VA wants to change how it bills payers for disabled vets' care

Michael Brady  October 28, 2019

The Veterans Affairs Department on Friday proposed to pay third-party payers the same amount for veterans' medical services regardless if it was in a VA facility or not.

The proposed rule involves healthcare services provided to veterans for disabilities that are unrelated to their military service.

The Trump administration would also require third-party payers—such as veterans' employer-sponsored health plans—to request a refund for military-related care within 18 months and bar them from disputing the VA's methodology for determining payment rates.

The changes would streamline billing practices, cut down on administrative work, and make payments fairer and timelier, according to the VA.

"Third-party payer(s) should not be disadvantaged and required to pay higher charges because the individual sought care at a non-VA facility," the VA said in its proposed rulemaking.

The proposal would help payers because "there is no scenario in which (third-party payers) would be charged more … than they are charged under the current rule."

The VA currently bills third-party payers for "reasonable charges" or the amount it paid to the provider for the care, whichever is higher. Under the proposed rule, those amounts would be the same so it wouldn't hurt payers.

The department is looking to impose an 18-month time limit for requesting refunds and tamp down on payers' delayed requests, which can come months or even years after the original payment was processed.

Congress and the VA have taken steps in recent years to make it easier for veterans to seek private-sector care. But veterans are increasingly seeking specialized care from the VA for health problems related to their military service, which means that it's often providing non-military related care too.

The proposed rule changes acknowledge that it's easier for the VA to bill payers separately for care unrelated to a service disability than to have veterans receive independent care from other providers for those issues.

https://www.modernhealthcare.com/law-regulation/va-wants-change-how-it-bills-payers-disabled-vets-care?utm_source=modern-healthcare-daily-dose&utm_medium=email&utm_campaign=20191028&utm_content=article4-headline