36C24219R0014-169.pdf

VA WESTERN NEW YORK HEALTHCARE SYSTEM

April 9, 2019 CENTER MEMORANDUM NO. 136-41

PATIENT INFORMATION COLLECTION MANAGEMENT PROGRAM (PICM)

1. PURPOSE: The purpose is to stipulate policy, responsibilities and procedures to be followed in conjunction VHA Directive 1910, “Patient Information Collection Management Processes (PICM)”.

2. POLICY:

A. It is policy that the facility maintains PICM processes in order to timely identify and update Veteran’s demographic and insurance information.

B. Under VA regulation Title 38 Code of Federal Regulation (CFR) 17.36, Veterans are required to complete VA Form 10-10EZ, Application for Health Care Benefits. This information is used to determine Veterans eligibility, enrollment priority group, mailing address, copayment requirements, and third-party health insurance liabilities. VA’s information collection for VA Form 10-10EZ was approved by the Office of Management and Budget (OMB) under OMB control number No. 2900-0091.

C. PICM processes establish or update a beneficiary’s record (e.g., military service history, demographics, insurance information, etc.) through the Veterans Health Information and Technology Architecture’s (VistA) registration application, load/edit application, pre-registration software and/or Insurance Capture Buffer (ICB) Software.

D. Title 38 United States Code (U.S.C.) Section 1729 authorizes VA to recover or collect for care or services, reasonable charges, as determined by the Secretary of Veterans Affairs, for care and services, provided for a non-service connected disability in or through a VA medical facility to a Veteran who is also a beneficiary under a third-party payer’s insurance plan. VA’s right to recover or collect is limited to the extent that the Veteran or a Community care provider of the care or services would be eligible to receive reimbursement or indemnification from the third-party payer, if the care or services had not been furnished by a department or agency of the United States. VA implements this authority under Title 38 CFR Section 17.101 and 17.106.

E. Title 38 U.S.C. Section 8111 authorizes the VA to recover or collect for care or services provided to a beneficiary that is covered under TRICARE entitlements.

F. VA medical facilities and Consolidated Patient Account Centers (CPAC) must utilize nationally standardized Patient Information Collection Management (PICM) processes to update the Veteran’s or other patient record in the Veterans Health Information Systems and Technology Architecture (VistA) system.

D.29 PATIENT INFORMATION COLLECTION MANAGEMENT PROGRAM (PICM) -

CM 136-41

CENTER MEMORANDUM NO. 136-41

G. Requesting and verifying insurance information is vital to the success of the VA revenue collection process because accurate information is required to effectively bill and collect reimbursements from third-party payers for services to Veterans and other beneficiaries. It is required to contact the third-party payer and verify the Veteran’s or other beneficiary specific policy coverage and other information before submitting claims to the third-party payer(s).

H. Accurate patient demographic information is essential in the successful delivery of VA healthcare programs and services to Veterans and their families. Accurate patient contact, emergency contact and next of kin contact information ensures the Veteran receives appointment information and reminders, medications by mail and provides clinical and administrative staff the information needed to coordinate care with the Veterans emergency contact or next of kin in the event the Veteran is unconscious or deceased.

I. It is policy to update a Veteran’s demographic, insurance and income information during any interaction with Enrollment, Health Administration Services or Admissions staff. This includes verifying an updated Means or Copay Test, VA Form 10-10EZR, Health Benefits Renewal Form, is on file. The following benefits are derived from the timely collection of patient information:

(1) Obtaining correct addresses helps ensure that VA is able to communicate important information, such as treatment information, prescriptions, appointment letters, patient copayment billings and information via mail, to the Veteran. This prevents the return of undeliverable mail and the associated costs of undeliverable mail. Correcting this data has the potential of improving patient care and saving significant amounts of money.

(2) Producing and maintaining accurate demographic and health insurance information within the VistA database decreases rework, delays, and frustrations for Veterans and employees.

(3) Gathering and updating pertinent insurance information affords Veterans the benefit of their insurance plan and may decrease or eliminate their VA copayment and increase the facility’s revenues.

(4) Verifying patients’ copay status is correct at all times ensures accurate revenue collection can occur while simultaneously eliminating the risk of billing veterans erroneously.

(5) Reminding patients of scheduled appointments helps improve patient care by reducing the no-show rate.

3. RESPONSIBILITIES:

A. The Medical Center Director is responsible for:

1. Designating a PICM Coordinator, which may be a collateral duty, with responsibilities listed in paragraph 4.g. below, and ensure local training is provided to support PICM staff in accordance with processes specified in Appendix A

2. Designating a TRICARE Coordinator as required by VHA Directive 1305 Treatment of Active Duty and Reserve Component Service members in VA Health Care Facilities, dated March 10, 2017, with responsibilities listed in paragraph 4.h.

below. This position may be a collateral duty to oversee non-Medical Care Cost Fund (MCCF) revenue activities, functions, and reports.

B. The Health Administration Service office is responsible for ensuring administrative data is entered in accordance with existing VHA policy guidance.

C. Service Chiefs are responsible for ensuring that staff understands the importance of accurate patient information and what actions should be taken if patient information needs to be updated and ensuring that staff attend the required training.

D. Supervisors of clerical staff are responsible for monitoring and evaluating their employee’s competency and performance with Patient Information Collection processes.

E. The PICM Coordinator is responsible for

(1) Ensuring the PICM processes have been incorporated into the medical center training program and that the training is available to the appropriate staff.

(2) Monitoring staff attendance at PICM training.

(3) Developing a compliance monitor and data integrity checks of PICM information; specifically monitoring the Veterans’ complete address, home and work telephone numbers, insurance information, next-of-kin, emergency contact, email address, and employer information.

(4) Providing the Chief, Health Administration Services a periodic report of completeness and integrity of PICM data.

F. Enrollment/HAS staff are responsible for:

(1) Verifying that patients’ demographic, insurance and income data on file are accurate and updated prior to scheduling an appointment, admission to the Emergency Room or for a scheduled Inpatient stay in order to facilitate accurate revenue collection and prevent erroneous copays.

4. PROCEDURES:

A. VISTA Pre-Registration menu should be used to update demographics.

Insurance Capture Buffer (ICB) software will be used for all insurance entries and updates. VA Form 10-10EZR should be used to update patients’ copay status; the effective date should be the date of admission or the date it was filled out, whichever is earlier.

B. If pre-appointment phone calls are made, staff will ask the Veteran for any changes to their demographics and update the changes in the VISTA system using VISTA Pre-registration option. Efforts should be concentrated on obtaining the information well before the day of the appointment.

NOTE: Personnel collecting the information telephonically must not request that the Veteran verify sensitive information such as Social Security, date or place of birth, or mother’s maiden name.

C. Information for patients who cannot be reached prior to their appointments, or who prefer to give information in person, may be updated at the point of service or on the same day of the appointment, including cases of urgent or emergent care. At Intake, patient information will be confirmed and updated prior to being seen utilizing VISTA Pre-registration option and the Insurance Capture Buffer (ICB) software.

D. Patients presenting to the Veterans Service Center for any service available therein will have their entire VistA registration updated as needed including:

demographic, insurance, income, and service data; ensuring patient is verified as eligible; and that a scanned copy of patient veterans’ DD214 exists in VistA Image.

E. Veterans can be directed to the check-in kiosks, to update their information.

Note: designated staff will be responsible for verifying and accepting any demographic updates to the VISTA system made by Veterans at a check in Kiosk.

F. Veterans can be directed to update changes in demographic information by using the MyHealtheVet website (http://www.myhealth.va.gov).

G. PICM coordinator will ensure demographic update (pre registration) and ICB reports are submitted to revenue committee

H. PICM coordinator ensures completion of 10% monitor of demographic data and report through local CAB.

5. RESCISSION: Center Memorandum 136-41 dated October 2, 2015 http://www.myhealth.va.gov/ http://www.myhealth.va.gov/

6. REFERENCES: Title 38 CFR 1736; VHA Directive 1904, July 10, 2018; VHA Directive 1604, April 22, 2016.

7. FOLLOW-UP RESPONSIBILITY: Veterans Service Manager (136)

8. AUTOMATIC REVIEW DATE: April 1, 2022

Michael J. Swartz, FACHE Executive Director VA Western New York Healthcare System

DISTRIBUTION: 1 copy each (00, 00QM, 136)