Include the 17 alpha-numeric (10 digits + "V" + 6 digits) VA-assigned internal control number (ICN) in the insured's I.D. 4. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. As of July 2015, the current mileage reimbursement rate is 41.5 cents per mile. In the outpatient data, each record represents a different procedure, as assessed through the Current Procedural Terminology (CPT) code. Veterans are not responsible for the remaining balance shown as patient responsibility on the explanation of benefits from their insurance carrier. Domains represent logically or conceptually related sets of data tables. more information please visit www.fsc.va.gov. You will have to pay this penalty for as long as you have Part B. SQL tables can be joined through linking keys. 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. 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. Veterans Crisis Line: All SAS prescription-related data is found in two files: the PHR file and the PHARMVEN file. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Q. These include Fee purpose of visit (FPOV), place of service (PLSER), type of treatment (TRETYPE), HCFA payment type (HCFATYPE), and record type (TYPE). Private health insurance coverage through a Veteran or Veteran's spouse is insurance provided by an employer, Veteran or other non-federal source, including Medicare supplemental plans. Then, to see which ICD procedure codes were coded for this inpatient stay, one must link to the [Dim]. To access the menus on this page please perform the following steps. Federal law puts prosthetics into a special payment category that mandates full financial support from VA. As implemented in VA policy, it requires that VA facilities provide all necessary prosthetics, orthotics, and assistive devices (prosthetics) needed by patients. The specific locations of the SAS payment variables and the SQL payment variables can be found in Chapters 4 and 5, respectively. In SQL, the outpatient data are housed in the FeeServiceProvided table. Basic demographic variables can be found in the [Patient]. SQL tables require linking before conducting any data analyses. The Routing tool manages how Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims will electronically flow through the FBCS program. what is specified but is not to exceed or affect previous decimal places. HERC: Fee Basis Data: A Guide for Researchers - Veterans Affairs All access or use constitutes understanding and acceptance that there is no reasonable 2. Thus, our recommendation is as follows: Use disbursed amount to calculate the cost of care, except in the case where disbursed amount is missing and the payment was not cancelled. 3. PDF VA Community Care - Veterans Affairs Providers are not required to accept VA payment in all cases. Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. One can use the same approach as for the inpatient SQL data described above to locate the date of service. If researchers wish to identify ED visits, they may want to use CPT codes or Place of Service codes, rather than FPOV. Users must ensure sensitive data is properly protected in compliance with all VA regulations. Technology must remain patched and operated in accordance with Federal and Department security policies and guidelines in order to mitigate known and future security vulnerabilities. The procedure code table has just as many records as there were procedures on the invoice. *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. SQL Fee data are available through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). There are different ways of costing out an inpatient stay in SAS and SQL data. 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. More information can be found at the OPES website: http://opes.vssc.med.va.gov. Please switch auto forms mode to off. 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). The VEN13N is the vendor ID with a suffix; VEN13N is more detailed than VENDID and is thus recommended for use. 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. DSS Fee Basis Claims Systems (FBCS) - DigitalVA VA has set a goal of processing all clean claims within 30 days. This is the main utility that passes information back into the FBCS Payment application. Guidance can be found under "VHA Data Quality Program Reports. Claims for Non-VA Emergency Care It is also possible that researchers will find a slight difference in the observations that the SAS versus SQL data contain. Payment guidelines for non-VA are outlined in federal regulations 17.55 and 17.56. To enter and activate the submenu links, hit the down arrow. Community provider mails the paper claims and documentation to the new mailing address of VA's central claims intake location. Prior to FY 2007, INTAMT has two implied decimal places. VENDID is the vendor ID. The veteran must wait over 30 days past their preferred appointment date or the date deemed medically necessary by their provider, b. To find all care provided in a particular fiscal year requires searching by treatment date over several years of Non-VA Medical Care claims. 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. Below are some answers to general questions about the FBCS tables. Accessed October 16, 2015. Veterans should mail or fax correspondence pertaining to compensation claims to the below location. Box 30780, Tampa FL 33630-3780. Table 3 lists their file names and gives a general description of their contents.10. 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). The new temporary end date is the maximum of the discharge date of the third observation and temporary end date from Step 2. [OEFOIFService]and [Dim].[POWLocation]. HERC did not investigate use of NPI for this guidebook. 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. [FeeInpatInvoiceICDProcedure] table. Internal use only. Updated August 26, 2015. Once the process is exhausted for a particular patient, STA3N and VEN13N combination, we calculate length of stay as the difference between the admission date of the first record and the temporary end date.. U.S. Department of Veterans Affairs. For some VEN13N, however, there is more than one MDCAREID. The status value A stands for accepted, meaning the claim was paid. Other work by HERC researchers indicates that in the FY 2014 data, DXLSF and DX1 were identical 47% of the time. For care received under the Choice Act, Veterans will work with the third party administrators of the Choice program to find an eligible provider in their area.4. Provider Portal - Veterans Affairs For example, an interest payment of $14.21 would appear as 1421. INTAMT is part of DISAMT; it should not be added to them. The funds are used to provide the best care possible to our Veterans. There is another category of Fee Basis care that is considered unauthorized care. In SQL, there are additional variables that will denote the type and location of the care provided along with the vendor. Chapter 6 contains more information about how to access these data. In SQL, the fields containing these data can be found in the FeeDispositionCode and FeeDispositionName Refer to Appendix C for a list of Fee Disposition Codes. Clinical variables in SAS format include ICD-9 diagnosis codes, ICD-9 surgical codes, CPT codes and CPT modifier codes, DRG codes and Present on Admission codes. SAS data also contain an additional diagnosis variable that is not present in the SQL data -- DXLSF. HERC investigation of Fee Files reveals certain data anomalies of which researchers should be aware. By June 2017, no Choice stays are found in FBCS. 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. For example, DISAMT=1000 in FY06 really indicates DISAMT=10.00. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. Prosthetic items. Of note, the relevant SQL tables for Fee Basis data are not only the [Fee]. Pre-2007, DISAMT and INTAMT each have two implied decimal places a value of 1000 would indicate $10.00. 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. If the patient was transported to a VA hospital after stabilization (as indicated by the DISTYP, or disposition type, variable), the record of the VA stay should appear in VA utilization databases. Lump sum payments are not paid via FBCS. Veterans Health Administration. Inpatient stays in both SAS and SQL Fee Basis data can denote hospital stays, nursing home stays, or hospice stays. 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). To enter and activate the submenu links, hit the down arrow. The Act amends 38 U.S.C. Steps to collapse records into a single inpatient stay: 1. In FY 2014, the longest length of stay associated with a single nursing home invoice was 31 days. In SAS, the outpatient data are housed in the MED files. Medication dosage/strength. Reimbursement for Pharmacists Services in a Hospital-based, Pharmacist-managed Anticoagulation Clinic. 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. Emergency care can also be authorized by VA in certain circumstances when the VA is notified within 72 hours. To access the menus on this page please perform the following steps. SAS data are housed in 8 ready-to-use datasets per fiscal year. VA Fee Basis Programs. 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. DSS Fee Basis Claims Systems (FBCS) - oit.va.gov What documents are required by VA to process claims for. 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. Sign up to receive the VA Provider Advisor newsletter. 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). SAS and SQL also have several geographic fields related to the vendor providing the non-VA care, such as the vendors city, county, state and zip code. Find out More Most ED visits will be identified through FPOV values of 32 or 33. To enter and activate the submenu links, hit the down arrow. The National Provider Identifier (NPI) is a unique 10-digit identification number issued by the Centers for Medicare and Medicaid Services to all health care providers in the United States. In this way, records that are missing MDCAREID can be given a MDCAREID based on the value of VEN13N and STA6A in the record. The vendor identity can be found through the VENDID or VEN13N variables in SAS. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. While NPI is available in SQL data, it does require special permissions to access, as it is located in the [Sstaff]. 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. Thus the variable INTIND (interest indicator) equals 1 if the claim is eligible for interest and 0 otherwise. The Veteran's full 9-digit social security number (SSN) may be used if the ICN is not available. Therefore, to get an understanding of the total cost of this care, one would have to link the Fee Basis data to VA utilization datasets. [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. Move on to the next patient ID, STA3N, VEN13N combination and repeat the entire process above. or use of this system constitutes user understanding and acceptance of these terms 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. FBCS supports payment of claims via VistA. The alternative, putting the procedure code fields in the invoice table, would not be as efficient. There is a lack of publicly available technical documentation and support may be limited to specific forums. For Veterans Choice Program Eligibility Details [online]. For inpatient and outpatient care, in general, VA will pay the lesser of the Medicare rate (or MPFS rate) or the billed charges. 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. Use Azure Rights Management Services (Azure RMS) for encrypted email. Many variables in the Fee Basis files record details of invoice and check processing. We suggest using only the first 3 characters from sta3n for the merge. To understand what procedures were performed during an inpatient stay in the [Fee]. 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. Visit the VHA Data Portal for further information on accessing restricted VSSC web reports. 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).