Billing Interface for Fee Care
The Chief Business Office (CBO) is requesting system enhancements to the Veterans Health Information Systems and Technology Architecture (VistA) Integrated Billing (IB), Accounts Receivable (AR), and Fee Basis software modules that would allow segregating all billing and collection activities for Non-Department of Veterans Affairs (VA), Care Third Party Insurance carriers’ reimbursement.
Current Medical Care Collections Fund (MCCF) Third Party billing and collections applications in the VistA information system do not segregate the Non-VA care claims from those claims for service rendered at Veterans Health Administration (VHA) healthcare facilities, which makes it difficult to determine whether all monies due VA for Non-VA care services are being billed and collected from Third Party insurance carriers, where applicable. The current process is a resource intensive, manual process with no assurance that all applicable Non-VA charges have been billed and collected.
Billing Precertification for Fee Care
The Chief Business Office (CBO), Purchased Care Program Office is requesting enhancements to assist the Department of Veterans Affairs Medical Centers (VAMCs) in obtaining timely precertification from third party payers before care is rendered by notifying the appropriate staff as soon as Department of Veterans Affairs (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.
Copays on Hold – Medicare/No Insurance
The Copays on Hold – Medicare/No Insurance project is one of five enhancements comprising the Electronic Data Interchange (EDI) Consolidated Patient Account Center (CPAC) Revenue Enhancements project. This project will modify the Veterans Health Information Systems and Technology Architecture (VistA) Integrated Billing (IB) software application to automatically release copay charges for patients based on certain conditions. This will result in more efficient use of Department of Veterans Affairs (VA) resources by discontinuing the manual process of releasing first party copayments. It will also ensure that business processes are in adherence with the Veterans Health Administration (VHA) Directive 2012-005 Application of Third-Party Reimbursement to Veteran Copayments.
The Veterans Health Administration (VHA) Chief Business Office (CBO), Purchased Care Program Office affirms that the current Veterans Health Information Systems and Technology Architecture (VistA) does not support the business processes for securing potential cost recovery of billable Non-Department of Veterans Affairs (VA) episodes of care in a timely and efficient manner. They are seeking enhancements to the VistA Fee Basis (FB) and Integrated Billing (IB)/Revenue software applications to automate the movement of billable Non-VA cases from VistA FB through the Revenue IB software product, to include prioritization of high cost claims, automation of Veterans’ co-pay requirements and decision support for assessing clinical review of cases.
Fee-Revenue Service Connected Condition Decision
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 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 care billed line item charges will appear on the PCRR, enabling the Revenue Staff to optimize cost recovery.
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