[Federal Register Volume 73, Number 49 (Wednesday, March 12, 2008)]
[Notices]
[Pages 13280-13282]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-4896]


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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 entitled ``The Revenue Program--Billing 
and Collections Records--VA'' (114VA16) as set forth in the Federal 
Register 67 FR 41573 and as amended in 69 FR 4205 and 70 FR 55207. VA 
is amending the system of records by revising the Purpose and Routine 
Uses of Records Maintained in the System.

DATES: Comments on the amendment of this system of records must be 
received no later than April 11, 2008. If no public comment is 
received, the amended system will become effective April 11, 2008.

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 [email protected]. 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: Stephania H. Putt, Veterans Health 
Administration (VHA) Privacy Act Officer, Department of Veterans 
Affairs, 810 Vermont Avenue, NW., Washington, DC 20420; telephone (704) 
245-2492.

SUPPLEMENTARY INFORMATION: VA is amending ``The Revenue Program--
Billing and Collections Records-VA'' (114VA16) to allow for the 
disclosure of the National Provider Identifier (NPI) of VA health care 
providers (individual practitioners) (1) to non-VA health care 
providers or their agents to support, or in anticipation of supporting, 
the submission of health care reimbursement claims by non-VA health 
care providers or their agents, and (2) to academic affiliates with 
which VA maintains a business relationship, to support, or in 
anticipation of supporting, the submission of health care reimbursement 
claims by these academic affiliates. Purpose(s) is amended to reflect 
how the data may be used to disclose individual NPI numbers to non-VA 
health care providers, their agents, and to academic

[[Page 13281]]

affiliates with which VA maintains a business relationship.
    We are proposing to establish the following Routine Use disclosure 
of information maintained in the system:
    A new Routine Use eighteen (18) is added. Individual NPIs may be 
disclosed to a non-VA health care provider or its agent for treatment 
of a veteran or in anticipation of treatment of a veteran where the VA 
referring provider's NPI is needed, or is anticipated to be needed, in 
order for the non-VA health care provider or its agent to submit a 
health care reimbursement claim or for any other lawful use of the NPI 
as specified in the Health Insurance Portability and Accountability Act 
(HIPAA) legislation (45 CFR Part 162).
    A new Routine Use nineteen (19) is added. Individual NPIs may be 
disclosed to an academic affiliate with which VA maintains a business 
relationship, where the VA provider (individual practitioner) also 
maintains an appointment to that academic affiliate's medical staff. 
This disclosure is to support, or in anticipation of supporting, a 
health care reimbursement claim or for any other lawful use of the NPI 
as specified in the HIPAA (Health Insurance Portability and 
Accountability Act) legislation (45 CFR Part 162).
    A new Routine Use twenty (20) is added. Any records may be 
disclosed to appropriate agencies, entities, and persons under the 
following circumstances: when (1) it is suspected or confirmed that the 
security or confidentiality of information in the system of records has 
been compromised; (2) the Department has determined that as a result of 
the suspected or confirmed compromise there is a risk of embarrassment 
or harm to the reputations of the record subjects, harm to economic or 
property interests, identity theft or fraud, or harm to the security or 
integrity of this system or other systems or programs (whether 
maintained by the Department or another agency or entity) that rely 
upon the compromised information; and (3) the disclosure is made to 
such agencies, entities, and persons who are reasonably necessary to 
assist in connection with the Department's efforts to respond to the 
suspected or confirmed compromise and prevent, minimize, or remedy such 
harm. This disclosure is to support mitigation efforts of the 
Department when a compromise to information in the system of records 
occurs.
    A new Routine Use twenty (21) is added. VA may disclose information 
in this system of records to the Department of Justice (DoJ), either on 
VA's initiative or in response to DoJ's request for the information, 
after either VA or DoJ determines that such information is relevant to 
DoJ's representation of the United States or any of its components in 
legal proceedings before a court or adjudicative body, provided that, 
in each case, the agency also determines prior to disclosure that 
release of the records to the DoJ is a use of the information contained 
in the records that is compatible with the purpose for which VA 
collected the records. VA, on its own initiative, may disclose records 
in this system of records in legal proceedings before a court or 
administrative body after determining that the disclosure of the 
records to the court or administrative body is a use of the information 
contained in the records that is compatible with the purpose for which 
VA collected the records.
    A new Routine Use twenty (22) is added. Disclosure to other Federal 
agencies may be made to assist such agencies in preventing and 
detecting possible fraud or abuse by individuals in their operations 
and programs.
    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.
    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: February 25, 2008.
Gordon H. Mansfield,
Deputy Secretary of Veterans Affairs.
Notice of Amendment to System of Records
    The system of records identified as 114VA16 ``The Revenue Program--
Billing and Collections Records--VA,'' published at 67 FR 41573, June 
18, 2002, and amended at 69 FR 4205, January 28, 2004, and amended at 
70 FR 55207, September 20, 2005, is revised to amend the purpose 
section and add routine use number 18, 19 and 20 as follows:
114VA16

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

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 data may be used to make application for an NPI, as required by 
the HIPAA Administrative Simplification Rule on Standard Unique Health 
Identifier for Healthcare Providers, 45 CFR Part 162, for all health 
care professionals providing examination or treatment within VA health 
care 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. The data may be used to 
support, or in anticipation of supporting, reimbursement claims from 
non-VA health care providers or their agents. The data may be used to 
support, or in anticipation of supporting, reimbursement claims from 
academic affiliates with which VA maintains a business relationship.

[[Page 13282]]

ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES 
OF USERS AND THE PURPOSES OF SUCH USES:
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    18. Relevant information may be disclosed to non-VA health care 
providers or their agents where the non-VA health care provider 
provides health care treatment to veterans and requires the Department 
provide that information in order for that entity or its agent to 
submit, or in anticipation of submission of, a health care 
reimbursement claim or, in the case of the NPI, for permissible 
purposes specified in the HIPAA legislation (45 CFR Part 162).
    19. Relevant information may be disclosed to an academic affiliate 
with which VA maintains a business relationship, where the VA provider 
also maintains an appointment to that academic affiliate's medical 
staff. This disclosure is to support, or in anticipation of supporting, 
a health care reimbursement claim(s) or, in the case of the NPI, for 
permissible purposes specified in the HIPAA legislation (45 CFR Part 
162).
    20. Any records may be disclosed to appropriate agencies, entities, 
and persons under the following circumstances: When (1) it is suspected 
or confirmed that the security or confidentiality of information in the 
system of records has been compromised; (2) the Department has 
determined that as a result of the suspected or confirmed compromise 
there is a risk of embarrassment or harm to the reputations of the 
record subjects, harm to economic or property interests, identity theft 
or fraud, or harm to the security or integrity of this system or other 
systems or programs (whether maintained by the Department or another 
agency or entity) that rely upon the compromised information; and (3) 
the disclosure is made to such agencies, entities, and persons who are 
reasonably necessary to assist in connection with the Department's 
efforts to respond to the suspected or confirmed compromise and 
prevent, minimize, or remedy such harm.
    21. VA may disclose information in this system of records to the 
Department of Justice (DoJ), either on VA's initiative or in response 
to DoJ's request for the information, after either VA or DoJ determines 
that such information is relevant to DoJ's representation of the United 
States or any of its components in legal proceedings before a court or 
adjudicative body, provided that, in each case, the agency also 
determines prior to disclosure that release of the records to the DoJ 
is a use of the information contained in the records that is compatible 
with the purpose for which VA collected the records. VA, on its own 
initiative, may disclose records in this system of records in legal 
proceedings before a court or administrative body after determining 
that the disclosure of the records to the court or administrative body 
is a use of the information contained in the records that is compatible 
with the purpose for which VA collected the records.
    22. Disclosure to other Federal agencies may be made to assist such 
agencies in preventing and detecting possible fraud or abuse by 
individuals in their operations and programs.
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[FR Doc. E8-4896 Filed 3-11-08; 8:45 am]
BILLING CODE 8320-01-P