[Federal Register: September 20, 2005 (Volume 70, Number 181)]
[Notices]
[Page 55207-55211]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr20se05-138]
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DEPARTMENT OF VETERANS AFFAIRS
Privacy Act of 1974; System of Records
AGENCY: Department of Veterans Affairs (VA).
ACTION: Notice of amendment to system of records.
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SUMMARY: As required by the Privacy Act of 1974, 5 U.S.C. 552a(e),
notice is hereby given that the Department of Veterans Affairs (VA) is
amending the system of records currently entitled ``The Revenue
Program--Billing and Collections Records-VA'' (114VA16) as set forth in
the Federal Register 69 FR 4205. VA is amending the system of records
by revising the Categories of Records in the System, Purpose and
Routine Uses of Records Maintained in the System. VA is republishing
the system notice in its entirety.
DATES: Comments on the amendment of this system of records must be
received no later than October 20, 2005. If no public comment is
received, the amended system will become effective October 20, 2005.
ADDRESSES: Written comments concerning the proposed amended system of
records may be submitted by: mail or hand-delivery to Director,
Regulations Management (00REG1), Department of Veterans Affairs, 810
Vermont Avenue, NW., Room 1068, Washington, DC 20420; fax to (202) 273-
9026; or e-mail to VAregulations@mail.va.gov. All comments received
will be available for public inspection in the Office of Regulation
Policy and Management, Room 1063B, between the hours of 8 a.m. and 4:30
p.m., Monday through Friday (except holidays). Please call (202) 273-
9515 for an appointment.
FOR FURTHER INFORMATION CONTACT: Veterans Health Administration (VHA)
Privacy Act Officer, Department of Veterans Affairs, 810 Vermont
Avenue, NW., Washington, DC 20420; telephone (727) 320-1839.
SUPPLEMENTARY INFORMATION: VA is amending ``The Revenue Program--
Billing and Collections Records-VA'' (114VA16) to allow for the
collection of the National Provider Identifier (NPI) of healthcare
providers in order for the NPI to be submitted on claims for payment of
healthcare services provided by VA. The Categories of Records in the
System is amended to add the NPI to the other demographic data
collected on healthcare providers. Purpose(s) is amended to reflect how
the data may be used to make application for a NPI, as required under
the Health Insurance Portability and Accountability Act (HIPAA)
Administrative Simplification Rule on Standard Unique Health Identifier
for Healthcare Providers which includes participation in pilot testing
of NPI enumeration system by the Centers for Medicare and Medicaid
Services (CMS).
We are proposing to amend and establish the following Routine Use
disclosure of information maintained in the system:
Routine Use ten (10) is amended to add NPI to the list of
healthcare provider demographic data that may be disclosed to a third
party where the third party requires the Department provide that
information before it will pay for medical care provided by VA.
Routine Use thirteen (13) is amended to replace ``Patient
identifying information may be disclosed'' to ``Relevant information
may be disclosed.'' Identifying information on a spouse sometimes must
be disclosed to a third party payer in order for VA to be reimbursed
for services.
A new Routine Use seventeen (17) is added. Provider identifying
information may be disclosed from this System of Records to CMS to test
the enumeration system for the NPI and, once the system is operational,
to obtain a NPI for any eligible healthcare professional providing
examination or treatment within VA healthcare facilities.
VA needs the NPI to be able to bill for services provided by the
healthcare provider.
The Privacy Act permits VA to disclose information about
individuals without their consent for a routine use when the
information will be used for a purpose that is compatible with the
purpose for which we collected the
[[Page 55208]]
information. In all of the routine use disclosures described above, the
recipient of the information will use the information in connection
with a matter relating to one of VA's programs, will use the
information to provide a benefit to VA, or disclosure is required by
law.
The Report of Intent to Amend a System of Records Notice and an
advance copy of the system notice have been sent to the appropriate
Congressional committees and to the Director of the Office of
Management and Budget (OMB) as required by 5 U.S.C. 552a(r) (Privacy
Act) and guidelines issued by OMB (65 FR 77677), December 12, 2000.
Approved: September 1, 2005.
Gordon H. Mansfield,
Deputy Secretary of Veterans Affairs.
114VA16
SYSTEM NAME:
The Revenue Program--Billing and Collections Records-VA.
SYSTEM LOCATION:
Records are maintained at each VA healthcare facility. In most
cases, back-up computer tape information is stored at off-site
locations. Address locations for VA facilities are listed in VA
Appendix 1 of the biennial publication of VA Privacy Act Issuances. In
addition, information from these records or copies of records may be
maintained at the Department of Veterans Affairs (VA), 810 Vermont
Avenue, NW, Washington, DC; the VA Austin Automation Center (AAC),
Austin, Texas; Veterans Integrated Service Network (VISN) Offices; VA
Allocation Resource Center (ARC), Boston, Massachusetts, and contractor
facilities.
Categories of individuals covered by the system:
1. Veterans who have applied for healthcare services under Title
38, United States Code, Chapter 17, and in certain cases members of
their immediate families.
2. Beneficiaries of other Federal agencies.
3. Individuals examined or treated under contract or resource
sharing agreements.
4. Individuals examined or treated for research or donor purposes.
5. Individuals who have applied for Title 38 benefits but who do
not meet the requirements under Title 38 to receive such benefits.
6. Individuals who were provided medical care under emergency
conditions for humanitarian reasons.
7. Pensioned members of allied forces (Allied Beneficiaries) who
are provided healthcare services under Title 38, United States Code,
Chapter 1.
8. Healthcare professionals providing examination or treatment to
any individuals within VA healthcare facilities.
9. Healthcare professionals providing examination or treatment to
individuals under contract or resource sharing agreements.
Categories of records in the system:
The records may include information related to:
1. The social security number and insurance policy number of the
veteran and/or veteran's spouse. The record may include other
identifying information (e.g., name, date of birth, age, sex, marital
status) and address information (e.g., home and/or mailing address,
home telephone number).
2. Insurance company information specific to coverage of the
veteran and/or spouse to include annual deductibles and benefits.
3. Diagnostic codes (ICD9-CM, CPT-4, and any other coding system)
pertaining to the individual's medical, surgical, psychiatric, dental
and/or psychological examination or treatment.
4. Charges claimed to a third party payer, including insurance
companies, other Federal agencies, or foreign governments, based on
treatment/services provided to the patient.
5. Charges billed to those veterans who are required to meet co-
payment obligations for treatment/services rendered by VA.
6. The name, social security number, universal personal
identification number, National Provider Identifier (NPI) and
credentials including provider's degree, licensure, certification,
registration or occupation of healthcare providers.
Authority for maintenance of the system:
Title 38, United States Code (U.S.C.), sections 1710 and 1729.
PURPOSE(S):
The records and information are used for the billing of, and
collections from, a third-party payer, including insurance companies,
other Federal agencies, or foreign governments, for medical care or
services received by a veteran for a nonservice-connected condition or
from a first party veteran required to make co-payments. The records
and information are also used for the billing of and collections from
other Federal agencies for medical care or services received by an
eligible beneficiary. The data may be used to identify and/or verify
insurance coverage of a veteran or veteran's spouse prior to submitting
claims for medical care or services. The data may be used to support
appeals for non-reimbursement of claims for medical care or services
provided to a veteran. The data may be used to enroll healthcare
providers with health plans and VA's healthcare clearinghouse in order
to electronically file third-party claims. For the purposes of
healthcare billing and payment activities to and from third party
payers, VA will disclose information in accordance with the
legislatively-mandated transaction standard and code sets promulgated
by the United States Department of Health and Human Services (HHS)
under the Health Insurance Portability and Accountability Act (HIPAA).
The records and information may be used for statistical analyses to
produce various management, tracking and follow-up reports, to track
and trend the reimbursement practices of insurance carriers, and to
track billing and collection information.
The data may be used to enroll healthcare providers with health
plans and VA's healthcare clearinghouse in order to electronically file
third party claims. The data may be used to make application for a NPI,
as required HIPAA Administrative Simplification Rule on Standard Unique
Health Identifier for Healthcare Providers, 45 CFR Part 162, for all
healthcare professionals providing examination or treatment within VA
healthcare facilities, including participation in pilot test of NPI
enumeration system by the Centers of Medicare and Medicaid Services
(CMS). The records and information may be used for statistical analyses
to produce various management, tracking and follow-up reports, to track
and trend the reimbursement practices of insurance carriers, and to
track billing and collection information.
Routine uses of records maintained in the system, including categories
of users and the purposes of such uses:
To the extent that records contained in the system include
information protected by 45 CFR parts 160 and 164, i.e., individually-
identifiable health information, and 38 U.S.C. 7332; i.e., medical
treatment information related to drug abuse, alcoholism or alcohol
abuse, sickle cell anemia or infection with the human immunodeficiency
virus, that information cannot be disclosed under a routine use unless
there is also specific statutory authority in 38 U.S.C. 7332 and
regulatory authority in 45 CFR parts 160 and 164 permitting disclosure.
1. On its own initiative, VA may disclose information, except for
the names and home address of veterans
[[Page 55209]]
and their dependents, to a Federal, state, local, tribal or foreign
agency charged with the responsibility of investigating or prosecuting
civil, criminal or regulatory violations of law, or charged with
enforcing or implementing the statute, regulation, rule or order issued
pursuant thereto. On its own initiative, VA may also disclose the names
and addresses of veterans and their dependents to a Federal agency
charged with the responsibility of investigating or prosecuting civil,
criminal or regulatory violations of law, or charged with enforcing or
implementing the statute, regulation, rule or order issued pursuant
thereto.
2. Disclosure may be made to an agency in the executive,
legislative, or judicial branch, or the District of Columbia government
in response to its request or at the initiation of VA, in connection
with the letting of a contract, other benefits by the requesting
agency, or the lawful statutory, administrative, or investigative
purpose of the agency to the extent that the information is relevant
and necessary to the requesting agency's decision. However, names and
addresses of veterans and their dependents will be released only to
Federal entities.
3. Disclosure may be made to a Congressional office from the record
of an individual in response to an inquiry from the Congressional
office made at the request of that individual.
4. Disclosure may be made to National Archives and Records
Administration (NARA) in records management inspections conducted under
authority of Title 44 U.S.C.
5. Disclosure may be made to the Department of Justice and United
States attorneys in defense or prosecution of litigation involving the
United States, and to Federal agencies upon their request in connection
with review of administrative tort claims filed under the Federal Tort
Claims Act, 28 U.S.C. 2672.
6. Any information in this system of records, including personal
information obtained from other Federal agencies through computer-
matching programs, may be disclosed for the purposes identified below
to any third party, except consumer reporting agencies, in connection
with any proceeding for the collection of an amount owed to the United
States by virtue of a person's participation in any benefit program
administered by VA. Information may be disclosed under this routine use
only to the extent that it is reasonably necessary for the following
purposes: (a) To assist VA in collection of Title 38 overpayments,
overdue indebtedness, and/or costs of services provided individuals not
entitled to such services; and (b) to initiate civil or criminal legal
actions for collecting amounts owed to the United States and/or for
prosecuting individuals who willfully or fraudulently obtain Title 38
benefits without entitlement. This disclosure is consistent with 38
U.S.C. 5701(b)(6).
7. The name and address of a veteran, other information as is
reasonably necessary to identify such veteran, including personal
information obtained from other Federal agencies through computer
matching programs, and any information concerning the veteran's
indebtedness to the United States by virtue of the person's
participation in a benefits program administered by VA may be disclosed
to a consumer reporting agency for purposes of assisting in the
collection of such indebtedness, provided that the provisions of 38
U.S.C. 5701(g)(4) have been met.
8. The name of a veteran, or other beneficiary, other information
as is reasonably necessary to identify such individual, and any
information concerning the individual's indebtedness by virtue of a
person's participation in a medical care and treatment program
administered by VA, may be disclosed to the Treasury Department,
Internal Revenue Service, for the collection of indebtedness arising
from such program by the withholding of all or a portion of the
person's Federal income tax refund. These records may be disclosed as
part of a computer-matching program to accomplish these purposes.
9. Relevant information (excluding medical treatment information
related to drug or alcohol abuse, infection with the human
immunodeficiency virus or sickle cell anemia) may be disclosed to HHS
for the purpose of identifying improper duplicate payments made by
Medicare fiscal intermediaries where VA was authorized and was
responsible for payment for medical services obtained at non-VA
healthcare facilities.
10. The social security number, universal personal identification
number, NPI, credentials, and other identifying information of a
healthcare provider may be disclosed to a third party where the third
party requires the Department provide that information before it will
pay for medical care provided by VA.
11. Relevant information may be disclosed to individuals,
organizations, private or public agencies, etc., with whom VA has a
contract or agreement to perform such services as VA may deem practical
for the purposes of laws administered by VA, in order for the
contractor and/or subcontractor to perform the services of the contract
or agreement.
12. Relevant information from this system of records may be
disclosed to the National Practitioner Data Bank and/or State Licensing
Board in the State(s) in which a practitioner is licensed, in which the
VA facility is located, and/or in which an act or omission occurred
upon which a medical malpractice claim was based when VA reports
information concerning: (a) Any payment for the benefit of a physician,
dentist, or other licensed healthcare practitioner which was made as
the result of a settlement or judgment of a claim of medical
malpractice if an appropriate determination is made in accordance with
agency policy that payment was related to substandard care,
professional incompetence or professional misconduct on the part of the
individual; (b) a final decision which relates to possible incompetence
or improper professional conduct that adversely affects the clinical
privileges of a physician, dentist or other licensed healthcare
practitioner for a period longer than 30 days; or, (c) the acceptance
of the surrender of clinical privileges, or any restriction of such
privileges by a physician, dentist, or other licensed healthcare
practitioner either while under investigation by the healthcare entity
relating to possible incompetence or improper professional conduct, or
in return for not conducting such an investigation or proceeding. These
records may also be disclosed as part of a computer-matching program to
accomplish these purposes.
13. Relevant information may be disclosed from this system of
records to any third party or Federal agency such as the Department of
Defense, Office of Personnel Management, HHS and government-wide third-
party insurers responsible for payment of the cost of medical care for
the identified patients, in order for VA to seek recovery of the
medical care costs. These records may also be disclosed as part of a
computer-matching program to accomplish these purposes.
14. Relevant information, including the nature and amount of a
financial obligation, may be disclosed in order to assist VA in the
collection of unpaid financial obligations owed VA, to a debtor's
employing agency or commanding officer, so that the debtor-employee may
be counseled by his or her Federal employer or commanding officer. This
purpose is consistent with 5 U.S.C. 5514, 4 CFR 102.5, and section 206
of Executive Order 11222 of May 8, 1965 (30 FR 6469).
[[Page 55210]]
15. Identifying information such as name, address, social security
number and other information as is reasonably necessary to identify
such individual, may be disclosed to the National Practitioner Data
Bank at the time of hiring and/or clinical privileging/re-privileging
of healthcare practitioners, and at other times as deemed necessary by
VA, in order for VA to obtain information relevant to a Department
decision concerning the hiring, privileging/re-privileging, retention
or termination of the applicant or employee.
16. Disclosure of individually-identifiable health information
including billing information for the payment of care may be made by
appropriate VA personnel, to the extent necessary and on a need-to-know
basis consistent with good medical-ethical practices, to family members
and/or the person(s) with whom the patient has a meaningful
relationship.
17. Provider identifying information may be disclosed from this
System of Records to CMS to test the enumeration system for the NPI and
once the system is operational, to obtain an NPI for any eligible
healthcare professional providing examination or treatment with VA
healthcare facilities.
DISCLOSURE TO CONSUMER REPORTING AGENCIES:
Pursuant to 5 U.S.C. 552a(b)(12), VA may disclose records from this
system to consumer reporting agencies as defined in the Fair Credit
Reporting Act (15 U.S.C. 1681a(f)) or the Federal Claims Collection Act
of 1966 (31 U.S.C. 3701(a)(3)).
POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING,
AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
Records are maintained on paper or electronic media.
RETRIEVABILITY:
Records are retrieved by name, social security number or other
assigned identifier of the individuals on whom they are maintained, or
by specific bill number assigned to the claim of the individuals on
whom they are maintained.
SAFEGUARDS:
1. Access to VA working and storage areas is restricted to VA
employees on a ``need-to-know'' basis; strict control measures are
enforced to ensure that disclosure to these individuals is also based
on this same principle. Generally, VA file areas are locked after
normal duty hours and the facilities are protected from outside access
by the Federal Protective Service or other security personnel.
2. Information in VistA may only be accessed by authorized VA
personnel. Access to file information is controlled at two levels. The
systems recognize authorized personnel by series of individually unique
passwords/codes as a part of each data message, and personnel are
limited to only that information in the file, which is needed in the
performance of their official duties. Information that is downloaded
from VistA and maintained on personal computers is afforded similar
storage and access protections as the data that is maintained in the
original files. Access to information stored on automated storage media
at other VA locations is controlled by individually unique passwords/
codes. Access by Office of Inspector General (OIG) staff conducting an
audit, investigation, or inspection at the healthcare facility, or an
OIG office location remote from the healthcare facility, is controlled
in the same manner.
3. Information downloaded from VistA and maintained by the OIG
headquarters and Field Offices on automated storage media is secured in
storage areas for facilities to which only OIG staff have access. Paper
documents are similarly secured. Access to paper documents and
information on automated storage media is limited to OIG employees who
have a need for the information in the performance of their official
duties. Access to information stored on automated storage media is
controlled by individually unique passwords/codes.
4. Access to the VA Austin Automation Center (AAC) is generally
restricted to AAC employees, custodial personnel, Federal Protective
Service and other security personnel. Access to computer rooms is
restricted to authorized operational personnel through electronic
locking devices. All other persons gaining access to computer rooms are
escorted. Information stored in the AAC databases may be accessed.
5. Access to records maintained at the VA Allocation Resource
Center (ARC) and the VISN Offices is restricted to VA employees who
have a need for the information in the performance of their official
duties. Access to information stored in electronic format is controlled
by individually unique passwords/codes. Records are maintained in
manned rooms during working hours. The facilities are protected from
outside access during non-working hours by the Federal Protective
Service or other security personnel.
RETENTION AND DISPOSAL:
Paper records and information stored on electronic storage media
are maintained and disposed of in accordance with records disposition
authority approved by the Archivist of the United States.
SYSTEM MANAGER(S) AND ADDRESS:
The official responsible for policies and procedures is the Chief
Business Officer, Chief Business Office (16), Department of Veterans
Affairs, 810 Vermont Avenue, NW., Washington, DC 20420. The local
officials responsible for maintaining the system are the Director of
the facility where the individual is or was associated.
NOTIFICATION PROCEDURE:
An individual who wishes to determine whether a record is being
maintained in this system under his or her name or other personal
identifier, or wants to determine the contents of such record, should
submit a written request or apply in person to the last VA healthcare
facility where care was rendered. Addresses of VA healthcare facilities
may be found in VA Appendix 1 of the biennial publication of VA Privacy
Act Issuances. All inquiries must reasonably identify the place and
approximate date that medical care was provided. Inquiries should
include the patient's full name, social security number, insurance
company information, policyholder and policy identification number as
well as a return address.
RECORD ACCESS PROCEDURE:
Individuals seeking information regarding access to and contesting
of records in this system may write, call or visit the VA facility
location where they were treated.
CONTESTING RECORD PROCEDURES:
(See Record Access Procedures above.)
RECORD SOURCE CATEGORIES:
The patient, family members or guardian, and friends, employers or
other third parties when otherwise unobtainable from the patient or
family; health insurance carriers; private medical facilities and
healthcare professionals; state and local agencies; other Federal
agencies; VA regional offices; Veterans Benefits Administration
automated record systems, including Veterans and Beneficiaries
Identification and Records Location Subsystem-VA (38VA23) and the
Compensation, Pension, Education and Rehabilitation Records-VA (58VA21/
22); and various automated systems providing clinical and
[[Page 55211]]
managerial support at VA healthcare facilities to include Health Care
Provider Credentialing and Privileging Records-VA (77VA10Q) and
Veterans Health Information Systems and Technology Architecture (VistA)
(79VA19).
[FR Doc. 05-18728 Filed 9-19-05; 8:45 am]
BILLING CODE 8320-01-P