This application is directly attached to TWAIN compliant scanners and works offline to VistA and the FBCS MS SQL databases. VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. VA employees working on research studies cannot create their own crosswalk file as they do not have permission to use these files. Community provider mails the paper claims and documentation to the new mailing address of VA's central claims intake location. 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. Of note, SQL and SAS data contain similar, but not exactly the same, information. This report covers the audit of payments made through VA's Fee Basis Claims System (FBCS), encompassing claims paid via that payment process from November 1, 2014 through September 30, 2016. U.S. Department of Veterans Affairs. 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. 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. 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 Fee Basis files primary purpose is to record VA payments to non-VA providers. Austin Information Technology Center (AITC) is one of the VAs five national data centers. Fact Sheet: Medical Document Submission Requirements for Care Coordination, ADA Dental Claim Form > American Dental Association website. Fee Basis providers vary in how frequently they submit an invoice for Fee Basis 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. VIReC Research User Guide: VHA Medical SAS Outpatient Datasets FY2006. Veterans Health Administration. 3. Fee Basis Services. 400, Wittman Drive Grand Rapids Itasca County MN - 55744 United States. [ICDProcedure] table and a foreign key in the [Fee]. The 2 sets of DRGs are not interchangeable. Presence of this software on the One-VA TRM does not equate to designation as a Class 1 National Software product and MUST NOT be assumed to comply with all VA programming standards, namespacing and interface control agreement standards, data management standards, documentation standards, information assurance standards, security standards and 508 compliance standards. PatientIEN and PatientSID are found in the general Fee Basis tables. Some VA medical centers purchase care from only one of the hospitals in the chain. Hit enter to expand a main menu option (Health, Benefits, etc). There are 34 Fee Basis Claims Systems (FBCS) servers, which were originally designed for episodes of care. In SAS, these data can be found in the Vendor file. Please contact the referring VAMC for e-fax number. Many variables in the Fee Basis files record details of invoice and check processing. Review the Supporting Documentation section below to learn how to properly submit supporting documentation with your claim. https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Authorized_5638.jpg, https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Unauthorized_242.jpg, https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Service_5480.jpg. Veterans Health Administration. Additional information on accessing the AITC mainframe is available on the VHA Data Portal (VA intranet only: http://vaww.vhadataportal.med.va.gov/Home.aspx). You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. VA decisions for specific versions may include + symbols; which denotes that the decision for the version specified also includes versions greater than
Those with access to the VA intranet can find a list of SQL fields on the CDW MetaData site. Please switch auto forms mode to off. 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. Chapter 6 provides information about how to access the Fee Basis data, while Chapter 7 provides information about the rules governing Fee Basis care. 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. Each prescription record has a fill date and a patient identifier (either PatientICN or scrambled social security number). These include Fee purpose of visit (FPOV), place of service (PLSER), type of treatment (TRETYPE), HCFA payment type (HCFATYPE), and record type (TYPE). 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. Payment guidelines for non-VA are outlined in federal regulations 17.55 and 17.56. The vendor no longer supports VA installations of this technology. Additional information appears in a federal regulation, 38 CFR 17.52. Compare the discharge date of the first observation to the admission date of the next (second) observation. However, in Table 4, we present some comparisons to demonstrate the different between SAS and SQL data. This is true for both the inpatient and outpatient data. more information please visit www.fsc.va.gov. Some important DIM tables that will be useful in analyzing Fee Basis data are FeePurposeOfVisit, FeeSpecialtyCode, FeeVendor, ICD, ICDProcedure Code, DRG, CPT, and CPT Category. If using payment amount, one would overestimate the cost of care. This application reads/creates/edits fee payment data in VistA and copies critical information into the central SQL database for off-line VistA applications to consume, and now includes Unauthorized payments. business and limited personal use under VA policy. Each VA facility has a local Fee Office to which the non-VA provider submits a claim for reimbursement. While a researcher could theoretically conduct a Fee Basis analysis using SAS data and then upload these SAS data to CDW and pull in the relevant variables from the SQL Patient domain, this poses some logistical challenges. Hit enter to expand a main menu option (Health, Benefits, etc). 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. VA medical centers may purchase prosthetics and related items, such as clothing specialized for prosthetic limbs, and then dispense them through VA facilities. A claim void must be identical to the original claim that it is intended to cancel. In some cases it may appear that single encounters have duplicate payments. Multiple SAS datasets have VENID and VEN13N. 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. More than 99% of claims for inpatient, ancillary and outpatient care are processed within 2 years. 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. Submit a claim void when you need to cancel a claim already submitted and processed. A description of the Patient and SPatient schema is available on the VIReC CDW Documentation webpage: http://vaww.virec.research.va.gov/CDW/Documentation.htm (intranet only). National Institute of Standards and Technology (NIST) standards. . Cunningham, K. VA implements the first of several Veterans Choice Program eligibility expansions. Guidance can be found under "VHA Data Quality Program Reports. The SAS data are stored at AITC. (Anything), but would not cover any version of 7.5.x or 7.6.x on the TRM. There are multiple potential identifiers for provider/vendor in the SAS data: the VENDID, VEN13N, MDCAREID, SPECCODE and NPI. 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. Below are some answers to general questions about linking the UB-92 form to the FBCS data. NPI and Medicare IDs have an M to M relationship. We are the third-party administrator for the VA CCN for Regions 1, 2 and 3, encompassing 36 states, Puerto Rico, the U.S. Virgin Islands and the District of Columbia. expectation of privacy in the use of Government networks or systems. U.S. Department of Veterans Affairs. In general, we recommend using the disbursed amount to capture the cost of care, for two reasons. The slight decrease in fiscal year 2012 spending from the fiscal year 2011 level was due to VA's adoption of Medicare rates as its primary payment method for fee basis providers. Much Fee Basis care is pre-authorized prior to the Veteran obtaining care and is thus considered Authorized Care. The SAS Fee Basis data are organized by fiscal year. It may duplicate the PatientIEN of another patient at another facility, and should not be used as an identifier. Matching outpatient prosthetics order records in the VA National Prosthetics Patient Database (NPPD) to health care utilization databases. VINCI Data Description: Dimension [online; VA intranet only]. 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. In the outpatient data, one observation represents a single CPT code. MDCAREID is not available in the outpatient SAS Fee Basis data, even though some outpatient services are provided in a hospital. Thus, researchers using later years of data should be aware that files are not static and will continue to be updated. 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. The travel payment data contains reimbursements for particular travel events (TravelAmount). VA can make payments to non-VA health care providers under many arrangements. Each patient should have only one ICN in the entire VA, regardless of the number of facilities at which he is seen. MDCAREID is the Medicare OSCAR number, which is a hospital identifier. Conversely, all stays should have at least one discharge diagnosis. VA can also pay for hospice care for Veterans when the VA facility is unable to provide the needed care; this happens frequently, as VA provides only inpatient-based hospice care and many Veterans may wish to receive hospice at home or in the community.