Gidwani R, Hong J, Murrell S. Fee Basis Data: A Guide for Researchers. 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. Steps to collapse records into a single inpatient stay: 1. [ SFeeVendor] table. PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. Basic demographic variables can be found in the [Patient]. For current information on Community Care data, please visit the page VA Community Care Data. Current Decision Matrix (10/21/2022) Menlo Park, CA. Accesed October 16, 2015. 1. However, one also needs to exercise caution with DRG; there are 2 different sets of DRGs used over time. 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. Once the VA system user has a TSO account, s/he may connect to the AITC mainframe through the Attachmate Reflection File Transfer Protocol (FTP). We present here one way to collapse records into a single inpatient stay, but users may wish to develop their own method specific to the research question at hand. Appendix D contains information on the primary and foreign keys needed to link the various SQL tables. Please switch auto forms mode to off. Box 537007Sacramento CA 95853-7007, CCN Region 5(Kodiak, Alaska, only)Submit to TriWest. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Researchers evaluating care over time may want to use the DRG variable. NPI and Medicare IDs have an M to M relationship. The OI&T Enterprise Program Management Office does not endorse nor support Class 2 and Class 3 products and does not support data usage or application programmer interfaces (APIs) between Class 1 National Software products and Class 2 or Class 3 products. Several variables are available for locating care in particular settings. The same cannot be said for DX2-DX25, however, as additional diagnosis codes are optional. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. Box 14830Albany, NY 12212. 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. Health plans include private health insurance, Medicare, Medicaid, and other forms of insurance that will pay for medical treatment arising from the patients injury or illness (e.g., automobile insurance following a car accident). Researchers and analysts will have to take care to collapse observations properly if warranted, for example to determine the costs, procedures or diagnosis associated with a single stay or visit. It is not available for claims in which payment was based on a contract amount. Bowel and bladder care for certain Veterans with SCI/D are considered supportive medical services due to the possibility of medical complications which would result in the need for hospitalization. Domains represent logically or conceptually related sets of data tables. Payment for care provided under the Veterans Choice Act may not exceed the Medicare Fee Schedule (i.e. There may be multiple CPT codes associated with a single encounter. would cover any version of 7.4. Given these different patient identifiers, it is difficult to conduct exact comparisons between SAS and SQL data. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. Each VA facility has a local Fee Office to which the non-VA provider submits a claim for reimbursement. Six additional variables indicate the setting of care and vendor or care type. A summary of the payment guidelines can be found in Appendix I. Payment of ambulance transportation under 38 U.S.C. 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. This service communicates via native SQL Server 2005 encrypted connections through the VA Wide Area Network (WAN). The Fee Basis VA program allows Veterans to be seen by a community provider. Attention A T users. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with.
Veterans Choice Program - Fee Basis Claims System in CDW - Veterans Affairs Second, there are some cases where the disbursed amount is $0, while the payment amount is greater than $0; these are cases in which the payment was cancelled and the true cost of care is thus $0. Questions about care and authorization should be directed to the referring VA Medical Center. However, a 7.4.x decision
This table contains information on inpatient care. However, there are best practices that all SQL-based analyses should follow. By June 2017, no Choice stays are found in FBCS. A Fee table will contain a record for an ICD-9 code, whereas a DIM table will contain the possible values of that ICD-9 code. However, there is one situation in which the payment amount will be more accurate than the disbursed amount: when the disbursed amount is missing, and the payment was not cancelled, one should use the payment amount to capture the cost of care. This is the main utility that passes information back into the FBCS Payment application. Ready. The status value A stands for accepted, meaning the claim was paid. April 14, 2014. Bowel and Bladder Care. (refer to the Category tab under Runtime Dependencies), Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. There may be many providers that use the same vendor for billing. SQL data must be linked from multiple tables in order to create an analysis dataset. To determine the location of care, MDCAREID will be more useful than VEN13N. 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. Get the latest updates on VA community care, including program changes, resources and more! what is specified but is not to exceed or affect previous decimal places. FBCS is where weve spent the bulk of our time investigating. In order to qualify for round trip mileage, an appointment must be scheduled. The prescriptions filled by fee-basis pharmacies are often small quantities of medication to meet the patients emergency or short-term needs while a CMOP prescription is being filled. Regardless of whether the care was pre-authorized or not, non-VA providers submit claims to VA if they wish to be reimbursed for care.
HERC: Fee Basis Data: A Guide for Researchers - Veterans Affairs Table 1 in the Data Quality Analysis teams guide Linking Patient Data in the CDW Updateprovides a brief summary for each identifier (Available atthe VHA Data Portal. is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not. _________________________________________________________________. 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. 3. You can use NPI to link providers in VA and Medicare. All access
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. Claims. The Act amends 38 U.S.C. VA patients who receive prescriptions from non-VA providers fill them from a VA pharmacy, often the VA Certified Mail Order Pharmacy (CMOP). Outpatient data are housed in the FeeServiceProvided table. 3. Please switch auto forms mode to off. These data records cannot be linked to particular patient identifiers or encounters. In general, persons on active duty in the U.S. military are excluded even if they are transitioning to VA care. 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:
VA is also the primary and sole payer for unauthorized emergent care approved under 38 U.S.C. TriWest VA CCN ClaimsP.O. Table 3 lists their file names and gives a general description of their contents.10. At the time of writing, no National Institute of Standards and Technology (NIST) vulnerabilities had been reported and no VA Cyber Security Operations Center (CSOC) bulletins had been issued for the latest versions of this technology. Some encounters have multiple procedures that are paid as a single encounter; other encounters have multiple procedures and there are separate payments for each procedure. There is very limited outpatient pharmacy data in the Fee files. Institutional Aspects of the Non-VA Medical Care System, https://www.va.gov/health-care/get-reimbursed-for-travel-pay/, http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. Available at: http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf.. 3. 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. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. 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. Given the variable definitions, it is not clear whether DX1 or DXLSF is the better choice to determine primary reason for inpatient stay. 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. VA must be capable of linking submitted supporting documentation to a corresponding claim. Internal use only. For example, an interest payment of $14.21 would appear as 1421. INTAMT is part of DISAMT; it should not be added to them. 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 data files in each fiscal year represent all claims processed in the FMS during the year. Subscribe to our E-newsletter The Service Connection Our monthly newsletter features about important and up-to-date veterans' law news, keeping you informed about the changes that matter. SQL Fee Basis files themselves contain limited patient demographic variables, but can be linked to other SQL data. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. The CDW SharePoint site has a document that lists the purchased care SQL tables, the fields of that they contain, and some sample SQL queries (VA intranet only: https://vaww.cdw.va.gov/metadata/Metadata%20Documents/Forms/AllItems.aspx). Community providers have three options that allow for that linkage: Submit the claim electronically via 837 transaction and the supporting documentation via 275 transaction. For example: services provided at a hospital anticoagulation clinic are billable for facility charges only if the anticoagulation is considered incident to physician services and certain other conditions are met.8. The SAS Fee Basis data are organized by fiscal year. More information can be found at the OPES website: http://opes.vssc.med.va.gov. The travel payment data contains reimbursements for particular travel events (TravelAmount). You may use VA Form 10-583 to fulfill this requirement. This variable is defined as 1st Diagnosis Code. A comparison from FY 2009 to 2014 data reveals that DX1 in SAS corresponds to DX1 in SQL data, and up to 2008, DXLSF in SAS corresponds to DX1 in SQL (see Table 5). MDCAREID is available in most inpatient SAS Fee Basis records. Therefore, it is not possible to do an exact comparison across the datasets. In the SAS data prior to FY 2007, the disbursed amount (DISAMT) had an implied decimal point whereas the payment amount (AMOUNT) did not. All instances of deployment using this technology should be reviewed to ensure compliance with. PatientIEN and PatientSID are unique to a patient within a facility, but not unique to a patient across VA facilities (e.g., a patient who had visited multiple VA facilities will have multiple PatientIENs and multiple PatientSIDs). Find out More 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. [Patient], [PatSub]. VA Claims Representation; RESOURCES. Appendices G and H, copied from the Non-VA Medical Care program website, describes in detail the types of records for which each Fee Purpose of Visit (FPOV) codes are assigned. [ICDProcedure] table through the ICDProcedureSID. VA medical centers may purchase prosthetics and related items, such as clothing specialized for prosthetic limbs, and then dispense them through VA facilities. 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. The generosity of the coverage is immaterial; if it covers any part of the providers bill, then VA may not pay anything. There is no information available in the SAS data that identifies the actual medication dispensed. If electronic capability is not available, providers can submit claims by mail. Veterans whose income exceed the established VA Income Thresholds as well as those who choose not to complete the financial assessment must agree to pay required copays to become eligible for VA health care services. The Fee Purpose of Visit Code (FPOV) has strong guidance from VA Fee Basis Office and thus may be a more accurate way of categorizing care. (2) Additionally, a Veteran must also meet at least one of the following criteria. There may be multiple STA3Ns for a single inpatient stay.
Health - Veterans Affairs The VHA Office of Community Care is the contact for all VA community care programs. Both ancillary and outpatient files have one record per CPT code. Mail to: DEPARTMENT OF VETERANS AFFAIRS. 1. U.S. Department of Veterans Affairs. Up to FY2008 data, DXLSF is labeled as 1st Diagnosis Code. In FY2009 and on, DXLSF is labeled as the Admitting or Primary Diagnosis Code. In FY 2009 and later SAS data, there is also another variable, DX1, which is not present in SAS data prior to FY2009. If researchers wish to identify ED visits, they may want to use CPT codes or Place of Service codes, rather than FPOV. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. In SAS, this variable is called DISTYP, or disposition type, and is located in the Inpatient and Ancillary tables. Please visit Emergency Care Claims to learn more. Veterans Health Administration. The key that allows for this linkage is the FeeInpatInvoiceSID which is a primary key in the [Fee]. However, there are data available regarding the category of visit. However, there are some outliers; some claims can take up to 8 years to process. The SQL tables [Dim]. With few exceptions these variables will be of little interest to researchers. A valid receipt showing the amount paid for the prescription. SAS data are also available in CDW, but are currently limited to those VA employees with operational access. 4. This care will be approved (or denied) by the local VA Fee Office; the Veteran is then free to seek non-VA care. To locate the facility at which the Veteran usually receives VA care, the VA Information Resource Center (VIReC) recommends consulting the preferred facility indicator in the VHA Enrollment Database.7. There is also a host of non-emergency surgery provided through Fee Basis mechanisms that may be of interest to researchers. Claims and other FBCS data will be found in PIT or Community Care Referral & Authorization domains. The two tables can be joined through FeePharmacyInvoiceSID. 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." Important: The mailing address below only pertains to disability compensation claims. [XXX] tables, but also the [DIM]. It would seem logical to use the vendors location, found in the vendor files PHARVEN and VEN, to associate care with a particular station, but this should be approached with caution. In order to gain access to the AITC mainframe, VA system users must contact their local Customer User Provisioning System (CUPS) Points of Contact (POC) and submit a VA Form 9957 to create a Time Sharing Option (TSO) account. Each observation in the SAS and SQL data has an accompanying vendor ID. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. We found SPECIALPROVCAT was missing in 93% of records. However, in all data files, the vast majority of observations are missing values for this variable. The FeeSpecialtyCodeName contains information on the specialty of the provider seen, such as oncology, chiropractic, pathology, neurosurgery, etc., but is missing much data. There are substantial differences in quantity of inpatient diagnosis and procedure data available in SAS versus SQL. This guide serves as an addendum to any technical documentation supplied by the healthcare clearinghouse when establishing a trading partner agreement. There is no separate payment for items such as oxygen or other supplies, the number of attendants, providing an EKG during the trip, etc. Payer ID: 1. to) monitoring; recording; copying; auditing; inspecting; investigating; restricting
Using the Non-VA Medical Care data for research requires a basic understanding of laws and regulations that govern it. Lump sum payments are not paid via FBCS. Many private health insurance companies will apply VA health care charges towards satisfying a Veteran's annual deductible and maximum out of pocket expnse. 5.
Department of Veterans Affairs Health Care Programs | Optum This technology can use a VA-preferred database. more information please visit www.fsc.va.gov. Use the column 'estimated cost' and it is available in the CDW FBCS data. This component provides a front end for scanning claim forms into a temporary image queue for a given patient. Researchers should pay special attention to reducing duplicates in the pre-2008 data. HERC Veterans Choice Program - Fee Basis Claims System in CDW Fee Basis Claims System (FBCS) in the VA Corporate Data Warehouse All Choice claims are processed by VISN 15. Users must ensure that Microsoft .NET Framework, Microsoft Structured Query Language (SQL) Server, and Microsoft Excel are implemented with VA-approved baselines. Submit a corrected claim when you need to replace an entire claim previously submitted and processed. Driving distance between a veterans residence and their closest VA facility is over 40 miles, c. The veteran must travel by boat or plane to access the VA facility closest to their home (excluding Guam, American Samoa, or the Republic of the Philippines), d. The veteran faces an excessive burden in traveling to a VA, including a body of water or geologic formation that cannot be crossed by road.
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