The U.S. Department of Veterans Affairs (VA) is notorious for communication problems and complicated processes. Its new claims appeal process was supposed to improve communications between providers and the VA and address inefficiencies in the old system, but those who are filing appeals are finding that the new process is not as advertised.
In the old system of appealing a claim denied by the VA, hospital billing staff would have to write a letter that contained the patient’s veteran’s identification number, the date(s) of service, total charges, and the reason for denial, explains Autumn Star Schneider, the director of Veterans Affairs Services at Argos Health.
Additionally, the original red and white billing claim form from the hospital and any other documents necessary to process the appeal – which could be new information or information that was missed by the VA when it processed the original claim – had to be attached to the appeals letter.
All that paper (yes, paper) would go into an envelope and be mailed to the appropriate VA office. Very often, it would take a year or more to get the appeal resolved, she says.
With the new process, the hospital has to get the patient to sign a form allowing the hospital (and its billing partners if it is working with a service such as Argos Health) to file an appeal of the denied claim, a step that was not required in the old process.
Contacting the veteran after discharge becomes one more step the hospital’s already-overburdened billing staff has to take and is not always successful, says Wilson Allgood, senior vice president of MVA and VA Solutions at Argos Health. To make matters more complicated for the hospital’s billing staff, in some cases, the veteran may have died and the billing staff has to try to track down and contact whoever is responsible for the veteran’s estate.
Getting the patient’s signature is just one aspect of the new process. Specific forms must be completed depending on which type of appeal is being filed: a supplemental appeal, a higher-level appeal, or a board appeal.
The supplemental appeal is very similar to the old process, Schneider says. The provider or provider’s representative submits new or relevant evidence that wasn’t included in the original claim.
A higher-level appeal is just what it sounds like: the claim is sent to senior reviewers at the VA for a closer look. The provider or provider’s representative doesn’t need to send new evidence as would be required in a supplemental appeal.
The last option is a board appeal. If you don’t agree with the decision that comes out of the supplemental and/or the higher-level appeal process, the appeal must be mailed to a veteran’s law judge at the Board of Veterans Appeals in Washington, DC.
Just like the old process, the new process is paper-based rather than electronic. The various parts of the documents required must be packaged together and then sent by postal service to the appropriate VA office. The paper-based process increases the chances that the entire appeal could be lost during transit or that individual pages could get lost or be mislaid once at the VA.
And even if providers request and get a return receipt, which the VA Services staff at Argos Health always does, when staff members call the VA to follow up, they are frequently told by VA customer service representatives that the appeal was not received, says Schneider.
The VA website says this new process will take no longer than 120 days, but that’s not what Argos Health is seeing, she says. “Our experience with the new process is it’s taking a lot longer.” Supplemental appeals that were filed last fall still do not have decisions as of late summer.
Making things more complicated is that not all VA offices are embracing the new process, she says. Some are continuing to process appeals using the old procedures. And figuring out which VA office is using the old process and which is using the new one is not simple, because when providers call the VA, they are often talking to customer service representatives at a call center, where there is often high turnover and no institutional knowledge. “They don’t necessarily have the information or have not been there long enough to know what really should be done,” she says.
In the experience of Argos Health’s VA Services staff, providers find out which offices are requiring the new process and which aren’t by receiving notification in response to an appeal that has been sent to the office which tells them to refile the appeal using the new process, which just adds to the already-lengthy procedure.
Once you successfully get an appeal to the VA, be prepared to follow up – a lot. “You have to keep contacting the VA to follow up on status. Is it still in processing? Is it still in review? Has the final decision been made?” says Schneider.
Follow up via phone calls is necessary because the VA doesn’t post appeal decisions to its online portal. “You actually have to call, and the hold times can be hours long,” she notes. And, if you’re trying to call on multiple appeals claims, you are limited to three claims per call. You’ll have to call back – and potentially speak to the same customer service representative – for additional claims.
The bottom line is that working with the VA to get claims processed or to appeal a denied claim is still a lengthy and challenging situation, one that takes a lot of time and effort from your billing staff, says Schneider. “We save the hospital the time and energy needed to do that work,” she says.
The Argos Health VA Services team stays on top of updates from the VA and invests in learning and training on whatever new processes come from the VA. “It’s difficult for hospitals to allocate the time and resources necessary to stay current with all of the process changes that happen within the VA,” she says, but Argos Health’s VA Services team has the know-how and has developed specific strategies to “push the process forward more quickly,” she says.
Looking for a partner to help you manage your VA claims? Argos Health understands the VA’s distinct denials and appeals processes and has strategies to obtain payment for you quickly. Learn more about our VA claims services by going here or filling out our contact form here.