[Federal Register Volume 69, Number 18 (Wednesday, January 28, 2004)]
[Notices]
[Pages 4205-4209]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-1762]


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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: The Privacy Act of 1974 (5 U.S.C. 552a(e)(4)) requires that 
all agencies publish in the Federal Register a notice of the existence 
and character of their systems of records. Notice is hereby given that 
the Department of Veterans Affairs (VA) is amending the system of 
records entitled ``The Revenue Program--Billing and Collections 
Records--VA'' (114VA17) as set forth in the Federal Register 67 FR 
41573-41578 dated June 18, 2002. VA is re-numbering the system of 
records and also amending the System Location, the Categories of 
Records in the System, the Purpose(s), the Routine Uses of Records 
Maintained in the System, including Categories of Users and the 
Purposes of Such Uses, and the System Manager(s) and Address. VA is 
republishing the system notice in its entirety.

DATES: Comments on this new system of records must be received no later 
than February 27, 2004. If no public comment is received, the new 
system will become effective February 27, 2004.

ADDRESSES: You may mail or hand-deliver written comments concerning the 
proposed amended system of records to the Director, Regulations 
Management (00REG1), Department of Veterans Affairs, 810 Vermont 
Avenue, NW., Washington, DC 20420; or fax comments to (202) 273-9026; 
or e-mail comments to [email protected]. All relevant material 
received before February 27, 2004, will be considered. Comments will be 
available for public inspection at the above address in the Office of 
Regulations Management, Room 1063B, between the hours of 8 a.m. and 
4:30 p.m., Monday through Friday (except holidays).

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: The purpose of this Billing and Collections 
system of records is to compile all relative information in order to 
(1) bill to or collect from third parties (insurance carriers) for 
medical care or services received by a veteran for a nonservice-
connected condition; (2) bill to or collect from other Federal agencies 
for medical care or services received by an eligible beneficiary; (3) 
bill to or collect from a veteran required to make co-payments based on 
eligibility (first party) for medical care or services received by a 
veteran for a nonservice-connected condition; (4) identify and/or 
verify insurance coverage of a veteran or veteran's spouse prior to 
submitting claims for medical care or services; (5) submit appeals to 
third parties for non-reimbursement of claims for medical care or 
services provided to a veteran; (6) enroll health care providers, 
utilizing the Provider Healthcare Ongoing Electronic Data Interchange 
(EDI) Billing Enrollment software (PHOEBE), with

[[Page 4206]]

third party health plans and VA's health care clearinghouse in order to 
electronically file claims for medical care or services; and (7) report 
analytical and statistical data related to management practices, 
reimbursement practices of insurance carriers, and billing and 
collection data.
    VA is renumbering the system of records to 114VA16 to reflect 
organizational changes. System Location is amended to include the 
maintenance of records at contractor facilities.
    VA is amending the Categories of Individuals Covered by the System 
by deleting the phrase ``International Government responsible for'' in 
number seven (7). Pensioned members of allied forces (Allied 
Beneficiaries) who are provided health care services under Title 38, 
U.S.C. Chapter 1 are covered by the system.
    VA is amending the Categories of Records in the System as described 
below:
     Number two (2) is amended to replace ``Insurance 
information specific to the veteran and/or spouse'' with ``Insurance 
company information specific to coverage of the veteran and/or 
spouse.''
     Number four (4) is amended to replace ``Charges 
claimed to an insurance company based on treatment/services provided to 
the patient'' with ``Charges claimed to a third party payer, including 
insurance companies, other Federal agencies, or foreign governments, 
based on treatment/services provided to the patient.''
     Number six (6) is amended to add the phrase 
``and credentials including the provider's degree, licensure, 
certification, registration and occupation.''
    The Purpose(s) has been amended to add ``For the purposes of health 
care 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 Routine Uses of Records Maintained in the System, including 
Categories of Users and the Purposes of Such Uses are amended as 
described below.
     Routine use ten (10) is amended to include 
disclosures of health care providers' credentials to a third party 
where the third party requires the Department to provide that 
information before it will pay for medical care provided by VA.
     Routine use eleven (11) is amended to replace 
``in order for the contractor to perform the services of the contract 
or agreement'' with ``in order for the contractor or sub-contractor to 
perform the services of the contract or agreement.''
     A new routine use fifteen (15) has been added. 
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 health 
care 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.
     A new routine use sixteen (16) has been added. 
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.
    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.
    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 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.
    Under section 264, Subtitle F of Title II of the Health Insurance 
Portability and Accountability Act of 1996 (HIPAA) Public Law 104-191, 
100 Stat. 1936, 2033-34 (1996), the United States Department of Health 
and Human Services (HHS) published a final rule, as amended, 
establishing Standards for Privacy of Individually-Identifiable Health 
Information, 45 CFR parts 160 and 164. VHA may not disclose 
individually-identifiable health information (as defined in HIPAA and 
the Privacy Rule, 42 U.S.C. 1320(d)(6) and 45 CFR 164.501) pursuant to 
a routine use unless either: (a) The disclosure is required by law, or 
(b) the disclosure is also permitted or required by the HHS Privacy 
Rule. The disclosures of individually-identifiable health information 
contemplated in the routine uses published in this amended system of 
records notice are permitted under the Privacy Rule or required by law. 
However, to also have authority to make such disclosures under the 
Privacy Act, VA must publish these routine uses. Consequently, VA is 
publishing these routine uses and is adding a preliminary paragraph to 
the routine uses portion of the system of records notice stating that 
any disclosure pursuant to the routine uses in this system of records 
notice must be either required by law or permitted by the Privacy Rule 
before VHA may disclose the covered information.
    System Manager(s) and Address is amended to reflect organizational 
changes.
    The Report of Intent to Publish and an advance copy of the system 
notice have been sent to the appropriate Congressional committees and 
to 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: January 12, 2004.
Anthony J. Principi,
Secretary of Veterans Affairs.
114VA16

SYSTEM NAME:
    The Revenue Program--Billing and Collections Records-VA.

SYSTEM LOCATION:
    Records are maintained at each VA health care 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.

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CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
    1. Veterans who have applied for health care 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 health care services under Title 38, United States Code, 
Chapter 1.
    8. Health care professionals providing examination or treatment to 
any individuals within VA health care facilities.
    9. Health care 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 and credentials including provider's degree, 
licensure, certification, registration or occupation of health care 
providers.

AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
    Title 38, United States Code, 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 health care 
providers with health plans and VA'' s health care clearinghouse in 
order to electronically file third-party claims. For the purposes of 
health care 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.

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 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

[[Page 4208]]

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 health 
care facilities.
    10. The social security number, universal personal identification 
number, credentials, and other identifying information of a health care 
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 health care 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 or dentist 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 or dentist, either while 
under investigation by the health care 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. Patient identifying 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).
    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 health care 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.

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

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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 health care facility, or an OIG 
office location remote from the health care 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 health care 
facility where care was rendered. Addresses of VA health care 
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 
health care 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 managerial 
support at VA health care facilities to include Health Care Provider 
Credentialing and Privileging Records-VA (77VA10Q) and Veterans Health 
Information Systems and Technology Architecture (VistA) (79VA19).

[FR Doc. 04-1762 Filed 1-27-04; 8:45 am]
BILLING CODE 8320-01-P