HERC: Technical Report 46: Including Lag Time for Community Care Data Analyses in VA Research
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Technical Report 46: Including Lag Time for Community Care Data Analyses in VA Research

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Suggested Citation

Lor MC, Scott W, Illarmo S. Including Lag Time for Community Care Data Analyses in VA Research. Technical Report 46. Health Economics Resource Center, VA Palo Alto Health Care System, U.S. Department of Veterans Affairs. June 2025.

 

For a list of VA acronyms, please visit the VA acronym checker on the VA intranet at http://vaww.va.gov/Acronyms/fulllist.cfm.

Highlights

  • IVC CDS is a central database of community care claims for health VA patients received from non-VA providers.
  • We analyzed the claim processing time to better understand the length of time data users should wait after service date before including IVC CDS data in their analysis.
  • For most analyses, including a 4-month lag period is sufficient; however, research focused on inpatient data should consider the additional lag time for some inpatient institutional claims.

1. Introduction

Community care is health care Veterans received from non-VA providers that is paid for by the Department of Veterans Affairs (VA). VA has used community care to supplement health care for Veterans since the 1920s, and eligible services have expanded over time (1). With the passage of the 2014 Veterans Access, Choice and Accountability Act and the 2018 MISSION Act, use of community care has grown dramatically: In 2014, community care for veterans accounted for $7.9 billion, and by 2021, Congressional Budget Office estimates that the cost of community care programs increased to $17.9 billion (1). Therefore, researchers looking for a complete overview of Veteran care and costs will likely need to include community care data in their analysis. 

The Veterans Health Administration (VHA) Office of Integrated Veteran Care (IVC) Consolidated Data Sets (CDS) is a central database of community care claims for health care VA patients received from non-VA providers [2]. IVC CDS contains referrals, claims, and payment data from Community Care Reimbursement System (CCRS), Electronic Claims Adjudication Management System (eCAMS), Fee Basis Claims System (FBCS), Plexis Claims Manager (PCM), and VistA Fee Basis Package (Fee) (2). These claims include information such as procedures performed, dates of service, amount billed for the service, amount paid for the service, etc., and cover services provided in inpatient and outpatient settings. The database contains claims processed on or after October 1, 2018 (i.e., fiscal year 2019 forward) (3). 

We analyzed the claim processing time to better understand the length of time data users should wait after service date before including CDS data in their analysis.

2. Methods

We summarized the number of days between the service end date and the paid date for each claim to analyze the claims with service start and end dates overlapping FY2022. We included claims from all systems available in CDS in FY22: CCRS, eCAMS, VISTA, PCM_VAChoice_TW, and PCM_Dialysis. The data was stratified by the type of care: inpatient, outpatient, and nursing home, and the claim type: professional, institutional, or dental. The list of codes for the type of care and claim type is available in the appendix. Only paid claims were included in the analysis and if multiple claims share the same claim ID, only the earliest claim was kept, identified by the Paid_Date variable. Reversed claims and claims with missing paid date were excluded. 

3. Results

In FY22, there were 31,752,913 total claims paid, not including reversed claims. 97.5% of the total claims were inpatient institutional, outpatient institutional, and outpatient professional claims. The primary source systems for these claims were CCRS and eCAMS (Table 1).

Table 1. Summary of Claims by Source Systems (CCRS and eCAMs Only), FY22
Source System Type of Care Claim Form Type N Claims Mean Days between End of Service and Paid Date Median Days between End of Service and Paid Date
CCRS Inpatient Institutional 419,389 160.6 33
eCAMS Inpatient Institutional 17,664 113.7 71
CCRS Outpatient Institutional 4,368,503 55.0 27
eCAMS Outpatient Institutional 300,622 77.4 44
CCRS Outpatient Professional 24,516,239 54.3 24
eCAMS Outpatient Professional 1,119,000 77.1 45

Table 2 displays the summary of total claims in FY22. Among all claims, the average time between the end of service and the paid date was 56.8 days. Outpatient dental, institutional, and professional claims had average payment times of 53.2 days. Inpatient institutional care (158.7 days) and nursing home care (85.3 days) had the longest average time. Outpatient professional and outpatient institutional claims had the most missing paid dates (1,516 claims). Outpatient professional care (1,099) and outpatient institutional care (448) had the most claims with multiple records. The maximum time to payment across all types of care was between 1,026 to 1,044 days which suggests some claims were taking as long as 2.8 years to be paid. 

Table 2. Summary of Claims in FY22
Type of Care Claim Form Type N Claims Mean Days between End of Service and Paid Date Min Days between End of Service and Paid Date Max Days between end of Service and Paid Date N Claims missing Paid Date N Claims with Multiple Records
Inpatient Institutional 437,184 158.7 7 1,043 67 22
Nursing Home Institutional 181,167 85.3 6 1,026 0 0
Outpatient Dental 618,660 48.5 5 1,041 17 38
Outpatient Institutional 4,848,123 55.7 5 1,044 697 448
Outpatient

Professional

 25,667,779 55.3 4 1,044 819 1,099
Total   31,752,913 56.8 4 1,044 1,600 1,607

About 87% of claims with non-missing paid date were paid within 0-90 days, with 60% paid within 0-30 days (Figure 1). Figure 2 shows the percentage of claims paid per 30-day increments by form type. Here we see that about 9% of inpatient institutional claims took 720 days to be paid.

Figure 1. Percentage of Claims Paid by 30-Day Increments

Figure 1. Percentage of Claims Paid by 30-Day Increments

 

Figure 2. Percentage of Claims Paid per 30-Day Increment by Claim Form Type

Figure 2. Percentage of Claims Paid per 30-Day Increment by Claim Form Type

4. Discussion

This report summarizes the distribution of days between service date and paid date for all claims overlapping FY22. Our findings show that 90% of claims were paid within 112 days of service. The majority of claims were from outpatient care. For most analyses, including a 4-month lag period is sufficient. However, research focused on inpatient data should consider the additional lag time for some inpatient institutional claims. 

Appendix

Appendix Table A. Categories of Care
Type of Care Bill_Type_Code
Inpatient 11
Nursing Home 18, 21
Outpatient All other bill type values

 

Appendix Table B. Claim Form Types
Claim Form Type Claim_Form_Type
Institutional I
Dental D
Professional P

References

  1. Congressional Budget Office. The Veterans Community Care Program: Background and Early Effects. October 2021., Accessed May 20, 2025. Available at https://www.cbo.gov/publication/57583#_idTextAnchor007.
  2. VHA Data Portal. Integrated Veteran Care Consolidated Data Sets. (Intranet only). January 22, 2025. Accessed May 20, 2025. Available at https://vaww.vhadataportal.med.va.gov/Data-Sources/IVC-Consolidated-Data-Sets 
  3. Health Economic Resource Center. Integrated Veteran Care Consolidated Data Sets (IVS CDS) Cost Data. August 29, 2024. Accessed May 20, 2025. Available at https://www.herc.research.va.gov/include/page.asp?id=cds