Roundup Newsletter – March 2022 Issue

1. IVC update and what to expect in the months ahead
2. Now Live! PPMS Release 15.0
3. New! Patient Safety Guidebook Version 6
4. ECR Tool Training Sessions Now Available!
5. New DoD Urgent Care SEOC and Group 18 Release
6. Consult Toolbox (CTB) Curriculum
7. VISN and VAMC Roles in IHS/THP Rap Course
8. CRM: Improving the Customer Experience One Interaction at a Time
9. VHA Teams Focus on Third-Party Payer Precertification for Community Providers
10. Support
11. Resources

 

IVC update and what to expect in the months ahead 

Dear VHA Team,

This month I’d like to highlight recent activities taking place in establishing the new VHA Office of Integrated Veteran Care (IVC).

In mid-February, Dr. Lieberman announced the high-level organizational chart for IVC. The new office will incorporate parts of the VHA Office of CommunityCare (OCC) and the Office of Veterans Access to Care (OVAC). The new organization will allow for better coordination and resource alignment, along with more streamlined and simplified access processes for the field, Veterans, and beneficiaries.

The IVC organization is expected to be formally established in April 2022. In May, you can expect communications to continue in a similar manner as they do now, through an IVC-branded monthly newsletter and occasional announcements from a central IVC distribution group. You can also expect more synchronized updates that directly impact the field as a result of the new organization.

In the coming weeks and months, I encourage you to continue to focus on the exceptional care you provide to our Veterans, beneficiaries, and their families. If you have any questions about IVC, please connect with your leaders or visit VHA Integrated Veteran Care (IVC) - SharePoint Site.

I look forward to this organizational change and all we will accomplish together in support of all those we serve. Thank you for being flexible and patient as we continue to work through our new journey as IVC.

Sincerely,

Julianne Flynn, MD
Acting Assistant Under Secretary for Health for Community Care

People, Process and Technology 💻 

Now Live! PPMS Release 15.0

Provider Profile Management System (PPMS), Release 15.0, deployed on February 17, 2022, allows users to identify specific providers within a community health care system.

Key feature and function upgrades include:

• Users can select 90 days for a provider’s inability to see a Veteran.
• When users hover over High Performing Provider (HPP), the definition of HPP is displayed when marked “Y” for yes in the provider locator user interface.
• Users can add the state for home services, enabling reports of all at-home services available to the Veteran.
• Users can search the PPMS provider locator’s at-home services by state.

These improvements continue to strengthen OCC’s searchable list of providers.

Resources and Support

• OCC Field Guidebook
• PPMS SharePoint
• PPMS Office Hours – Information and Training
  • Weekly on Mondays with PPMS System Expert 9 PT/10 MT/11 CT/12 ET  
  • Join Meeting
• Questions? Contact Clinical Integration and Field Operations at VHA10D1D1CILeadership@va.gov
  
  

New! Patient Safety Guidebook Version 6 

The VHA Patient Safety Events in Community Care: Reporting, Investigation, and Improvement Guidebook has been updated to enhance and align existing documentation of roles and responsibilities and business processes.  

Highlights include:

• Information on fraud, waste, abuse, and complaints/grievances.
• New information defining and differentiating what constitutes community care.
• Updated and aligned guidance with the Joint Patient Safety Event Reporting System (JPSR) business rules and guidebook on the roles and responsibilities of reporting community care-related patient safety and quality reporting and investigation processes with:
  • VA Medical Center (VAMC) staff,
  • Veteran Service Integrated Network (VISN) Patient Safety Officer (PSO),
  • VA facility Patient Safety Manager (PSM),
  • Facility Community Care staff,
  • Third-Party Administrator (TPA) Quality and Patient Safety (Q&PS) representative.
• Enhanced user experience, including direct links to sections, resources, documentation, training, etc.
• Direct links to the JPSR information, including the JPSR business rules and guidebook, JPSR system, and JPSR training.
• VHA Community Care patient safety and quality event flow chart delineating the various PS/Q reporting processes about Community Care.

These updates will ensure consistency in understanding and standardization of business processes related to reporting community care patient safety and quality events. 

Resources and Support

• OCC Patient Safety and Quality Home Page
• Questions? Contact VHA OCC Patient Safety and Quality at cc-patientsafety@va.gov
  
  

ECR Tool Training Sessions Now Available!

In preparation for the Emergency Care Reporting (ECR) tool replacing the Emergency Care Authorization Tool (ECAT), four ECR tool training sessions were held in February 2022.

If you were unable to attend a training session, please visit Chapter 3.6 of the OCC Field Guidebook to access training recordings along with additional information and guidance on Centralized Authorization of Emergency Care (CAEC), including the ECR tool and ECAT closeout processes.

Resources and Support

• Questions? Contact Clinical Integration and Field Operations leadership at VHAOCCCIFOLeadership@va.gov
  
  

New DoD Urgent Care SEOC and Group 18 Release

OCC recently released a new Department of Defense (DoD) Urgent Care Standardized Episode of Care (SEOC) to use for DoD Military Medical Treatment Facilities (MTFs) and 2022 Quarter One (Q1) Centers for Medicare and Medicaid Services (CMS) coding updates to 117 SEOCs for use beginning February 15, 2022.

Only VA facilities with an active VA-DoD Health Care Resource Sharing Agreement (VA-DoD RSA) can use the DoD Urgent Care SEOC when referring Veterans directly to the MTF Urgent Care Clinic or when Veterans self-present to the MTF Urgent Care. These facilities must amend their agreement to include urgent care as a shared service.

VA uses SEOCs as part of the community care referral process. At the time of a referral from a VA provider, a VA medical facility sends a referral packet for an individual Veteran to the community provider that includes a consult order, a SEOC, pertinent clinical information, and an offline referral form. The consult order is a clinical order for care and lists the reason for referral and/or what specific services are being requested to be provided by the community provider.

The SEOC is a list of allowable health care services that relate to a specific category of care or specialty and is assigned by VA based on the request in the consult order. Additionally, the SEOC identifies the specified number of visits (certain services will have limitations listed on the SEOC), list of allowable services, and duration of care. SEOCs help reduce the need for community providers to seek separate authorizations for each element of care. 2022 Q1 CMS coding updates include the removal of codes not covered by Medicare and the addition of new codes.

More information about the Group 18 release and the full list of SEOCs and updates can be found in the February 2022 quarterly announcement document on the SEOC Solutions Page.

Resources and Support

• Questions related to your VA-DoD RSA’s? Contact the VA-DoD Medical Sharing Office at vhacoshaagr@va.gov
• VA-DoD Advanced Payment SharePoint
• SEOC Solutions Page
• SEOC Database
• Other questions? Contact VHAOCCCILeadership@va.gov

Get Smart💡

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.

Eligibility, Consults, and Referrals Training

Consult Toolbox (CTB) Curriculum consists of seven modules presenting the latest processes, features, dashboard, and an introduction to the new RCT role. Experience various role-based scenarios and role-specific tasks, which allow you to work through a simulated CTB tool. (TMS ID 4622566)

Finance, Community Providers, and Contract Administration Training

VISN and VAMC Roles in IHS/THP RAP course provides VISN and VAMC staff with an overview of the Indian Health Service (IHS)/Tribal Health Program (THP) Reimbursement Agreements Program (RAP) which supports health care for American Indian/Alaska Native Veterans. The course focuses on the roles and responsibilities of associated VISN and VAMC staff and how they pertain to the IHS/THP RAP. (TMS VA 4619464)

Overview Training

CRM: Improving the Customer Experience One Interaction at a Time teaches learners how to document and complete various customer relationship management (CRM) requests in real-time using the Microsoft dynamics VA Community Care CRM application—the new web-based CRM application for OCC. Learners will experience the CRM application through scenario-based, simulated activities such as creating an interaction and searching for a Veteran. This course will also provide learners with a solid understanding of the benefits and importance of documenting all customer relationship interactions in the CRM application. (TMS VA 4619161)

VHA Teams Focus on Third-Party Payer Precertification Education for Community Providers

VA is making the community provider precertification process more accessible and easier to understand.

What is precertification as it relates to the VHA third-party payer revenue process?

Precertification is the process where a community provider is required to notify VHA when scheduling services for a Veteran from an approved VA referral that requires third-party payer precertification. VA has worked to make the precertification process simple and accessible. This notification is critical for VA to perform effective third-party payer billing.

Can it delay patient care? NO! But notification of precertification can assist in offsetting a Veteran’s copayment responsibility and provide funds to VA facilities.

Why is Precertification Important?

Title 38 Federal law requires VA to bill third-party payers for non-service connected/special authority care, including community care services. VA requires timely notification of care requiring third-party payer precertification and timely clinical medical record documentation.​

VA must comply with third-party payer precertification requirements as any other provider of service expecting to collect third-party payer reimbursement.

Some Veterans are required to pay VA copayments. Reimbursement from third-party payers is applied to their VA copayment responsibility and reduces the Veteran’s out-of-pocket expense.​ Third-party payer reimbursements are used by VA to provide health care services to Veterans.

How is VHA making it easier for community providers to understand if a referral requires recertification?

Providers can find precertification information and instructions using the HealthShare Referral Manager (HSRM) Community Provider Portal by clicking on the Offline Referral link. Providers should review the updated VA Offline Referral page to determine if the referral requested includes bill codes that require review for VA recertification.

VA Precertification requirements are found here:​  https://www.va.gov/COMMUNITYCARE/providers/PRCT_requirements.asp

If the provider does not have access to the HSRM provider portal, they must notify VA by completing and submitting the Third Party Payer Precertification Form. Completed forms must include the referral ID/SEOC authorization number and be submitted to the appropriate fax number, based on regional location. Locations and fax numbers can be found at the following link: https://www.va.gov/COMMUNITYCARE/providers/PRCT_requirements.asp

How can Community Care staff learn more about the precertification process?

For more information on the precertification process, visit Precertification Requirements - Community Care (va.gov)

Resources and Support

• Third-party payer precertification education for community providers (VAntage Point)
• Questions? Contact the Revenue Operations Nurse Executive Team at VHA104ROCPACNurseExecutive@va.gov