Question Billing Medicare when VA Authorizes partial services

Messages
4
Location
Brentwood, TN
Best answers
0
Questions for those of you with more knowledge of Medicare vs VA for Acute Inpatient Care in Medicare-certified facility. I don't see clear answers on these issues in CMS's IOM.

A client (Medicare-certified Acute Care facility) asks, for patients with both Medicare and VA benefits:
1) Where VA authorization is received for an inpatient admission: if the claim wasn't submitted timely to VA, can the provider go ahead and submit the claim to Medicare even though they had received a VA authorization (assuming it's still within timely filing for Medicare)?
Summary quote: Are we allowed to file to Medicare and get payment if we have a VA authorization?

2) Where VA authorization is received only for emergency treatment in an ER: if the patient is admitted to the same facility as an inpatient within 72 hrs of the VA-authorized ER visit, should the provider refund VA for the ER claim, and then submit one claim to Medicare that includes all dates and charges for both the ER and Inpatient admissions? Or should the provider submit a separate claim to Medicare for only the inpatient admission.?
Summary quote: If we have a VA authorization for the ER Only but the ER is within 72 hours of the inpatient claim we are refunding VA and link the ER into the inpatient claim. Is this correct?

The third question from the same client is semi-related to question #2 above:
"Patient came through ER and was admitted to Senior Psych. There is an authorization in PC. [authorization is for emergent care]
"The claim was denied as we are not contracted for psych with VA CCN. An AWO was sent to me but the patient has a Medicare Replacement plan so I am questioning if we should file to them since we have a denial for CO242 services not provided by network/primary care providers." "The ED and ED Physician charges were paid... I am looking for some information on this but wanted to get your input."
 

SharonCollachi

True Blue
Messages
1,875
Location
Clovis, CA
Best answers
3
I'll take the first question. The answer is no. You have the VA auth, which carries no copay to the patient. You didn't fulfill your obligations to file the claim in a timely manner, so now you want to bill Medicare. You cannot bill the patient for the Medicare copay, because you had the VA auth to cover it. You cannot write off the Medicare copay, because you have no justifiable reason to do so (meaning you attempted to collect and it is uncollectable).
 
Top