Veteran Service Organization ‘Officers Day’December 3, 2010

Fee Basis

What is Fee Basis?

A more accurate name would be NON-VA PURCHASED CARE

Non-VA Purchased CareIs a program to manage and process all requests for

Non-VA provided Health Care Services

In general, Veterans seeking health care should obtain treatment at VA facilities. Non-VA purchased care is generally only authorized when appropriate VA services and/or facilities are not available or cannot be economically provided to the veteran.

The use of Non-VA purchased care is NOT considered a permanent solution for veteran health care needs.

Programs Covered Include:Outpatient MedicalNon-VA HospitalFee ID CardPharmacyDentalEmergent Care

Outpatient MedicalMust be ordered by your VA providerMUST BE PRE-AUTHORIZEDIs for treatment of a specific condition with

specified number of visits, tests or procedures

If Non-VA provider wants to do tests or procedures that are not included on the authorization they MUST contact your VA provider first!!

Non-VA HospitalMuch like the Outpatient Medical Program

but only covers inpatient careMUST BE PRE-AUTHORIZEDEmergent care in a community hospital can

be pre-authorized under certain conditions:Emergent care for a rated Service Connection condition,

or condition determined to be adjunct to a Service Connected condition

Emergent care for any patient rated as Permanently and Totally disabled as a result of a Service Connected condition, or a veteran receiving House Bound, or Aid and Attendance

Emergent CareVA must be notified within 72 hours of

admission

Must meet the clinical definition of an emergency

Must accept transfer to a VA facility if VA is available

Fee ID CardEntitles Service Connected veteran to seek

routine care in the community at VA expense for their Service Connected conditions

Limited to $125 per month

Is a very limited program used for Service Connected patients who live long distances from VA care and are too disabled to travel to VA for care

PharmacyFee ID card holders may obtain a 14 day

supply of emergent medications, such as antibiotics for treatment of Service Connected conditions at their local pharmacy at VA expense

DentalEligibility for Dental care is limited

Non-VA Dental care is only authorized if ordered by a VA dentist

Unauthorized Emergent CareEmergent treatment of a Service Connected

or adjunct conditionEmergent treatment of any condition for a

veteran rated as Permanently and Totally disabled as a result of a Service Connected condition

Veteran participating in the Vocational Rehab/Chapter 31 program

VA can only pay to the point of “stability”

Mill BillVeteran must meet ALL of the criteria:

Must be enrolledHas been seen in VA in previous 24 monthsIs not covered by health insuranceThere is no 3rd party liabilityNot eligible for payment under any other VA

programVeteran is financially liableMeets the layperson definition of emergency

Mill BillOther Facts:

Claim can only be paid to the point of stabilityClaims must be filed within 90 days of the date

of service

NotesThe admission of a veteran to a non-

Department of Veterans Affairs hospital at VA expense MUST be authorized in advance. In the case of an emergency which existed at the time of admission, an authorization MAY be deemed a prior authorization if an application (formal or in-formal) by telephone, telegraph or other means of communication is made by the veteran or by others in his/her behalf is dispatched to the VA within 72 hours of the admission.

Notes ContinuedPayments by the VA shall be considered as

payment in full and the provider may not impose any additional charge on a veteran or their health care insurer for any inpatient services for which payment is made by the VA.

Who Do I Call?Boise Fee Call Center (208) 422-1252VIRS Coordinator *for weekdays (208) 422-

1021AOD *for off hours and weekends (208) 422-

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