This means the data were placed in the PIT and the claim was not paid through FBCS. You may use VA Form 10-583 to fulfill this requirement. This is true for both the inpatient and the outpatient data, albeit for different reasons. See 38 USC 1725 and 1728.). FBCS Upload leverages LEADTOOLS Professional Optical Character Recognition (OCR) and is included in the FBCS workstation install package. Researchers should use PatientICN to link patient data within CDW. 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. There may be many providers that use the same vendor for billing. 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. Table 9 lists a number of financial variables the SQL data contain. VA systems are intended to be used by authorized VA network users for viewing and retrieving information only; except as otherwise explicitly authorized for official business and limited personal use under VA policy. 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. In SAS, the inpatient (INPT) file includes PAMT, the Medicare prospective payment that would apply to the stay. Fee Basis data live in both SAS and SQL format. The FPOV variable can be found in both the SAS and SQL data. 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. This table also includes claims related to inpatient care and other services. The impact on inpatient and emergent care is unclear, however, as the definition of prosthetic in VA is so broad as to include items placed inside the body, such as internal fixation devices, coronary stents, and cardioverter defibrillators. . PDF Office of Inspector General - Oversight.gov Facility charges vs. ancillary charges: There are instances when there may be claims for facility charges with no corresponding ancillary provider charge. SAS versus SQL data differ in three main ways: Appendix A lists all variables in the SAS files. 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. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. Emergency care can also be authorized by VA in certain circumstances when the VA is notified within 72 hours. Multiple SQL tables contain these variables. Some vendors use centralized billing services located in other cities, in a few cases in other states. Two domains in which researchers can find reports on Non-VA Care are Resource Management and Workload. [FeeInpatInvoice], and a foreign key in the [Fee].[FeeInpatInvoiceICDProcedure]. 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. SAS Fee Basis data can be linked to other SAS files with additional demographic data (e.g., Vital Status files, enrollment files). No, only one type of care can be covered by a single authorization. have hearing loss. access; blocking; tracking; disclosing to authorized personnel; or any other authorized You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. On March 17, 2022, The U.S. Court of Appeals for the Federal Circuit issued a ruling that changes VA's ability to reimburse as secondary payer under 38 U.S.C.1725. 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. 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. All instances of deployment using this technology should be reviewed to ensure compliance with. When there is no available rate in the Medicare Fee Schedule, the VA will follow the payment guidelines for Non-VA Medical Care. All analyses using this cohort should use PatientICN as indicative of a unique patient. If the payment was made outside of FBCS, they wont show here. For example, sta3n 589A5 will be found as 589. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). From 1998 to 2014, approximately 50% of claims were paid within 30 days of VA receiving the invoice, and 95% of claims are paid in 200 days or less. The Veterans Emergency Care Fairness Act (Public Law 111-137), signed February 1, 2010, authorizes VA as a secondary payer to third party liability insurance not related to health insurance. In SQL, these variables can be found in the [Dim]. Chief Business Office. Gidwani R, Hong J, Murrell S. Fee Basis Data: A Guide for Researchers. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. HERC: Fee Basis Data: A Guide for Researchers - Veterans Affairs SQL data are housed at CDW, which is a collection of many servers. At the time of writing, version 4.2 is the most current version. If this is the case, then it can be assumed that any care provided by the vendor with that VEN13N is actually a hospital with that MDCAREID. There are a number of different variables that denote the category of care a Veteran received through Fee Basis (see Table 2) Appendices B and H present more details about the values these variables can take. A single inpatient encounter may generate zero, one, or multiple ancillary records, depending on the number of ancillary procedures and physician services received. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). Appendix G lists all available FPOV codes and classifies them as inpatient or outpatient. Per the May 5th, 2015 memorandum from the VA Chief Information Security Officer (CISO) FIPS 140-2 Validate Full Disk Encryption (FOE) for Data at Rest in Database Management Systems (DBMS) and in accordance with Federal requirements and VA policy, database management must use Federal Information Processing Standards (FIPS) 140-2 compliant encryption to protect the confidentiality and integrity of VA information at rest at the application level. Multiple claims can be paid against a single authorization. Electronic Data Interchange (EDI): Payer ID for medical claims is TWVACCN. Unlike the inpatient data, there can be multiple records with the same invoice number. FBCS is where weve spent the bulk of our time investigating. U.S. Department of Veterans Affairs. There is limited information on the providers associated with Fee Basis care. This is in line with the way VHA Office of Productivity, Efficiency & Staffing (OPES) ascertains ED visit. 1. 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. 2. [FeeServiceProvided], [Fee]. Accessed October 27, 2015. Values for Fee Purpose of Visit (FPOV), HCFA Payment Type (HCFATYPE), Treatment Code (TRETYPE), Place of Service (PLSER), and Vendor Type (TYPE) appear in Appendix B. Please switch auto forms mode to off. Paper claims and supporting documentation submitted to us are converted to Electronic Data Interchange (EDI) transactions. Appropriate access enforcement and physical security control must also be implemented. Box 30780 Tampa, FL 33630-3780, P2E Documentation Cover Sheet, VA Form 10-10143f. Payment for these types of care falls under the Non-VA Medical Care program. This rare event most likely indicates a transfer. 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. This guide serves as an addendum to any technical documentation supplied by the healthcare clearinghouse when establishing a trading partner agreement. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. 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. Smith MW, Su P, Phibbs CS. This most likely reflects a low frequency of surgery rather than missing data. FBCS supports payment of claims via VistA. Non-VA providers submit claims for reimbursement to VA. [FeePrescription] table contains rich information on the type of drug prescribed and dispensed, including the drug name, manufacturer, strength, quantity, date filled and charge and disbursed (payment) amount. 2. We continue on this process until we find a gap greater than 1 day or we have evaluated all observations with that patient ID, STA3N and VEN13N. However, not all dates on the claim are approved. It is also possible that researchers will find a slight difference in the observations that the SAS versus SQL data contain. Before this time, data were entered by hand, and there was no easy way to tell whether the claim being entered was a duplicate one. 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. This is the main utility that passes information back into the FBCS Payment application. 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. U.S. Department of Veterans Affairs. Researchers will need to link to the Patient and SPatient domains to access this geographic information in the SQL data. 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). Office of Media and Public Relations. In SAS, the outpatient data are housed in the MED files. More information on the proper use of the TRM can be found on the 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. The key field indicates which invoice they appeared on. This component communicates with the FBCS MS SQL and VistA database in real time. 1725 (the Mill Bill) by enabling VA to pay for or reimburse Veterans enrolled in VA health care for the remaining cost of emergency care if the liability insurance only covered part of the cost. Health Information Governance. [PatientRace] tables. Matching outpatient prosthetics order records in the VA National Prosthetics Patient Database (NPPD) to health care utilization databases.