VINCI Data Description: Dimension [online; VA intranet only]. Accessed October 16, 2015. In summary, in order to create a research cohort, one must first identify the cohort based on PatientSID, then request the CDW data manager to link the PatientSIDs in her cohort to unique PatientICNs, and finally remove test/dummy/unnecessary PatientSIDs and PatientICNs. As a single encounter may have more than one CPT code, users may have to aggregate multiple observations in order to evaluate the care received on a particular day. The diagram below (Figure 1) displays how payment is processed and sent to the non-VA provider. 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. More than 99% of claims for inpatient, ancillary and outpatient care are processed within 2 years. Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. In SAS, the inpatient (INPT) file includes PAMT, the Medicare prospective payment that would apply to the stay. 2. The SQL tables [Dim]. The electronic 275 transaction process may be utilized to supply Remittance Advice documentation for timely filing purposes. Many URLs are not live because they are VA intranet only. Care provided in foreign countries other than the Philippines. The Veteran files contain the richest patient demographic information in the SAS data; these include the Veterans date of birth, sex, prisoner of war status and war code. 6. The VEN13N is the vendor ID with a suffix; VEN13N is more detailed than VENDID and is thus recommended for use. Last updated August 21, 2017 As noted above, non-VA care may be authorized under the Non-VA Medical Care program when VA cannot offer needed care. 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. There is a lack of publicly available technical documentation and support may be limited to specific forums. 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 seeming complicated arrangement is an efficient way to store data. Complete and accurate standard Center for Medicare & Medicaid Services (CMS) or electronic transaction containing false claims notice (such as CMS 1450, CMS 1500 or 837 EDI transaction). Fee Basis tables, however, only list PatientSID and do not list PatientICN. This application reads, creates, edits authorization data in VistA, and copies critical information into the central SQL database for off-line VistA applications to consume. Race and ethnicity are found in the [PatientEthnicity], [PatSub]. Researchers will notice a high degree of concordance between SAS and SQL data in most years of analysis. However, 99% of inpatient hospital invoices were associated with a length of stay of 33 days or less. Not all of these variables appear in every utilization file. what is specified but is not to exceed or affect previous decimal places. 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. U.S. Department of Veterans Affairs. SAS and SQL contain different variables to identify the provider and/or vendor associated with the care. The Medicare hospital provider ID (MDCAREID) is entered by fee basis staff in order to calculate hospital reimbursement using the Medicare Pricer software. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. The mileage is calculated using the fastest route. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. We believe that payments are then made from the claim data available from the Claims Reconciliation and Auditing: Program Integrity Tool (PIT) with lump sum/expedited payments being made on a weekly basis and retrospective review, as well as recoupment efforts for overpayments/duplicates. Veterans who meet certain criteria may be eligible for mileage reimbursement for travel to and from VA or Non-VA care. The same cannot be said for DX2-DX25, however, as additional diagnosis codes are optional. _________________________________________________________________. SQL Fee Basis data are stored in CDW in multiple individual tables. Sort data by the patient ID, STA3N, VEN13N, and the admission dates. Access; upload; download; change; or delete information on this system; Otherwise misuse this system are strictly prohibited. If electronic capability is not available, providers can submit claims by mail or secure fax. Note: A Veterans insurance coverage or lack of insurance coverage does not determine their eligibility for treatment at a VA health care facility. 1. Persons interested in studying care provided under the Choice Act may wish to explore the VACAA tables or the FBCS tables at VA Corporate Data Warehouse (CDW). In SQL, there are multiple patient identifiers, with the most useful being the PatientICN. A claims scrubber software program is run to ensure completeness and to locate possible errors. SQL tables require linking before conducting any data analyses. The vendor no longer supports VA installations of this technology. This product is Class 2 or Class 3 VA-designed and built Local Software OR is a commercially-licensed software product purchased or leased that will run in a VA VISTA environment or integrate with Class 1 National VISTA Software. How Much Life Insurance Do You Really Need? You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. 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). The Medicare ID is missing if the payment is determined via a different mechanism (e.g., a contract). In this chapter, we discuss general aspects of Fee Basis data. 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. 9. Multiple claims may be submitted for each inpatient stay and the various claims do not have a common identifier indicating they are all part of the same inpatient stay. Information from this system resides on and transmits through computer systems and networks funded by the VA. Given these different patient identifiers, it is difficult to conduct exact comparisons between SAS and SQL data. 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 gratefully acknowledge comments and contributions from Sharon Dally, Susan Schmitt and Paul Barnett. Office of Media and Public Relations. The vendor identity can be found through the FeeVendorSID or the FeeVendorIEN variables in SQL. U.S. Department of Veterans Affairs. 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. It is not necessarily the station at which the Veteran receives most VA care or the station which will pay for a particular Non-VA Medical Care service. Unauthorized care can be of an inpatient or outpatient nature. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. In VA datasets, the MDCAREID does not have an accompanying address, but one can use other non-VA datasets (e.g., Hospital Compare) and determine the address of the hospitals physical location through the common MDCAREID variable. The CDW is a relational database organized into a collection of data domains implemented on the Microsoft SQL server in VINCI. Request and Coordinate Care: Find more information about submitting documentation for authorized care. Unlike the inpatient data, there can be multiple records with the same invoice number. Name of the medication. FBCS is where weve spent the bulk of our time investigating. Emergency claims covered under the Veterans Millennium Care and Benefits Act, Public Law 106-117); see 29 CFR 17.120 and 38 CFR 17.1004. Include the claim, or a copy of the claim, on top of the supporting documentation that is mailed to the following address: Include a completed cover sheet with the supporting documentation that is mailed to the above address. A claim void must be identical to the original claim that it is intended to cancel. PO BOX 4444. Review the Where to Send Claims section below to learn where to send claims. It is only relevant for claims linked to VistA patients. At the time of writing, version 4.2 is the most current version. While NPI is available in SQL data, it does require special permissions to access, as it is located in the [Sstaff]. PatientIEN is assigned by the facility. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. A missing value of the primary diagnosis code should therefore be treated as truly missing. 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. For the inpatient data, we compared observations with the same patient identifier, based on PaidDate in SQL and TRANSDAT in SAS. More information on the proper use of the TRM can be found on the Include the authorization number on the claim form for all non-emergent care. 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). The VA pays for both emergency and non-emergency care through Fee Basis mechanisms. Attention A T users. The SAS Fee Basis data are organized by fiscal year. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Authorized care claims must be submitted within 6 years of the date of service, service-connected emergency care claims must be submitted within 2 years of the date of service, and non-service-connected emergency care claims must be submitted within 90 days of the date of service/discharge. 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. March 2015. Electronic Data Interchange (EDI) Interface. Two domains in which researchers can find reports on Non-VA Care are Resource Management and Workload. This latter table contains a variable called InitialTreatmentDateTime. To evaluate the time it takes VA to process Fee Basis claims, we evaluated SAS data for FY2014. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with. 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. How to create a secondary claims in eclinicalworks electronically; . 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. 2. PMS-DRG was effective in FY 2008; prior to this time CMS-DRGs were used. In SAS, the outpatient data are housed in the MED files. There are also variables pertaining to Veteran geographic information, particularly ZIP, HOMECNTY and HOMESTATE in the SAS data and County, Country, Province, and State in the SQL data. This improves claim accuracy and reduces the amount of time it takes for us to process claim determinations. In the SQL files, there is no separate ancillary file; rather, data regarding the physician cost of the inpatient stay is denoted in the [Fee]. Researchers will thus need permissions to allow the CDW data manager to obtain SCRSSN or SSN to PatientICN crosswalk to allow for the necessary data linkages. Contact the VA North Texas Health Care System. Community providers have three options that allow for that linkage: Submit the claim electronically via 837 transaction and the supporting documentation via 275 transaction. Non-VA providers submit claims for reimbursement to VA. Care provided under contract is eligible for interest payments. If electronic capability isnot available, providers can submit claims by mail or secure fax. privacy policies and guidelines. Five additional variables Financial Management System (FMS) transaction number, line number, date, batch number, and release date reflect processing of payments through the FMS. For some VEN13N, however, there is more than one MDCAREID. Business Product Management. As part of the process, claims and supporting documentation are scanned for compliance prior to conversion to electronic format. Of note, the relevant SQL tables for Fee Basis data are not only the [Fee]. 11. Payment guidelines for non-VA are outlined in federal regulations 17.55 and 17.56. One can evaluate which encounters were unauthorized by joining the FeeUnauthorizedClaim table through the FeeUnauthorizedClaimSID key. Patient residence related geographic information is available in the [Patient]. Hit enter to expand a main menu option (Health, Benefits, etc). Technologies must be operated and maintained in accordance with Federal and Department security and You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. 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. Fee Basis data live in both SAS and SQL format. FBCS is moving to a centralized system in the near future, where there will be centralized rules and national policies with 3 distinct groups: CCN (network), CCRA (authorization), and CCRS (reimbursement system; an IBM product). 1728. Six additional variables indicate the setting of care and vendor or care type. The outpatient pharmacy data includes medications dispensed in a pharmacy. To understand what procedures were performed during an inpatient stay in the [Fee]. However, in all data files, the vast majority of observations are missing values for this variable. Multiple SAS datasets have VENID and VEN13N. Users of the data should keep in mind that these data represent the physical location of the entity billing for care, which may or may not be the same as the providers location. The National Provider Identifier (NPI) is a unique 10 digit identifier mandated to be used in health claims under the Health Insurance Portability and Accountability Act (HIPAA). 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. 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. Inpatient stays in both SAS and SQL Fee Basis data can denote hospital stays, nursing home stays, or hospice stays. This application queues critical claims data into the FBCS shared MS SQL database for further processing and reporting. 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. Outpatient prescriptions beyond a 10-day supply. The same concept (such as fiscal year, state, or county) may be represented by several variables, sometimes in differing formats. Additional information appears in a federal regulation, 38 CFR 17.52. This component distributes fee workload to particular users using the FBCS MS SQL database and the VistA Gateway. The vendor represents the entity billing for the non-VA care, while the provider represents the person who was involved in care provision. The data files in each fiscal year represent all claims processed in the FMS during the year. have hearing loss, Community Care Network Region 1 (authorized), Community Care Network Region 2 (authorized), Community Care Network Region 3 (authorized), Community Care Network Region 4 (authorized), Unauthorized Emergent Care (unauthorized). VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). *From the date the Veteran was discharged from the facility that furnished the emergency treatment; the date of death, but only if the death occurred during transportation to a facility for emergency treatment or if the death occurred during the stay in the facility that included the provision of the emergency treatment; or the date the Veteran exhausted, without success, action to obtain payment or reimbursement for treatment from a third party.
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