Wiki Incident-to Billing for Veterans Administration?

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trarut

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Hi everyone. We don't do much Veterans Administration billing but someone asked today if the VA allows Incident-to billing. I haven't been able to find an answer with multiple web searches so I thought I'd see if we have any VA credentialing/billing experts on here that would know? (If you have any links to share, they'd be greatly appreciated :))

TIA,
Tracy
 
I want to say yes because they follow CMS, however, you would want to make 100% sure because that's just my gut feeling and brain recall (lol). I haven't dealt with the VA in years. There is a credentialing process with VA too I believe.

blob:https://www.vacommunitycare.com/ff2299bc-7a6b-431d-b82e-6d06f9507b5d

pg. 34 from link above: "All coding and billing guidelines issued by CMS will be followed by the provider in submitting claims, unless otherwise specified in the Provider Agreement and any applicable payment appendices."

You can look in the CMS manual for incident-to rules: https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf
 
Amy, thank you so much for this reply. I completely forgot I submitted the question :unsure: - too many things going on! I appreciate the links you provided. I was not having any luck with my own searches. I will check those out!
 
I work with the VA weekly as we have many pts in our practice that use the VA. What I have found is that they do tend to follow CMS guidelines, but for some reason do not recognize mid level providers. I have 4 NPs that I bill for and the VA always denies the claims even though they are credentialed with them. I tried to bill a claim as incident to with the MD and it was denied as well. I think it may depend on who your VACCN provider is. Ours is Optum and they do not do it.
 
Interesting, I don't think we've run in to that with our APPs. Our VACCN provider is also Optum. Thanks for the heads up!
 
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