| REQUIRED BUILD |
-
- FB*3.5*148
- ACTION: Don't install, remove global
-
- IB*2.0*554
- ACTION: Don't install, remove global
-
- FB*3.5*135
- ACTION: Don't install, remove global
-
- FB*3.5*133
- ACTION: Don't install, remove global
-
- FB*3.5*98
- ACTION: Don't install, remove global
-
- FB*3.5*108
- ACTION: Don't install, remove global
-
- FB*3.5*154
- ACTION: Don't install, remove global
|
| DESCRIPTION OF ENHANCEMENTS |
This National Patch consists of FEE BASIS enhancements related to the
received from Non-Department of Veterans Affairs (VA) providers which
are necessary for third party billing.
The proposed enhancement seeks modifications the FB application's
Potential Cost Recovery Report (PCRR) to ensure that all Non-VA Care
billed line item charges are included, regardless of responses entered
in the FB software by Fee Clerks." By removing the report filtering
that pertains to the SC Condition and Potential Cost Recovery data
values, line item charges previously excluded based on responses to
POTENTIAL COST RECOVERY and SC CONDITION prompts in FB all Non-VA
following NSRs:
care billed line item charges will appear on the PCRR, enabling the
Revenue Staff to optimize cost recovery.
NSR #20081010 - Billing Precertification Enhancements
Typically, Department of Veterans Affairs (VA) facilities are able to
provide all of the necessary medical care and services required by its
patients. However, there are times when the Veteran is not able to
access VA health care facilities based on geographic constraints, due
to medical emergencies, or because it is economically advantageous to
provide treatment in the community. In these cases, the VA may
authorize medical care at private-sector facilities for those Veterans
who meet the eligibility requirements. This concept is referred to as
FEE BASIS (FB) (or Non-VA) care.
Regardless of where the care is provided, precertification is often a
prerequisite for certain services before payment is issued by insurance
companies. Precertification is the process of obtaining approval from
the Veteran's private insurance health plan for routine hospital
inpatient admissions or outpatient visits prior to the delivery of
NSR ##20110304 - Service Connected Decision
health care. Currently, Medical Care Collections Fund (MCCF) Staff is
not notified of scheduled VA-provided outpatient services requiring
precertification. Notification regarding authorized
nonservice-connected FB care is received after treatment has been
rendered. As a result, VA Medical Centers (VAMCs) often miss
opportunities to be reimbursed by insurance companies for care due to
the lack of obtaining timely precertification.
The goal of this project is to assist the VAMCs in obtaining timely p
recertification from third party payers before care is rendered by
notifying the appropriate staff as soon as VA-provided outpatient
services requiring precertification are scheduled and authorizations
are created in the Veterans Health Information Systems and Technology
Architecture (VistA) Fee Package for inpatient or outpatient care. This
would also provide an opportunity for insurance identification/
verification processes (either internally or externally/outsourced) to
be completed prior to treatment.
The Fee-Revenue Service Connected (SC) Condition Decision project will
enhance the interface between the Integrated Billing (IB) and Fee Basis
(FB) Veterans Health Information Systems and Technology Architecture
(VistA) applications by automating the transfer of data elements
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