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August 2022
Dear VHA Team,
IVC is settling in as VHA’s newest program. I’d like to share our focus areas going forward. You’ll see these reflected in our initiatives and projects being rolled out in the coming months that will eventually affect your work at the facility and VISN and levels. Our focus areas are:
- Optimize Veterans’ and beneficiaries’ access to care.
- Create the best possible outcomes for the care they receive.
- Provide each and every Veteran and beneficiary with the best care experience.
So how will IVC support these areas, specifically? In partnership with the field, IVC will prioritize building and strengthening VA's capacity and service offerings. To get there, we’re developing an updated operational care model for both VA and community care that is built on data-driven insights and close collaboration with field and other stakeholders.
In building the updated care model, we’ll be looking closely at key VHA processes, such as referrals, scheduling and care management. We’ll also be focusing on the vital education and training needed by staff to carry out new or existing processes.
Our IVC vision is to provide Veterans and beneficiaries trusted, timely, equitable and high-quality care with exceptional outcomes and experiences. This will support our mission to provide Veterans with patient-centered and value-driven care within VHA and the community through an integrated and coordinated care model.
Going forward, look for announcements about new IVC projects and initiatives supporting care access, outcomes and experiences. As these are implemented, we’re committed to clear and timely communication so you can focus on providing quality care and services to our Veterans and beneficiaries.
Thank you for your partnership! More to come.
Miguel H. Lapuz, MD, MBA
Assistant Under Secretary for Health
for Integrated Veteran Care
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Did you know there is a process that can help Veterans get the care they need and bring funding back to VHA directly impacting care?
It’s called “Precertification.” Community providers are asked to submit a precertification request to VHA Revenue Operations via the HealthShare Referral Manager (HSRM) portal before performing care that requires precertification.
Submissions can be made using the task called "Provider Precert Notification.” Instructions how providers submit these in HSRM and information on what types of Standardized Episode of Care (SEOC) services may require precertification are available in the HSRM Community Provider User Guide, starting on page 33.
VA is required to bill Third Party Payers (TPP) for care that is not adjudicated as a service-connected (SC) disability or Special Authority (SA) exposure or experience. This requires VA to call TPPs for precertification for patients who are VHA beneficiaries with other billable health insurance (OHI). Claims for ancillary services will be processed in accordance with Medicare National Correct Coding Initiative (NCCI), Medically Unlikely Edits (MUE) and related edits.
Once the community provider has notified VHA Revenue Operations that the test/procedure/admission requiring TPP precertification is scheduled, there is no requirement to wait for the TPP approval or response prior to performing the test/procedure/admission included as part of the SEOC referral.
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Congratulations to the following VAMCs for having the highest percentage of consults in the RCT Inclusion Stop Code List with RCT engagement as of July 31, 2022!
• (VISN 6) Salisbury, NC 87.6%
• (VISN 9) Louisville, KY 85.4%
• (VISN 21) Honolulu, HI 85.1%
• (VISN 12) Hines, IL 83.9%
• (VISN 17) Amarillo, TX 80.7%
We can still reach our target goal of 90% of consults with RCT engagement by Sept. 30, 2022.
What are RCT Teams?
Referral Coordination Teams share health care options with Veterans to put them in control of where, when and how they receive care. This empowers Veterans to make the right health care choice for them.
Why is it important?
VA’s RCT engagement metric monitors the percentage of RCT Inclusion Stop Code List consults that have a comment by a RCT member based on the RCT User role assignment in Consult Toolbox or the #RCT# comment added to a consult. This metric highlights RCT engagement with Veterans to ensure important conversations about health care options occur and highlights successes and gaps in RCI implementation. Watch this video on assigning user roles.
Where do I find it?
RCT engagement data is available in the RCI VSSC Dashboard - RCT Usage Report. Click the “Reset to default” button at the top of the report to ensure the appropriate filters are applied to view your VISN/VAMC.
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Consult Toolbox (CTB), a software used by VA staff to manage the consult process nationwide, currently has an average usage of 60.5% for consults with a file entry date between October 2021 and June 2022, as seen in the chart below. We expect the value of CTB to increase as staff continues to address new consults and additional sites begin using CTB.
Since the release of CTB in all sites in Fiscal Year 2021, staff has provided feedback on the positive experience with capturing standardized consult comments, receiving clear guidance on consult management processes and the ability for data mining along with the quick turnaround of software updates.
During the peak of the COVID-19 pandemic, CTB enhancements such as incorporating standardized language into the referral process prioritized appointment scheduling for Veterans and allowed staff to capture clear and timely scheduling instructions for scheduling prioritization.
CTB’s value hasn’t ended as VA looks to return to regular patient care activities. Enhancements to CTB help identify a patient’s needs, match them with the right, timely care and ensures seamless access to care our Veterans deserve.
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Support
VA no-cost flu shots are available for eligible Veterans from Sept. 1, 2022, through Apr. 30, 2023, at all VA medical centers or one of 70,000 Community Care Network (CCN) in-network retail pharmacies or in-network urgent care locations.
Please remind eligible Veterans who have used VA or CCN services within the last 24 months how important it is to receive a flu shot to avoid symptoms and complications. They can even get a COVID-19 shot and booster at the same time.
Encourage Veterans to visit www.va.gov/communitycare/flushot.asp and scan the billing information QR code on the page or the one located here for billing information.
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Training & Education
Nationwide Dialysis Service Contracts (NDSC) Referral Authorization System (RAS) Transition to HealthShare Referral Manager (HSRM) video explains the transition and change from NDSC RAS referrals to Community Care consults, which payment authority to select and how to select the correct NDSC provider in HSRM.
TMS ID VA 4629967
All About the RFS Form 10-10172 guides users on locating, accessing and using the Request for Service (RFS) Form 10-10172. The form is the standard VA document community providers submit to a facility community care office to request clinical services for Veterans.
TMS ID VA 4527029
Support:
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Resources
Questions
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