krburke
Expert
Does anyone have some good resources for billing patients who are covered by the VA when they are seen outside of VA facilities? My doctors (inf. dis. specialists) who see VA patients rarely get paid, but the remittances are not clear about whether or not the patient can be billed for those services.
For example, on a recent office visit, the remark code stated that "Veteran was not pre-approved for outpatient services by the Dept of Veterans Affairs." Some payers hold patients responsible for getting services preauthorized, but does the VA? Or is this supposed to be the provider's responsibility/write-off?
On hospital visits, we often get this one: "A VA Medical facility was readily available in the patient's geographic area and capable of furnish (sic) economical care." If the patient chooses to come to the local hospital instead of going to the VA facility, can the patient be billed for those charges, or is the provider supposed to write those off? We have had some claims where the VA requested complete medical records before deciding that the patient had not been sick enough to warrant emergent treatment in the local hospital, but again, they don't state who is financially responsible for the charges that were incurred.
Every single remittance contains the following statement: "Payment by VA constitutes payment in full. The veteran may not be billed for any services covered by VA's authorization." There are no phone numbers on these remittances to call with questions, and trying to find answers on the VA website is next to impossible.
Can anyone explain this program to me? And in the immortal words of Denzel Washington in the movie Philadelphia, "explain it to me like I'm a six-year-old."
Kathy Burke, CPC
HealthCare Billing Resources
For example, on a recent office visit, the remark code stated that "Veteran was not pre-approved for outpatient services by the Dept of Veterans Affairs." Some payers hold patients responsible for getting services preauthorized, but does the VA? Or is this supposed to be the provider's responsibility/write-off?
On hospital visits, we often get this one: "A VA Medical facility was readily available in the patient's geographic area and capable of furnish (sic) economical care." If the patient chooses to come to the local hospital instead of going to the VA facility, can the patient be billed for those charges, or is the provider supposed to write those off? We have had some claims where the VA requested complete medical records before deciding that the patient had not been sick enough to warrant emergent treatment in the local hospital, but again, they don't state who is financially responsible for the charges that were incurred.
Every single remittance contains the following statement: "Payment by VA constitutes payment in full. The veteran may not be billed for any services covered by VA's authorization." There are no phone numbers on these remittances to call with questions, and trying to find answers on the VA website is next to impossible.
Can anyone explain this program to me? And in the immortal words of Denzel Washington in the movie Philadelphia, "explain it to me like I'm a six-year-old."
Kathy Burke, CPC
HealthCare Billing Resources