ED) visits. All Fee Basis care will be found in the Fee files. SAS Fee Basis data can be linked to other SAS files with additional demographic data (e.g., Vital Status files, enrollment files). Documentation, including data contents, field frequencies, and record counts, is also available on VIReCs CDW Data Documentation page (VA intranet only: http://vaww.virec.research.va.gov/CDW/Documentation.htm). Medication dosage/strength. Veterans Health Administration. Get the latest updates on VA community care, including program changes, resources and more! Unauthorized inpatient or outpatient claims must be submitted within 90 days from the date of care. VA employees working on research studies cannot create their own crosswalk file as they do not have permission to use these files. Persons looking to find the date of service should be advised that it will not be contained in the FeeServiceProvided table. 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. A claim for which the Veteran had coverage by a health plan as defined in statute. 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. 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. Business Product Management. These include Fee purpose of visit (FPOV), place of service (PLSER), type of treatment (TRETYPE), HCFA payment type (HCFATYPE), and record type (TYPE). CLAIMS INTAKE CENTER. What documents are required by VA to process claims for. As of July 2015, the current mileage reimbursement rate is 41.5 cents per mile. 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. Compare the discharge date of the first observation to the admission date of the next (second) observation. The conversion happens before claims and records are accepted into our claims processing system. [FeeInpatInvoice] and [Fee]. Note: The last extract occurred in December 2020. http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. One can use the FeeInitialTreatmentSID variable in the FeeServiceProvided table to link to the Fee.FeeInitialTreatment table. 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. For example, the meaning of DRG001 is not the same in FY05 vs FY15. Available at: http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf.. 3. Veterans Health Administration. MDCAREID is not available in the outpatient SAS Fee Basis data, even though some outpatient services are provided in a hospital. One can evaluate which encounters were unauthorized by joining the FeeUnauthorizedClaim table through the FeeUnauthorizedClaimSID key. Note: Admission date is only relevant for inpatient stays; it is not relevant for outpatient visits. There are two types of keys: primary keys and foreign keys. Claims related to this care are considered authorized care. There is limited information on the providers associated with Fee Basis care. (1) A Veteran must be enrolled in VA health care16. There is another category of Fee Basis care that is considered unauthorized care. [Spatient], and [Spatient]. 1. As noted in Chapter 2, the important variables capturing cost of care are AMOUNT and DISAMT. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. There is no information available in the SAS data that identifies the actual medication dispensed. This improves our claims processing efficiency. The Florida Department of Veterans' Affairs has Claims Examiners co-located with the VA Regional Office in Bay Pines, each VA Medical Center and many VA Outpatient Clinics. This latter table contains a variable called InitialTreatmentDateTime. The FeeSpecialtyCodeName contains information on the specialty of the provider seen, such as oncology, chiropractic, pathology, neurosurgery, etc., but is missing much data. One way to do this is to concatenate the vendor identifier, the patient identifier, and the visit date. This technology is not portable as it runs only on Windows operating systems. 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. Hit enter to expand a main menu option (Health, Benefits, etc). The DSS Fee Basis Claims System (FBCS) is a web-based claim management system. Eligibility and claims submission information for emergent care will be provided after notification is made to the VA. Claims for emergent care not eligible for authorization upon notification, may be eligible for consideration as Unauthorized Care. VA must be capable of linking submitted supporting documentation to a corresponding claim. This application is directly attached to TWAIN compliant scanners and works offline to VistA and the FBCS MS SQL databases. U.S. Department of Veterans Affairs. June 5, 2009. 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. 14. For more information call 1-800-396-7929.Claims for Non-VA Emergency CareVeterans need to make sure any bills for non-VA emergency care of non-service connected conditions are submitted to the VA Medical Centers NVCC Office within 90 days. We give an example here that relates to FeeInpatInvoice table. VA's fee basis care program. VA employees working on operations studies can build their own crosswalk file as they have permission to use these file. The two tables can be joined through FeePharmacyInvoiceSID. [FeeInpatInvoiceICDProcedure] table. Office of Media and Public Relations. Data Quality Analysis Team. The inpatient data will also need to be linked to the ancillary data, or the data representing the professional services provided to a patient while in the hospital, in order to determine the total cost of the inpatient stay. Updated August 26, 2015. Accessed October 16, 2015. 400, Wittman Drive Grand Rapids Itasca County MN - 55744 United States. If the payment was made outside of FBCS, they wont show here. If the provider declines VA payment then it may be able to charge the patient a greater total amount. Information from this system resides on and transmits through computer systems and networks funded by the VA. [FeeServiceProvided], [Fee]. Most commonly, authorized care refers to medical or dental care that was approved and arranged by VA to be completed in the community. VSSC provides numerous relevant web reports, data resources, and analytics support, including summary data by facility and VISN and national summary data. Given the variable definitions, it is not clear whether DX1 or DXLSF is the better choice to determine primary reason for inpatient stay. FBCS supports payment of claims via VistA. NNPO. 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. More information about can be found on their website: https://www.va.gov/communitycare/. 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." Claims for Non-VA Emergency Care More information can be found at the OPES website: http://opes.vssc.med.va.gov. Outpatient prescriptions beyond a 10-day supply. If the gap is 0 or 1, it is part of the same hospital stay and we then want to assess its discharge date. As a Class 2 or Class 3 product, it MUST NOT be assumed to having been released into production through all OI&T product release and sustainment process controls for project management; requirements, development and testing management; and configuration, change, and release management necessary to satisfy OI&T process and product compliance. Seven refer explicitly to Veterans alone, while the remaining two are for diagnostic services or eligibility exams, neither of which constitutes treatment. have hearing loss. 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). 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. visit VeteransCrisisLine.net for more resources. This is a critical difference from VA utilization files, which are organized by date of service. This section describes two elements of the program: the range of services covered and the payment rules used to determine the amount that VA will pay (DISAMT). [FeeVendor] table. The Act amends 38 U.S.C. For more information call 1-800-396-7929. [FeeInpatInvoiceICDProcedure] table. To enter and activate the submenu links, hit the down arrow. As noted above, in SAS, the patient identifier is the SCRSSN; this is unique to each patient across the entire VA. This component provides administration, reporting, and letter generation for all of the components of the Fee Basis Claims Systems (FBCS) via native Microsoft Structured Query Language (SQL) Server database communication drivers. 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. PatientIEN and PatientSID are unique to a patient within a facility, but not unique to a patient across VA facilities (e.g., a patient who had visited multiple VA facilities will have multiple PatientIENs and multiple PatientSIDs). Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. The discussion below pertains to both SAS and SQL data. The process of linking can be complex; analysts should take care to reduce errors during this process. For more detailed information, researchers should visit the VHA Office of Community Care website. [FeeInpatInvoice] table, one must first link that table to the [Fee]. This guidebook is intended to help researchers understand and use the National Fee Basis files, which come in both SQL and SAS formats. If using payment amount, one would overestimate the cost of care. Many private health insurance companies will apply VA health care charges towards satisfying a Veteran's annual deductible and maximum out of pocket expnse. [1] The Health Care Financing Administration (HCFA) was renamed the Centers for Medicare and Medicaid Services. 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. Attention A T users. SAS has more data on inpatient diagnosis and procedure variables than do SQL data. [FeePharmacyInvoice] table contains information on vendor, amount claimed, and amount paid. 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. 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. 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. Hit enter to expand a main menu option (Health, Benefits, etc). VA Informatics and Computing Resource Center (VINCI). VA Claims Representation; RESOURCES. Researchers can read more information about accessing CDW on the VHA Data Portal (http://vaww.vhadataportal.med.va.gov/DataSources/CDW.aspx; VA intranet only). SQL Fee Basis data are stored in the form of multiple relational tables that must be linked, or in SQL parlance, joined, in order to create an analysis dataset. VA Informatics and Computing Resource Center (VINCI). Summary Fee Basis expenditure data are also available through the VHA Support Services Center (VSSC) intranet site, further information about accessing these summary data can be found in Chapter 6. The vendor identity can be found through the VENDID or VEN13N variables in SAS. In order to gain access to the AITC mainframe, VA system users must contact their local Customer User Provisioning System (CUPS) Points of Contact (POC) and submit a VA Form 9957 to create a Time Sharing Option (TSO) account. 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. The prescriptions filled by fee-basis pharmacies are often small quantities of medication to meet the patients emergency or short-term needs while a CMOP prescription is being filled. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. At the time of this writing, the NPI number was often missing from fee basis claims. YESElectronic Remittance (ERA)YESICD- 1. If electronic capability is not available, providers can submit claims by mail. However, one also needs to exercise caution with DRG; there are 2 different sets of DRGs used over time.