Improving Your Process

Maximizing VA Reimbursements on Emergency Conditions

Do you have a process in place to identify when a transported individual is a veteran being carried to a non-VA facility? In an emergency condition, it may prove very beneficial for you to have a consistent process within your billing department to ensure that you can identify these patients in order to maximize reimbursement, while also avoid billing the patient inappropriately.

A recent ruling by the U.S. Court of Appeals found that the VA has failed to revise its reimbursement regulations to comply with the 2009 Congressional mandate regarding payment of emergency services for veterans who have other insurance. I will go into much more detail regarding how you can use this ruling to assist the veterans you transport in pursuing full reimbursement for the emergency treatment provided at the American Ambulance Association’s Regional Workshop in Almeda County, California on June 9, 2016. If you have not registered, you can learn more here.

 

For those unable to attend, it is important to put a process in immediately. There are three main components you will need to begin the process:

  • Amend your Patient Care Report to add the question “Are you a military veteran?” in order to prompt the EMT or Paramedic to gather the information. This element is critical in order to segregate these invoices to a specific unit or individual for special handling.
  • Create a specialized unit or train one or two individuals within your billing team to become experts at VA reimbursement issues. Due to the complexity of this payer, it is critically important to understand how the reimbursement works for veterans who are transported for an emergency to a non-VA facility.
  • Challenge every denial received from the VA. A recent study by the Government Accountability Office indicated that 2/3 of all denials from the VA for non-VA services were denied inappropriately.

At the AAA Regional Workshop in June, I will go into much  more detail surrounding these three main components, as well as provide you with materials on why you should do this based upon examples of successful results and implementation. Remember, a consistent process can prove very beneficial to ensure you are identifying these patients in order to maximize potential reimbursements.

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