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Choice Bill and Provide Payment

The issue of delayed payments for community providers has been under increased scrutiny, especially with VA’s expansion of community care in recent years. A Government Accountability Office (GAO) report in May 2016 noted that VHA’s average claims processing timeliness in fiscal year 2015 was “significantly lower” than Medicare’s and TRICARE’s timeliness and far below its own standard of paying 90% of claims within 30 days.

“Absent a responsive provider customer service component and timely payment of claims, many community providers may opt not to participate in VA’s network, thereby narrowing the choices veterans have for seeking care from community providers. In turn, this could lead to longer wait times for veterans to receive care and a greater reliance on VA medical centers, some of which have already experienced long wait times for veterans seeking care,” the report explained.

Additionally, GAO noted that “millions of dollars in interest penalties resulting from the late payment of claims by VHA could dilute the funding available for the direct delivery of care to veterans.”

Acknowledging the problem, Shulkin cited it as a priority area last year during a press briefing in which he talked about 13 areas of “significant risk” for VA.”

“Providers are increasingly frustrated with the VA’s ability to get them payments, to the point that some of them are actually leaving our network. And that’s obviously working against us,” he said at the time.

Shulkin explained that it took more than 30 days to process 20% of its clean claims at VA, which affects about 25,000 providers across the country. In addition, he said that VA had yet to pay about $50 million in out-patient bill charges that were six months or older.

The issue of payment to providers outside VA has rankled lawmakers. Senate Committee on Veterans Affairs Committee Ranking Member Jon Tester (D-MT) called VA’s recent announcement “long overdue.”

“I will hold the VA accountable to ensure this is not a hollow promise. Veterans’ health care is too important to let government bureaucracy get in the way of doctors who need to serve our veterans,” Tester vowed.

Pending Choice program reform bills in both the House and Senate include measures to improve timeliness of provider payments.

VA said in its announcement that it would “work with Congress to consolidate and simplify all VA community care program, including provisions for prompt payment of claims.”

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