Roundup Newsletter – June 2021 Issue

  1. FMP: COVID-19 Vaccine Reimbursement
  2. New! VEText Appointment Reminders
  3. Unscheduled Consult Review Initiative
  4. OCC Standardized Consult Templates
  5. AMCMS New Releases Available
  6. Use ECAT to Prevent In-Network Deceased Veteran Referrals
  7. Updated Request for Service (RFS) Form
  8. Latest Community Care Stories
  9. OCC Receives 2021 FedHealthIT Innovation Awards
  10. Managing Unauthorized Commitments (UACs)
  11. OCC Informatics and Data Analytics (IDA) Reporting
  12. Consult Toolbox 2.0 Overview Course
  13. Support
  14. Resources

Foreign Medical Program COVID-19 Vaccine Reimbursement

Dear VHA Colleagues,Dr. Mark Upton

As you know, here in the United States, COVID-19 vaccines are widely available. But for Veterans living abroad, some have had a much more challenging experience getting vaccinated against the virus.

I spoke recently with two Veterans living in Thailand who shared some of the issues they experienced getting a vaccine, such as high cost, limited availability, and vaccines becoming available that are not authorized for use in the United States without clear information about their safety and effectiveness. These Veterans living abroad also wish to get back a sense of normalcy in their lives and wanted to know how VA could help.

While these concerns are complex and will take the US and international community time to address, an important step forward occurred through the passage of the SAVE LIVES ACT. As a result of this legislation, VA can now reimburse COVID-19 vaccines to eligible Veterans through the VA Foreign Medical Program (FMP). Check out this short video which explains it in simple terms.

If you know a Veteran who is or may be eligible for a vaccine through FMP, please reach out to them and refer them to several resources we have that explain eligibility and the process for getting reimbursed:

In addition, if you have a question about this process or other questions about the FMP, please reach out to our team at this e-mail address: hac.fmp@va.gov

Sincerely,

Mark Upton, MD

Acting Assistant Under Secretary for Health (AUSH) for Community Care


People, Process and Technology 💻 

New! VEText Appointment Reminders

Facility community care offices are using VEText, a new interactive mobile solution, to remind Veterans about their upcoming appointments via text message using Self-Scheduling Appointment Retrieval and Community Care Appointment Reminders. VEtext gives Veterans a quick and easy way to confirm and/or cancel appointments and receive text reminders.

Self-Scheduling Appointment Retrieval

The Self-Scheduling Appointment Retrieval solution is for sites that opted-in to participate with the Community Care Veteran Self Scheduling (VSS) process. If the Veteran chooses to self-schedule their community appointment, and the consult is not in a scheduled or completed status 21 days from the date outreach occurs, VEText will send a text reminder requesting the appointment information. Veterans can respond to the VEText message with the community appointment date and time.

Community Care Appointment Reminders 

Sites will use the Community Care Appointment Reminders solution, which sends community appointment reminders to Veterans confirming their first appointment with the community provider. The first text reminder will be sent seven days before the appointment, and a second text will be sent two days before the appointment. An optional third message may be configured to send to all patients, or only Veterans who have a high no-show probability and are listed on the National Initiative to Reduce Missed Opportunities (NIRMO) report.

VEText for Community Care Tools

Community care offices have tools available to them for adding reminders and requests to VA staff to view available reports in VEText. Each VA facility has a VEText point of contact with administrative access who is able to obtain appointments, cancellations, and other reports.

Resources and Support

Unscheduled Consult Review Initiative 

VA medical facilities with community care consults in an active status, aged 90 days or more, must prioritize from oldest to newest, and take action to schedule, complete, cancel or discontinue as appropriate. To support facilities resolving unscheduled consults, sites are no longer required to keep unscheduled consults in an active status indefinitely.

The consults that will be reviewed for this effort are all open/unscheduled community care consults.

How to Review a Consult

To review a consult, use these steps:

  1.  Facility community care managers will pull the data from the Open Consult Report.
  2. Facility community care offices will review and appoint or disposition in sequence the unscheduled community care Consults > 365 Days; Consults > 180 Days; and Consults > 90 Days using their master spreadsheet from oldest to newest for all categories of care. Prioritize high volume/high risk services and Priority 1 & 2 consults.
  3. For unscheduled consults where care is still needed: clinically review the consult to ensure care has not already occurred through different means and to ensure it is not a duplicate request.
    • Use the Consult Toolbox (CTB) to document the care coordination process accordingly.
    • Proceed with care coordination process.
  4. For unscheduled consults where care already occurred: place the consult in scheduled status by scheduling the appointment for the date the appointment occurred and follow local process to obtain records and complete the consult.
  5. For unscheduled consults where care is no longer needed: the consult should be cancelled. Document the reason as a CTB comment in the consult. Send a significant finding alert to the ordering Provider via Computerized Patient Record System (CPRS).
  6. For unscheduled consults where care is still needed and the facility community care office is unable to coordinate the care at this time: use the Appt. Tracking tab and expand “Network Issues” section under the Returned from Community Care Provider Section by clicking the + sign. Select appropriate option based on the specific scheduling challenge experienced.

Please note, to mitigate duplication of efforts, it is highly recommended the CTB be used for all consult actions/documentation.

 Resources and Support

OCC Standardized Consult Templates 

When referring a Veteran for community care, all facility Clinical Application Coordinators (CACs) must now implement the new consult templates using the Standardized Consults and Templates technical guide. Four consult services and twelve consult templates have been created to be used when referring a Veteran for community care. These consult templates are not to be modified or customized. Use of these standardized templates is mandated by Community Care Standardized Consult Template Guidance 10N Memorandum dated May 29, 2020.

The following consult templates are now available for use:

Radiology

Consult Service

  1. Community Care-Breast Imaging

Consult Templates

  1. CC V10.2 MRI.txml
  2. CC V10.2 CT Scan.txml
  3. CC V10.2 Ultrasound.txml
  4. CC V10.2 Breast Imaging.txml
  5. CC V10.2 Mammography Female Screening.txml
  6. CC V10.2 Mammography Female Diagnostic.txml
  7. CC V10.2 Mammography Male.txml

Pain Management

Consult Service

  1. Community Care-Spinal Cord Stimulator

Consult Templates

  1. CC V10.1 Spinal Cord Stimulator.txml
  2. CC V10.1 Pain Management.txml

GEC:

Consult Template

  1. CC V10.1 GEC Skilled Home Care.txml

Infertility

Consult Services

  1. Community Care-Cryostorage Infertility
  2. Community Care-Cryostorage IVF

Consult Templates

  1. CC V10.1 Cryostorage Infertility.txml
  2. CC V10.1 Cryostorage IVF.txml

The technical guides to build the new consults and templates can be found in the document titled Standardized Consults & Templates located in the Help Tips folder on the OCC CAC Consult Template SharePoint site.

Resources and Support

 

AMCMS New Release Available

Following deployment of the Advanced Medical Cost Management Solution (AMCMS), new capabilities are available to support community care budget tracking, monitoring, and forecasting.

Enhancement releases include new reports and reporting suites using innovative forms of reporting and data visualization outputs and functionalities. These enhancements support the user experience and improve reporting outputs.Person's hands typing on computer keyboard

Recent new releases consist of:

If you would like to gain access to the AMCMS tool, please follow the steps in the AMCMS Access Request SOP and complete the AMCMS Access Request Form. If you are already an AMCMS user, the left-hand menu in the AMCMS tool will allow you to view new reports and reporting suites as they become available.

 Resources and Support

 

#ICYMI👀 

Use ECAT to Prevent In-Network Deceased Veteran Referrals

Using the Emergency Care Authorization Tool (ECAT) SharePoint, VA staff are required to follow these action steps for an interim solution to prevent in-network deceased Veteran referrals.

Last year's HealthShare Referral Manager (HSRM) Release 11 hard stop eligibility requirement prevented users from sending a referral through HSRM, if any of the following were applicable:

  1. No eligibility status is present
  2. A Veteran is deceased (which has an eligibility 'X' code status)
  3. A Veteran Community Care Eligibility (VCE) has a code of “Not Eligible

This new requirement caused an unintended consequence and disrupted users from processing referrals for deceased Veterans who are automatically assigned an eligibility ‘X’ code upon entry of date of death into VistA. 

An interim solution is to utilize the Emergency Care Authorization Tool (ECAT) SharePoint to create referrals for in-network deceased Veterans until a long-term HSRM system fix can be implemented.

Action Required

Locate the “Deceased Veterans Worksheet” on the CI Reports SharePoint and enter the affected Veteran’s information exactly as instructed for the Centralized Authorization of Emergency Care (CAEC) team to submit through ECAT. You will need to verify the Veteran’s prior VCE code in the Enrollment System.

The CAEC Team will generate referrals in ECAT. Then, the HSRM Referrals for Deceased Veterans worksheet will identify these referrals for the claims invoices to be paid. The worksheet will be emailed by the Clinical Integration Field Assistants to the facility community care staff.

If a provider did not file a claim within 180 days from the date of service, the claim will be denied for not filing timely and a provider must submit an appeal. If a provider has previously attempted to file within the 180 days and received a denial, you may proceed with this process.

Resources and Support

Updated Request for Service Form

The updated RFS Form 10-10172 standardizes how community providers request care for Veterans and must be used for all community care requests including Durable Medical Equipment (DME) and Prosthetics and Sensory Aid Services (PSAS).

Used for all requests from community providers, the signed RFS form must be attached to all REFDOC packets to establish a process for placement, tracking, managing, and reporting requests. A separate RFS form is required for each service requested.

To prevent delays in care, RFS forms submitted by community providers must be complete, signed and accompanied by medical documentation to support the request. Facility community care offices are required to process complete requests within 72 hours of receipt; the result being the RFS is reviewed, approved or denied, consult (order) is created (if approved) and notification is sent to the community provider. All RFS forms, whether approved or denied, must be scanned into VistA Imaging.

Resources and Support

Latest Community Care Stories

Catch up on these blogs recently posted on VAntage Point: Mental health matters, now more than ever (May 25); CCN improvements (May 25); and, Copayment refund notification letters mailed to Veterans (May 27).

OCC Receives 2021 FedHealthIT Innovation Awards 

The OCC Community Care Referral and Authorization project (CCRA) and the Financial Services Center’s (FSC) Electronic Claims Administration Management System (eCAMS 3.0) were recently named winners of the 2021 FedHealthIT Innovation Award!

CCRA is an enterprise-wide program used by VA to generate patient referrals and authorizations for Veterans receiving community care. Through HealthShare Referral Manager (HSRM), VA moved from a manual process to an automated system to standardized referrals and authorizations to:

VA Financial Services Center (FSC) updated their administrative support services and replaced an aging commercial-off-the-shelf claims processing system with a centralized system to support all existing and potential customers. FSC selected a standards-based, configurable platform known as Electronic Claims Administration Management System (eCAMS), to increase processing capacity, efficiency, and accuracy. The most innovative aspect of eCAMS 3.0 is its business rule driven, automated, near real-time adjudication, and scalable, configurable architecture which efficiently and accurately processes the ever-increasing volume of claims.

“Doing things we do every day quicker, sooner or better – that's innovation,” said Dr. Clinton Greenstone, executive director, Clinical Integration, VHA Office of Community Care. “VA is a proven leader in innovation and these awards exemplify our daily commitment to improving our methods while enhancing the experience of our Veterans, their families and our employees.”

The 7th Annual FedHealthIT Innovation Awards recognize and honor the Federal Health technology and consulting community by celebrating programs nominated and selected by their peers for driving innovation and results across the Department of Veterans Affairs, Military Health, Health and Human Services, and Centers for Medicare and Medicaid Services.

 

Get Smart💡

New and updated community care training courses are now available in the updated Training Catalog on the Training Page of the Community Care Hub. Please see below for specific updates.

Finance, Community Providers, and Contract Administration

Managing Unauthorized Commitments (UACs) explains unauthorized commitments (UACs) for staff who interact directly with contractors. Participants will learn how to prevent UACs and identify what to do when a UAC occurs. (TMS VA 4570088)

OCC Informatics and Data Analytics (IDA) Reporting provides an overview of community care reporting that enables users to visualize various data using Microsoft’s business intelligence (BI) solution, Power BI. (TMS VA 4570530)

Eligibility Consults and Referrals Training/VAOS

Consult Toolbox 2.0 Overview Course provides users with an overview of the updated Consult Toolbox 2.0 and outlines the new functionalities and enhanced capabilities of the tool. (TMS VA 4568812)

Support 🛠

Community Care Hub – General resources on community care programs and processes. (Intranet)

 

Field Guidebook – Technical operational guidance for community care operations. (Intranet)

 

Public Website – Main external website for community care. (Internet)

 

Public Website for Community Providers – Main public website for community providers. (Internet)

 

YouTube Channel – Public video library on a variety of community care and revenue operations topics.

Resources ⌨️

Technical Questions

General Questions

Communications/Newsletter Questions and Feedback