Embed Size (px)
Citation preview
The VA State Home Per Diem ProgramReimbursement and Electronic Invoicing Process
Training for State Veterans Homes
Kelly Schneider, Program Manager State Home Per Diem Program
February 2013
VETERANS HEALTH ADMINISTRATION 2
Agenda
• Invoice Process • What has changed?
• Submitting Invoice through OB10• System for Acquisition Management (SAM) Registration and DUNS• State Veteran Home Program Management• Reimbursement Overview
• Reimbursement Chart• Veterans Eligible for Higher Per Diem• Per Diem Reimbursement
• Per Diem Overview• Basic Admission Process Flow for State Homes• Instructions for SVHs Submission of 10-5588 for February 1, 2013
VETERANS HEALTH ADMINISTRATION 3
Agenda Cont’d
• Monthly Invoicing Processing Flowchart– Invoice Review and Payment Process Flowchart
• Electronic Invoicing• Retroactive Payments
– What has Changed?– Overview
• Draft 10-5588A (Retro Payment) Under OMB Review• State Home Per Diem Website• State Home Per Diem Contacts • Questions
VETERANS HEALTH ADMINISTRATION 4
Invoice Process
What has changed?• MANDATE for electronic invoice submission to the VA Financial
Services Center (VAFSC) to eliminate improper payment. • A Federal Register rule mandating electronic invoice
submissions was published November 27, 2012 and can be located at: https://federalregister.gov/a/2012-28612
• State Homes were granted an extension to submit/upload their electronic invoicing by April 1, 2013.
• VA Form 10-5588 and supporting documents must be submitted in Tag Image File Format (TIFF) in OB10.
• VAMC must provide the Purchased Order (PO) number to the SVH so that they can invoice the VA through OB10.
VETERANS HEALTH ADMINISTRATION 5
Submitting Invoice through OB10
DEMO http://ob10.com/Country/Us/
• OB10 US Help Desk support for State Home: 1-877-489-6135
• Additional OB10 and Veterans Affairs information can be found at: http://ob10.com/Country/US/VeteransAffairs
VETERANS HEALTH ADMINISTRATION 6
System for Acquisition Management (SAM) Registration and DUNS
• It is MANDATORY for all State Veteran Homes (SVHs) to have a DUNS number and be registered in the new System for Acquisition Management (SAM).• SAM transitioned from the Central Contractor Registry (CCR). • An active “Representations and Certifications” (ORCA) in SAM is
also required.
• State Homes should double-check their organization’s record in SAM to confirm that all of their information has migrated correctly into the new system. • Refer to the website: https://www.sam.gov/portal/public/SAM
VETERANS HEALTH ADMINISTRATION 7
System for Acquisition Management (SAM) Registration and DUNS Cont’d
• If you are not registered in SAM, you will need a Duns & Bradstreet (DUNS) number to do so. • If you already have a DUNS number, the full registration
process in SAM can take 3-5 days. • If you do not have a DUNS number, you can obtain one at
http://fedgov.dnb.com/webform.
• For assistance with SAM, contact the Federal Service Desk at www.fsd.gov or by phone at 866-606-8220 (toll-free).
VETERANS HEALTH ADMINISTRATION 8
System for Acquisition Management (SAM) Registration and DUNS Cont’d
• Please confirm you are registered in SAMS and that the DUNS number is valid by sending an e-mail to Ms. Jeanne Crook at [email protected]. • For questions, contact Ms. Cook via e-mail at [email protected]
or by phone (303) 398-5224.
• Failure to register in SAMS and/or having an invalid DUNS number will result in VA not being able to reimburse the SVH for services provided until the issues have been resolved.
VETERANS HEALTH ADMINISTRATION 9
State Veteran Home (SVH) Program Management
• SVH Responsibilities:• Provide services as defined in 38 CFR Part 51• Complete/submit 10-10SH and 10-10EZ to VAMC• Maintain health records of residents• Maintain tracking log• Track and report per diem cost• Submit monthly gains and losses to VAMC• Completed OB10 invoice, prepare and upload VA 10-5588
and any supporting documentation electronically into the OB10 web link
VETERANS HEALTH ADMINISTRATION 10
Reimbursement
• To receive payment, SVHs must upload a completed VA Form 10-5588 in OB10 by the 5th workday following the end of the month in which services were rendered.
• All payments by VA to the SVH will be made by electronic funds transfers (EFTs).
• VA Form 10-5588 is considered to be complete when all required information is provided and when the form is signed by the SVH Administrator.
• In cases where the SVH is operated under a contractual agreement for the State, the form must be signed by a State representative.
VETERANS HEALTH ADMINISTRATION 11
Reimbursement Cont’d
• Failure to upload a timely and completed VA Form 10-5588 and required supporting documentation may result in delayed or denied payments.
• For services that the SVH is not responsible for providing pursuant to 38 CFR Part 51 (such as hospital care, hearing aids, eyeglasses, etc.): • On behalf of the Veteran, the SVH may contact its VA Medical
Center of Jurisdiction to request VA to consider providing or paying for such services.
VETERANS HEALTH ADMINISTRATION 12
Reimbursement Chart
VETERANS HEALTH ADMINISTRATION 13
Veterans Eligible for Higher Per Diem
• VA will reimburse the SVH the prevailing rate for nursing home care for certain eligible Veterans residing in State Veterans Homes.• The definition for eligible Veterans remains unchanged, which include s
Veterans who are 70 percent or more service-connected, who require nursing home care because of a service-connected (SC) disability, or are totally disabled and unemployable.
• Public Law 112-154 states that the VA payment for these eligible Veterans “constitutes payment in full to the State home” for nursing home care provided to the Veteran.
• Veterans with SC disabilities 60% or below and are receiving nursing home care unrelated to their SC disability will receive the basic rate.
• The Prevailing Rate is calculated using the methodology in effect prior to enactment of Section 105 of Public Law 112-154. • Methodology is set forth in 38 CFR 51.41(b)(1).
VETERANS HEALTH ADMINISTRATION 14
Per Diem Reimbursement
Change Higher Per Diem
$$
Question: As of February 2, 2013, what will go away?Answer: For higher per diem payments - the language stating “the lesser of the two figures,” which is either the daily care
cost or the prevailing rate
No ChangeBasic Per Diem
VETERANS HEALTH ADMINISTRATION 15
Per Diem
• State home per diem rates are non-negotiable and established by VA as a rate that is payable per resident per day.
• VA uses two primary methods for reimbursement of nursing home services: • A “prevailing rate” for certain Veterans with service connected
disabilities.• A “basic rate” for Veterans who do not have a service-connected
disability that qualifies them for the prevailing rate. • VA also uses a basic rate for domiciliary and ADHC services. • Basic rates for each level of care (nursing home, domiciliary, and ADHC)
are standardized nationally and are not subject to regional variations.• These rates are readjusted every fiscal year.
VETERANS HEALTH ADMINISTRATION 16
Per Diem Cont’d
• The FY 2013 rates were released in October 2012. • Whatever prevailing rate applies for your particular SVH is what will be used
after February 2, 2013 for both the provider agreement and contract . • To compute the prevailing rate, VA uses the national CMS RUG rates
instead of the individual case mix of Veterans that reside in the SVH. • VA has been paying these rates on a yearly basis.
• One rate is calculated every year. • The formula takes the average of all the CMS rates for each fiscal year.
• A wage index is factored for each geographic area of the SVH. • A physician visit amount is tacked onto the amount.
• That is how the average rate is calculated for each SVH in a particular geographic area.
VETERANS HEALTH ADMINISTRATION
Basic Admission Process Flow for State Homes
.
17
Applicant is an eligible Veteran or an eligible Veteran-related category (spouse, surviving
spouse, or gold star parent)
Eligible for Admission
Admissions Review
Can the home provide the level of care required?
Admission Denied
Can the Applicant Pay?
Applicant Qualifies for Pay Sources
(e.g., VA Per Diem, Medicare, Medicaid, A&A, Private Pay, etc.)
Yes
Yes
Yes
No
No
No
VETERANS HEALTH ADMINISTRATION
Basic Admission Process Flow for State HomesCont’d
.
18
Applicant Qualifies for Pay Source(s)
Veteran Only Eligible Veteran-Related can be Admitted, but VA Per Diem is not Authorized for
Payment
(other pay sources may be used)
Applies for VA per diem @ VAMC of Jurisdiction
Meets Administrative Eligibility Criteria
Reviewed by VA Physician
Skilled Care Required
Admission not Approved, per diem cannot be paid
Admission not approved, per diem cannot be paid
Per diem payments can be approved effective on the admission date when applications are received within ten days of admission. If
received after ten days of admission, per diem payments begin on the day the application is received.
No
No
VETERANS HEALTH ADMINISTRATION 19
Instructions for SVHs Submitting 10-5588 for February 1, 2013
• The SVHs will complete one invoice and upload one 10-5588 for the month of February 2013. • The SVHs will separate the old methodology (February 1, 2013) from the
new methodology (February 2, 2013 and going forward) on the 10-5588. • For February 1, 2013 only:
• SVHs will use the old methodology by manually recording the one day of care in the remark section of the 10-5588 report.
• This involves the lesser of, “the daily cost of care or the prevailing rate”. • It is important for the SVH to add the amount of the one day of care stated
in the remark section to the overall total.• If the SVH was eligible to receive the VA prevailing rate prior to February
1, 2013 as the daily cost of care exceeded the prevailing amount: • The SVHs will complete the 10-5588 in the usual way with no changes made
to the report; please clarify in remarks section.
VETERANS HEALTH ADMINISTRATION
Monthly Invoicing Processing Flowchart
20
Develop Gains & Losses Report
Compiled Based on
Eligibility Category
(Service Connected v. Basic Rate)
Compute Total Cost of Care
(Direct and Indirect)Costs in Accordance with
Cost Principles: 2 CFR 225 (A-87)
Enter information into OB10 Link and
upload VA Form 10-5588 and supporting documentation
(Gains & Losses Report/Spreadsheet electronically via VA Finance Service
Center’s OB10 Linkby the 5th of month, effective date April 1, 2013
Complete Form10-5588
Reconcile and Correct Errors to Gains & Losses Report with VAMC
21
8 CBO StaffSVH will complete invoice & upload 10-5588 and any other supporting
documentation into OB10
The 10-5588 and supporting documentation is automatically
populated in OLCS
Austin sends email
alert to VAMC of
Jurisdiction Certifying Official(s) to certify
invoices for payment
VAMC reconciles 10-5588
by accepting
or rejecting
for payment via OLCS
If rejected,
FSC returns
the invoice/10-5588
to SVH to correct
SVH corrects invoice/10-5588
and uploads
into OB10 Link. Austin sends alert to VAMC
VAMC prints & signs
10-5588 to certify the
amount payable
and enter into SQL
VAMCFiscal
Service completes
audit of printed 10-
5588. Certifying
official certifies payment
Invoice Review & Payment Process Flowchart
VETERANS HEALTH ADMINISTRATION 22
Electronic Invoicing• Beginning April 1, 2013:
• All monthly SVH invoices will be processed electronically• VA Form 10-5588, State Home Report and Statement of Federal Aid Claimed, must be
scanned and uploaded by each SVH after the close of each monthly reporting period into the VA Finance Service Center’s OB10 Link: http://www.ob10.com/
• To ensure timely payment, the State home may wish to upload a supporting documentation spreadsheet that lists: • the name of each Veteran (last name, first name),• last four digits of their social security number, and• total days of care claimed with the corresponding VA per diem payment rate
approved for the fiscal year. • In this spreadsheet, we recommend that Veterans on whose behalf VA pays the basic per
diem rate are reported separately from other Veterans.• Once uploaded into the OB10 system, the invoice and supporting documentation will be
transmitted into the On-line Certification System. • The Finance Service Center will then send an e-mail notice to the Medical Center of
Jurisdiction’s designated staff to certify the payment.
VETERANS HEALTH ADMINISTRATION 23
Electronic Invoicing Cont’d
• Prior to certification, the designated VA Medical Center staff will review each monthly invoice report and any supporting documentation for completeness & accuracy and will resolve any discrepancies with the SVH.
• The Report must not be certified if the report is incomplete. • For example, all appropriate blocks are completed and report is signed by the
SVH administrator and, if applicable, the State employee if the SVH is operated by a contractor.
• When the form is complete and accurate: • accounting should sign the printed 10-5588 and date the audit block, and • the individual assigned to certify will complete the certification in the On-line
Certification System. • As of April 1, 2013: All payments must be made through the On-line
Certification System. • Payment will be made by electronic funds transfer (EFT).
VETERANS HEALTH ADMINISTRATION 24
Retroactive PaymentsPL 112-154, Section 105:
Contracts and Agreements for Nursing Homes
What Has Changed?
• Veterans under VA provider agreement with SVHs ARE authorized retroactive payment using the prevailing rate effective February 2, 2013. • Prior to February 2, 2013, the old methodology for retroactive
payments is in effect.
• To date (February 2013) VAMCs of jurisdiction do not have contract agreements in place with State Homes.
VETERANS HEALTH ADMINISTRATION 25
Retroactive Payments Cont’d
• Veterans under VA Contract (nursing home beds) with a new SVH that passed their Recognition Survey and received the signed letter from the VA Under Secretary for Health are not authorized for retroactive per diem payment after February 2, 2013• If a new home is recognized and approved by the Under Secretary
for Health prior to February 1,2013, they will be allowed to receive retroactive payments based on the old methodology.
• Veterans under a VA provider agreement are allowed to collect retroactive per diem payments using the prevailing rate as of February 2, 2013. • Prior to February 2, 2013, the old methodology for retroactive
payments is in effect.
• A SVH may not opt for the basic rate for highly service-connected Veterans as outlined in Public Law 112-154.
VETERANS HEALTH ADMINISTRATION
Draft 10-5588A (Retro Payment)Under OMB Review
26
Admissions Review
required?
Admission Denied
Can the Applicant Pay?
Applicant Qualifies for Pay Sources
(e.g., VA Per diem, Medicare, Medicaid, A&A, Private Pay, etc.)
Yes
Yes
No
No
No
VETERANS HEALTH ADMINISTRATION 27
State Home Per Diem Program Website
http://www.nonvacare.va.gov/state-homes.asp
VETERANS HEALTH ADMINISTRATION 28
State Home Per Diem Program Contacts
Kelly J. SchneiderState Home Per Diem Program Manager
[email protected](308)389-5106 or (402)613-2379
Brenda WigginsProgram Analyst
[email protected](202) 461-6757
Jeanne CrookProgram Specialist
[email protected](303) 398-5224
Gloria TestaBudget Analyst
[email protected](303) 398-5573
Gus HarrisProgram [email protected]
(303) 398-4761
Stephanie HaddockAdministrative Support
[email protected](303) 331-7504
Michelle SlusserProject Manager
[email protected](303) 780-4826
Gloria J. SanfordDeputy Program [email protected]
(303) 331-7856
