The charge for an ambulance trip to a non-VA hospital may be paid through the Non-VA Medical Care program if the medical center determines that the hospital services meet the criteria for an unauthorized claim or a 38 U.S.C 1725 (Mill Bill) claim, or if the patient died while in route to the facility. If the gap is 0 or 1, evaluate the discharge date of the first and second observation. The SAS Fee Basis data are organized by fiscal year. The potential exists to store Personally Identifiable Information (PII), Protected Health Information (PHI) and/or VA Sensitive data and proper security standards must be followed in these cases. The process for filing a claim for services rendered to a Veteran in the community varies depending upon whether or not the services were referred by VA and by the entity through which the services were authorizedVA or one of the VA Third Party Administrators (TriWest Healthcare Alliance or Optum United Health Care). Thus, the mailing address of the vendor is not always the vendors actual location. 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. (Anything) - 7.(Anything). This is the main utility that passes information back into the FBCS Payment application. For more detailed information, researchers should visit the VHA Office of Community Care website. The Routing tool manages how Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims will electronically flow through the FBCS program. There are different ways of costing out an inpatient stay in SAS and SQL data. 16. VA has established rules for timely filing of unauthorized and Mill Bill claims (i.e. To enter and activate the submenu links, hit the down arrow. If the Veteran went to the ED and was not admitted to the hospital, this would be considered outpatient care. For more details, including rules for handling patients transferred during a stay, see federal regulation 38 CFR 17.55. 5. For pension claims, use the Pension Management Center (PMC) that serves your state. 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. In FY05, DRG001 means CRANIOTOMY- >17 W CC, compared to HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC for DRG001 in FY15 DRG001. A subsequent report will contain the results of an audit conducted to assess This application completes the update of critical claims data into the FBCS shared MS SQL database for further processing and reporting. Data Quality Program. Last updated validated on Tuesday, January 3, 2023 Facility Information Security Officers (ISOs) are often the CUPS POC. Review the Where to Send Claims section below to learn where to send claims. However, investigation has confirmed these are partial payments made for a single encounter or procedure. VA systems are intended to be used by authorized VA network users for viewing and
The Fee Basis program or Non-VA Care is health care provided outside VA. NVCC Office coordinates services and payments for Veterans receiving non-VA care for emergent and non-emergent medical care. The codes for the procedures provided for a given hospital stay are kept in a separate table, a table of procedures. The key field indicates which invoice they appeared on. Submit a corrected claim when you need to replace an entire claim previously submitted and processed. 2. Include the 17 alpha-numeric (10 digits + "V" + 6 digits) VA-assigned internal control number (ICN) in the insured's I.D. Another approach is to search other fee claims submitted by the same vendor to see if a Medicare hospital ID was assigned to those claims. Learn how to prevent paper claim rejections. In SQL, these variables can be found in the [Dim]. 3. . U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Multiple claims can be paid against a single authorization. Care provided under contract is eligible for interest payments. 1. JANESVILLE, WI 53547-4444. or Fax to: TOLL FREE: 844-531-7818 & 248-524-4260 (Utilized for Foreign Claimants) return to top. 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. Non-VA CareP.O. Data are presented in Table 4. SAS versus SQL data differ in three main ways: Appendix A lists all variables in the SAS files. The Fee Basis program or Non-VA Care is health care provided outside VA. NVCC Office coordinates services and payments for Veterans receiving non-VA care for emergent and non-emergent medical care. Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. In this chapter, we discuss general aspects of Fee Basis data. The Medicare hospital provider ID (MDCAREID) is entered by fee basis staff in order to calculate hospital reimbursement using the Medicare Pricer software. Accesed October 16, 2015. This component is a service that communicates with an outside `Adjudication Engine` which scrubs claims data and sends back scrub results to the service via a secure Pretty Good Privacy (PGP) Secure Sockets Layer (SSL) web service connection. Of note, the relevant SQL tables for Fee Basis data are not only the [Fee]. SQL tables can be joined through linking keys. Steps to collapse records into a single inpatient stay: 1. Medical specialty type (SPECCODE) is a provider-specific variable and indicates the specialty type of the provider rendering the service. If a researcher decides to use FPOV, please note that an FPOV value of 52 indicates ED visit for persons whose care is covered under the Millennium Bill and should thus be included in evaluating ED care. Appendix H lists their current values. would cover any version of 7.4. You may use VA Form 10-583 to fulfill this requirement. This technology integrates with Veterans Information Systems and Technology Architecture (VistA) through Massachusetts General Hospital Utility Multi-Programming System (MUMPS) or a Structured Query Language (SQL) database system on the backend. If disbursed amount is missing, use payment amount instead. Electronic Data Interchange (EDI): Payer ID for medical claims is TWVACCN. U.S. Department of Veterans Affairs. The data files in each fiscal year represent all claims processed in the FMS during the year. The Medicare Ambulance Fee Schedule consists of a base rate plus mileage. 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." 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. With few exceptions these variables will be of little interest to researchers. Pre-2007, DISAMT and INTAMT each have two implied decimal places a value of 1000 would indicate $10.00. 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. There may be multiple vendor IDs (VENDIDs) for a single inpatient stay. This guidebook is intended to help researchers understand and use the National Fee Basis files, which come in both SQL and SAS formats. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. 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. If a patient saw two different providers on the same date who use the same vendor for billing, it will not be possible to distinguish the two encounters. [FeeTravelPayment] contain information on travel type and payment. Important: The mailing address below only pertains to disability compensation claims. 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. We detail differences amongst the SAS and SQL Fee Basis data in the guidebook below. It is only relevant for claims linked to VistA patients. There is a CPT field in the inpatient files, but this is always missing; hospitals do not use CPT codes to bill. As of April 2019, this guidebook is no longer being updated. Outpatient prescriptions beyond a 10-day supply. Veterans who have private health insurance should consider a number of important factors before canceling their health insurance, such as: If you cancel your Medicare Part B Coverage, you need to know that you cannot be reinstated until January of the following year, and you may be penalized for reinstatement. Veterans should mail or fax correspondence pertaining to compensation claims to the below location. Note: records with status= R can have missing values for the variables vistapatkey and vistaauthkey, depending on whether or not these were linked before rejecting as a re-route to HAC. Inpatient data are housed in the FeeInpatInvoice table as well as the FeeServiceProvided table, although the latter does not contain only inpatient data. The procedure code table has just as many records as there were procedures on the invoice. PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. 2. Primary keys are denoted by (PK) and foreign keys are denoted by (FK). In SQL, the outpatient data are housed in the FeeServiceProvided table. Hit enter to expand a main menu option (Health, Benefits, etc). 1728. There are nine situations in which Non-VA Medical Care is authorized. At the time of this writing, the NPI number was often missing from fee basis claims. By store procedure codes as records in another table, the SQL relational database uses the minimum amount of storable space. In the Fee Basis inpatient data, each record represents a separate claim; these separate claims must be aggregated to capture the totality of the inpatient stay. VA evaluates these claims and decides how much to reimburse these providers for care. 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. privacy policies and guidelines. Coverage will start July 1 of that year. [FeeInpatInvoiceICDProcedure] table. Attention A T users. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, Outreach, Transition and Economic Development Home, Warrior Training Advancement Course (WARTAC), Staff Appraisal Reviewer (SAR) Information, How to Apply for Nonsupervised Automatic Authority, VALERI (VA Loan Electronic Reporting Interface). Fee Basis: 214-857-1397 C & P. VA Claims Representation; RESOURCES. The payment category (PAYCAT) is missing for all records in the inpatient services (ANCIL) file. To determine the location of care, MDCAREID will be more useful than VEN13N. VA payment constitutes payment in full. This table also includes claims related to inpatient care and other services. 2. PatientIEN is assigned by the facility. HERC investigation of Fee Files reveals certain data anomalies of which researchers should be aware. Therefore, on the outpatient side as well one must aggregate multiple records to get a full picture of the outpatient encounter. Each year represents the year in which the claim was processed, not the year in which the service was rendered. All access
YESElectronic Remittance (ERA)YESICD- 1. Accessed October 16, 2015. 1. Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA care. Electronic Data Interchange (EDI): Payer ID for medical and dental claims is VA CCN. In the SAS data prior to FY 2007, the disbursed amount (DISAMT) had an implied decimal point whereas the payment amount (AMOUNT) did not. April 08, 2014. 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. We are grateful for their cogent work. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. Office of Media and Public Relations. [FeeInpatInvoiceICDDiagnosis] with the [Dim]. The Department of Veterans Affairs has implemented centralized mail processing (CM) for compensation claims to reduce incoming paper handling and shipping requirements. 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. The Fee Basis program or Non-VA Care is health care provided outside VA. NVCC Office coordinates services and payments for Veterans receiving non-VA care for emergent and non-emergent medical care. When MDCAREID is not available, it is possible to assign MCCAREID based on the relationship between VEN13N and STA6A. 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. If you are submitting a paper claim, please review the Filing Paper Claims section below for paper claim requirements. Records that relate PatientSID to PatientICN are found two tables: Patient.Patient and SPatient.Spatient. However, there are best practices that all SQL-based analyses should follow. VENDID is the vendor ID. The table can be linked to the [Dim]. Office of Information and Analytics. Each VA facility has a local Fee Office to which the non-VA provider submits a claim for reimbursement. There is a strong, but imperfect, concordance, between the observations housed in the SAS and SQL data. Of note, SQL and SAS data contain similar, but not exactly the same, information. Fact Sheet: Medical Document Submission Requirements for Care Coordination, ADA Dental Claim Form > American Dental Association website. Claims should be mailed to the following address: VA Eastern Kansas Health Care System Attn: Fee Basis Office 2200 SW Gage Blvd Topeka. VSSC web reports are organized into nine domains: Business Operations, Capital & Planning, Clinical Care, Customer Service, Quality & Performance, Resource Management, Special Focus, Systems Redesign, and Workload. Payment guidelines for non-VA are outlined in federal regulations 17.55 and 17.56. One way to do this is to concatenate the vendor identifier, the patient identifier, and the visit date. 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). 12. It is not available for claims in which payment was based on a contract amount. Persons who wish to access data in the secure tables on CDW (denoted by a S prefix) must complete a Real SSN Access Request Form. This form must be signed by the IRB and Associate Chief of Staff for Research and submitted with the DART data request. VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. These vendors are presumably hospital chains. VA may reconsider and provide retroactive reimbursements for emergency treatment that was provided prior to the date of enactment (July 19, 2001), if documentation sufficiently demonstrates the original denial was because the Veteran received partial third party payment. Journal of Rehabilitation Research and Development. If a Veteran has only Medicare Part B or has both Medicare Parts A and B, no VA payment may be made. Guidance can be found under "VHA Data Quality Program Reports. The funds are used to provide the best care possible to our Veterans. Attention A T users. Researchers will have to select observations from the SQL FeeServiceProvided table in order to ensure they are only evaluating outpatient data. Questions about non-VA care claims may be directed to the Fee Basis Unit between the hours of 8:00 a.m. Email Address Required. More information about provider reimbursement can be found in the document Working with the Veterans Health Administration: A Guide for Providers (available on the VHA Office of Community Care website, on the Provider Resources page).5. 2. Hit enter to expand a main menu option (Health, Benefits, etc). Box 30780, Tampa FL 33630-3780. The clinic of jurisdiction, or medical facility, authorizes such care under the fee-basis program . To access the menus on this page please perform the following steps. If you are in crisis or having thoughts of suicide,
U.S. Department of Veterans Affairs. VA evaluates these claims and decides how much to reimburse these providers for care. YESInstitutional/UB Claims. 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. Missing values of PAYCAT could be imputed by finding the corresponding inpatient stay in the INPT file. VA Information Resource Center VHA Corporate Data Warehouse [webpage]. There are multiple potential identifiers for provider/vendor in the SAS data: the VENDID, VEN13N, MDCAREID, SPECCODE and NPI. 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. Any variable that has an S prefix indicates secure data and requires special permission to access; researchers should be aware of this when submitting their IRB applications and their CDW DART data access requests. Chapter 6 provides information about how to access the Fee Basis data, while Chapter 7 provides information about the rules governing Fee Basis care. Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. HERC did not investigate use of NPI for this guidebook. One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. Veterans Health Administration. In SAS, the inpatient (INPT) file includes PAMT, the Medicare prospective payment that would apply to the stay. Inpatient care beyond the time when a patient is stabilized and can be transferred to a VA facility, except where a VA facility is not feasibly available. Missingness can vary substantially by year and by file. (1) A Veteran must be enrolled in VA health care16. The variable DTStamp represent the date the claim was received. There are five forms of patient identifiers in SQL files at CDW (including but not limited to the Fee Basis files): PatientICN, PatientSID, PatientSSN, ScrSSN, and PatientIEN. If disbursed amount is missing (but not $0), use payment amount instead. This component is a service that communicates directly with the High Availability Controller (HAC) SQL database for syncing critical fee data back into the local FBCS MS SQL database. Available at: http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. (Veterans may submit unauthorized claims, however, and VA has legal authority to pay them under certain conditions. Claims Assistance | Veterans' Affairs Home Claims Assistance Claims Assistance Contacting the Columbia VA Regional Office Call us at (803) 647-2488, or email VetAsst.VBACMS@va.gov, and provide your: Name Contact information and, Best time of day for contact between 8:00am and 4:00pm Additionally, we found 0.94% of records were approved Choice claims (e.g., records where SPECIALPROVCAT= CHOICE and STATUS= A (approved)). Accessed October 16, 2015. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. If the Veteran received care in the community that was not pre-authorized, it is considered unauthorized by VA. U.S. Department of Veterans Affairs. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. VA Technical Reference Model v 23.2 DSS Fee Basis Claims Systems (FBCS) General Decision Reference Component Category Analysis General Information Technologies must be operated and maintained in accordance with Federal and Department security and privacy policies and guidelines. SQL Fee data are available through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). There may be multiple CPT codes associated with a single encounter. Customer Call Center: 877-881-76188:05 a.m. to 6:45 p.m. Eastern TimeMondayFriday, Sign up for the Provider Advisor newsletter, Veterans Crisis Line:
This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year.
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