VA Updates Emergency Care Reimbursement, Payment Activities

January 11, 2018 - The VA has announced that it will expand provider payment eligibility for emergency treatment services and make  administrative and regulatory changes aimed at creating payment process improvements.

The January 9th, 2018 rule extends reimbursement for emergency providers that received partial payment after treating a veteran in a non-VA facility. The new rule now allows these providers to receive fuller payments based on the totality of services needed for emergency treatment.

“VA will begin processing claims for reimbursement of reasonable costs that were only partially paid by the Veteran’s other health insurance (OHI),” the agency said in a press release. “Reasonable costs may include hospital charges, professional fees and emergency transportation, such as ambulances.”

The announcement came just a week after the VA announced technical and administrative changes aimed at improving payments delivery to community-based providers.

VA proposed ambitious payment administrative goals which include increasing the numbers of claims processed by 300 percent in January of 2018 and doubling that number to 600 percent by April. Additionally, the VA plans to cleanly process 90 percent of its claims within 30 days.

VA plans to work with their third-party administrators (TPAs), Health Net Federal Services and TriWest Healthcare Alliance, as well as additional stakeholders to develop further payment efficiencies. The agency also aims to install various IT investments by the first half of 2018 to streamline claims submissions, reduce payment times, and add transparency to claims data.

Leaders within the VA believe that the changes will improve the speed and efficiency of payments to community providers and increase veterans’ access to healthcare services.

“It is vital to the health of our network of providers that we provide payment in a timely and consistent fashion,” said VA Secretary Dr. David J. Shulkin. “Our outside providers are an essential part of our network and we need to improve our system of payments for their services.”

The ongoing payment changes follow payment concerns and data audits posed by the The American Federation of Government Employees (AFGE) and the Government Accountability Office (GAO).

AFGE, a VA employee union and the largest federal union in the US, sent a letter to VA leaders that proposed an investigation into $90 million in improper payments made to TPAs.

AFGE described double billing practices and the use of improper payment rates by TPAs when they received payments through the VA Choice Health program.

 "The questionable practices used by third-party administrators of the VA Choice Program, TriWest and HealthNet, including double billing and improper payment rates, have directly harmed veterans and undermined the capacity of the VA health care system to provide them with the exemplary care that they have earned with their service," said AFGE National President J. David Cox.

GAO audits previously found that veterans waited an average of 24 days to receive care at a Veterans’ Choice program facility and may wait up to three years to submit appeals for healthcare benefits.

The recent decisions made by VA suggest that the agency has taken payment and administrative concerns seriously following internal payment audits in September of 2017.

The VA Office of the Inspector General (VA-OIG) reviewed Choice program data and identified several payment errors including duplicate claims payments and unadjusted payment rates for Medicare-related services.

“Making accurate and timely payments in the Choice program has proven to be a significant challenge for VA, and, based on our pending audit work, identified payment errors total in the tens of millions of dollars,” VA-OIG said in its memo.

Community and emergency care providers can review the new policies and additional resources on the VA website.