The National Inpatient Recovery Contract is an audit of all VHA diagnostic related group (DRG)
payments for inpatient episodes of care. The scope of the audit includes fee basis, CHAMPVA and
Spina Bifida Healthcare payments disbursed for Fiscal Years 2003-2006. The contract was awarded
on November 15, 2004 to TCAssociates. In partnership with Health Net Federal Services, TCAssociates
contract operations will begin March 1, 2005. The administration of the contract was assigned to
the VHA Chief Business Office's Health Administration Center. Each VISN and VA medical facility
has designated a point of contact to facilitate contractor data requests and related issues.
Scope of Contract
The data required to conduct the initial review will be provided to the Contractor from the VA central database. Following an initial review, the Contractor will select cases for intensive auditing to determine:
If the health care provider used the correct ICD codes on the bill submitted to VA for payment,
If VA input the correct ICD codes into the computer application used to determine the amount of payment,
If VA used the correct payment methodology.
During the course of the audit, the Contractor may request supporting documentation or clarification of identified issues related to this contract from the designated VA point of contact. The Contractor receives 29.5% of all funds recovered as a result of the audit. The remaining funds will be returned to the identified facility for use.
Exclusions
Excluded from this contract are payments related to outpatient professional services, domiciliary, State home, contract nursing homes, any payments made by VA under contract or sharing agreement, and any payments made by VA for care furnished outside the United States and its territories.
Contacts
Non-VA inquiries on this contract should be referred to the contracting officer technical representative, Catherine Wasson, at 303-331-7516. Written inquiries may be referred to Ms. Wasson at: Department of Veterans Affairs, Health Administration Center, PO Box 469060, Denver, CO 80246-9060.
