Starting in 2008, some institutional files contained Medicare Provider Numbers with a “V” in the fifth position. These provider numbers represent Veterans Administration (VA) Demonstration claims. A full explanation is found in the CMS Internet Only Manuals, 100-04 Claims Processing Manual, Chapter 37 – Department of Veterans Affairs (VA) Claims Adjudication Services Project.
These VA records are found in the RIF and LDS versions of the MedPAR, Inpatient, and Outpatient files.
| File | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 |
|---|---|---|---|---|---|---|---|
| IP RIF (claims) | <100 | <600 | <500 | 0 | <100 | 0 | <400 |
| MedPAR RIF | 0 | <600 | <500 | 0 | <100 | 0 | <1,000 |
| OP RIF (claims) | <100 | <3,400 | <2,000 | 0 | 0 | 0 | 0 |
Table 1. Number of observations (claims or stays) with provider number containing “V” in 5thposition (rounded to the nearest 100)
Recommendation:
ResDAC recommends excluding these claims from the utilization files because these records don’t represent all the services provided to Medicare beneficiaries at VA hospitals.