VA Complex Claims Revenue Recovery Service
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Many providers find billing US Department of Veterans Affairs (VA) Claims to be very challenging. Would you like to achieve any of the following?
- Substantially reduced VA accounts receivable
- Higher overall net revenue on VA claims and a lower bad debt reserve
- VA payments received in a more timely manner
- No more struggling to determine the proper location to send documents
- Reduced VA denials
- Knowing your VA claims remain compliant when regulations and processes change
- More time for your PFS staff to focus on their core competencies of Medicare, Medicaid, and commercial claims
If so, Argos Health can definitely help.
Introduction
Voucher Examiner
Office of Community Care, VA Medical Center, Dublin, GA
Argos has been providing VA community care claims services longer than any other complex claims vendor – since the beginning of the Veterans Choice program in 2013.
It’s not unusual for our clients to see a 100% increase in overall VA payments, along with a 50% reduction in days to pay. How do we achieve this? When hospitals and other vendors pursue VA claims, many typically end up as bad debt. Argos works our VA claims with persistence and efficiency and gets more VA claims paid.
Why are so many VA claims written off? The VA may state that no prior authorization exists when we have evidence that it does. The VA might tell us that medical records need to be sent when we have confirmation of them being sent several times already. When this occurs, it could be that the patient has relocated, and the responsible VA location has changed. We know the right questions to ask our VA contacts to determine the real story. It’s not surprising that others less experienced with the nuances of the VA give up and move on to other accounts.
Recovering revenue for VA claims means you must work under a complex set of rules unique to the VA. Argos Health has a large, dedicated team specializing in VA and related claims.
VA claims also have a distinct denial and appeals process. We work with hospitals to manage these complicated cases successfully and obtain accurate payment as quickly as possible.
As the healthcare industry rapidly moves toward value-based care, and providers continue to consolidate, hospitals need to consider how to keep their employees’ skills relevant. This is probably not the right time to try to develop and maintain billing expertise related to complex VA programs that generally make up only a small percentage of a hospital’s revenue.
Argos Health can handle all of your VA billing and collections needs.
The Argos Advantage
Argos Health sets itself apart from the competition by accurately and diligently working all claims from beginning to end, regardless of the ultimate source of payment or challenges along the way. Here’s one example:
A hospital mistakenly submitted a VA claim to the patient’s health insurance. Our team submitted the claim to the proper VA organization, along with medical records. The VA claim was rejected for errors multiple times, and Argos Health worked with our hospital facility to obtain a corrected claim.
After nine months of follow up and working toward a resolution, a payment for 33% of total charges was made to the Argos Health client hospital.
A Financial Model to Fit Your Needs
Director of Finance
300+ bed hospital
If you’re like financial managers at most hospitals, you’re under pressure to keep your accounts receivable under control. VA claims can take up to 200 days to pay. This may very well exceed the point at which your hospital’s policies require that you record a bad debt reserve, write off the claim, and pass it on to a general A/R vendor.
Argos can work within your processes and policies to customize a relationship that’s the best fit for your hospital or health system.
Most of our VA clients assign us the claim on the day of discharge. Our team will verify claim receipt with the VA and perform timely follow-up on every claim to expedite resolution. Our streamlined process gives VA claims the best chance to pay in the shortest possible time.
If desired, Argos can also serve as a “relief valve” for your VA A/R. If a claim hasn’t paid within your organization’s time limit, pass it on to us at that point. If we’re able to obtain payment on a VA claim with a bad debt reserve, it means 100% additional net revenue for your hospital.
If you’ve already written off VA claims that are less than a year old, we may still be able to get them paid. Reactivate them and assign them to Argos.
Finally, if you’re currently sending your aging VA claims to a general healthcare A/R recovery firm, send them to us instead. Without experienced, specialized staff, the chance of another vendor obtaining reimbursement on these claims is limited.
Regardless of when VA claims are assigned to Argos, our contingency pricing model means you won’t pay unless we’re successful. The return on investment is even more compelling when you realize that any existing business office staff that have been focused on VA can turn their attention to other government and commercial accounts and collect more revenue in those areas.
VA Revenue Recovery Service Video
Watch the video below to learn more about the VA revenue recovery process.
What Makes Argos Different?
Given their complexity and a near guarantee of continuing regulatory change, VA claims are a perfect candidate for outsourcing. What makes Argos different than other vendors who attempt to provide VA services?
We’ve Seen it All
Our team works with hospitals across a variety of geographic regions, and we’ve developed the knowledge and relationships within the VA that are necessary to work these claims effectively. We’ve been doing this longer than any other vendor. When others give up, we don’t.
Why might someone give up?
Maybe a VA contractor accidentally sent a payment for your claim to the wrong provider. Much of the VA payment process is manual and managed by humans who understandably make mistakes. Unfortunately, fixing errors when they occur isn’t simple. Trust us – it’s not just a matter of asking the VA to cut a new check. We know how to address this problem along with many others, and we do, even though it can take months of regular contact with the VA to ultimately succeed.
A True Partner
We share our extensive knowledge of the VA’s scheduling and authorization process with the front-end departments at our clients through training sessions. This can reduce common reasons for rejected claims that originate at this point in the revenue cycle and ultimately result in claims paying faster.
Technology
The key to efficiency when working with disparate VA systems and procedures is technology. Argos has developed proprietary technology and processes focused on the unique realities of dealing with the VA.
One key example of our technical approach is related to phone calls. VA claim status and follow up still depend heavily on the telephone.
Ask your PFS staff working on VA claims how much time they spend on hold with the VA. Imagine how much more productive those employees could be if they were focused on other types of claims.
We’re Complex Claims Experts, Not Just VA Experts
We offer other complex claims services besides VA revenue recovery, allowing a hospital to centralize the management of multiple types of challenging claims with a single vendor if desired.
Many clients recognize the advantage this provides, since a complex claim may start down one path (VA, third party liability, workers’ compensation, etc.) and end up being paid by any number of payers. Once we are referred a VA or other complex claim, we’ll pursue whichever payer is appropriate until all revenue is recovered.
Proven Success
We can get clean claims paid in four to five weeks. How? Knowing where to properly file the claim initially, when, where, and how to send required documentation, and who to talk to if something goes wrong.
We can demonstrate prior success in reducing average payment times and overall VA A/R. Ask us for references.
VA White Paper
VA Hospital Claims: Deconstructing the Resolution Process
The US Department of Veterans Affairs (VA) augments its healthcare resources by purchasing care from non-VA community providers. This is done under a variety of overlapping programs that combine to create a complex environment in which community providers must operate. In addition to the inherent complexity, there is substantial uncertainty related to the future of the VA purchased care programs and how hospital participation will be impacted over time.
The white paper covers the following topics:
- A background on the various VA community care programs
- Authorization and scheduling
- Claim submission and timely filing
- Claim follow-up
- Payment reconciliation
- The VA denial process
- And more…
Download our white paper to learn more about the processing, follow-up, and payment verification of VA claims.
VA Sales Sheet
Click here to download our VA revenue recovery service sales sheet.
Frequently Asked Questions
What does it cost to get started with your service?
We have no implementation fees or startup costs, and our work is performed on a contingency basis.
Do you require a client to provide a minimum volume of VA claims?
We have no minimum claim volume or client size requirements. Depending on its location, a small hospital may have a high volume of VA claims. At the other end of the spectrum, we work with high-volume health systems, as well.
Can you help us improve our registration operations when it comes to VA patients?
As part of our service, we’re happy to educate our clients’ registration process related to VA claims. This may include on-site education sessions, making introductions to our VA contacts, reviewing relevant registration paperwork, etc.
Our employees have to spend hours waiting on the phone to get information from the VA on our claims. Is this normal?
Unfortunately, this is what most hospitals experience. One of the ways we are more successful in collecting VA revenue is that we’ve made investments in a proprietary telecommunications process to address this issue.
How do you get these claims paid when we can’t?
We have a dedicated team focused only on VA claims. We’ve taken on outsourced VA claim billing and follow-up work since the inception of the Veterans Choice program in 2013, so we’ve seen everything that the VA can throw at providers. We also have established relationships within the VA that help with the most challenging accounts. We’ve been told by VA staff that our expertise helps them process claims and pay hospitals faster.
Can you provide references?
We’d be glad to have you speak with our satisfied customers. We have client relationships that go back over twenty years. We work hard to keep our customers happy.
What other complex claims services does Argos Health provide?
We offer other complex claims services besides VA claims billing and collections. This allows a hospital to centralize the management of multiple types of challenging claims with a single vendor.
Many clients recognize the advantage this provides, since a complex claim may start down one path (VA, third party liability, workers’ compensation, out-of-state Medicaid, etc.) and end up being paid by any number of payers. Once we are referred a complex claim, we’ll pursue whichever payer is appropriate until all revenue is recovered.