Slow Reimbursement Frustrated Clinicians, Hurt Veterans’ Credit
By Sandra Basu
WASHINGTON—Citing the importance of providing payments in a “timely and consistent manner,” the VA announced that it has revised its regulations for payment and reimbursement of non-VA providers.
“Our outside providers are an essential part of our network and we need to improve our system of payments for their services,” said VA Secretary David J. Shulkin, MD, in the announcement. Slow payment has frustrated clinicians and put veterans in financial jeopardy, with their credit affected by unpaid medical bills.
The agency said it would begin processing claims for reimbursement of “reasonable costs that were only partially paid by the veteran’s other health insurance. Those costs may include hospital charges, professional fees and emergency transportation, such as ambulances.”
VA also began to publish a list identifying providers with “high dollar value” of unpaid claims last month. Other actions immediately taken by VA included creating rapid response teams to “to work on the ground with these providers to reach financial settlement within 90 days” and increasing the number of claims processed by vendors by 300% in January 2018 and by 600% in April 2018 with a goal of 90% clean claims processed in less than 30 days.
The agency also plans to “deploy multiple IT improvements within the first six months of 2018 that streamline the claims submission and payment process to reduce time for payments significantly,” according to the statement. Additionally, the agency said it will award “four new contracts in 2018 for implementation in 2019 to establish the new Community Care Network that includes elements designed to ensure prompt payment of claims.”
“We could not be more pleased at the aggressive focus on this critical topic,” David McIntyre, president and CEO of TriWest, one of VA’s third-party administrators, responded.