In a 2020 report to Congress, the Dept. of Veterans Affairs declared its intention to aim for the timely processing of 90% of all claims.
How often had they achieved it in FY2019? Barely more than half the time.
In the hospital revenue cycle management arena, VA reimbursement could be considered playing the long game. While VA guidance asserts that clean claims will be processed within 30 to 45 calendar days, it’s not unusual for claims to remain pending for more than a year.
Numerous factors contribute to the delay:
- Antiquated processes that are still largely paper-based
- A first-in-first-out processing strategy that increases turnaround timeframes as more aged claims in the backlog are processed
- Strict policies—such as one that limits the number of claims that can be discussed per call, or one that requires certain claims to be escalated to a different processing team
- Mistakes—such as documents reported as missing despite evidence of multiple deliveries of the same material, or such as call center staff incorrectly believing that HIPAA privacy laws prevent them from providing details on a claim
With several institutional roadblocks complicating the claims process, there’s no one magic strategy for VA reimbursement. Rather, successful resolution of these claims requires fortitude and perseverance.
A High-Touch Process
Case in point: An Argos Health representative followed up with the VA seven times, over the course of nine months, before ultimately securing payment of approximately $8,000. What was happening during that time? The claim was awaiting review to confirm that all criteria for reimbursement were met, as outlined by the Millennium Act.
However, sometimes follow-up is more than just a waiting game. Another Argos Health representative spent 13 months correcting errors to follow the claim through to resolution. The journey included:
- Faxing proof-of-delivery documents when VA records showed incorrectly that that documents had not been received
- Formally requesting that the claim be reopened
- Requesting again after discovering it inexplicably had not been successfully reopened
- Resolving a VA error that caused an erroneous rejection
Persistence pays off. A November 2019 report from the VA Office of the Inspector General (OIG) revealed that the VA had been storing thousands of rejected claim appeals in boxes and file cabinets without processing them. The average unprocessed appeal had been pending for 710 days.
Divide and Conquer
Considering that typical hospital claims are recovered in no more than one or two touchpoints, the effort required to secure VA reimbursement is extraordinary. Add to that the VA’s low reimbursement rates relative to other payers, and it’s not surprising that many hospitals choose to write off VA hospital claims.
We adhere to a different strategy. We find that it takes a dedicated VA specialist to navigate the VA’s web of terms, policies, and processes. Whether in-house or outsourced, a specialized VA claims representative will master the nuances of VA policy, obtaining full command of filing deadlines and requirements.
For one 714-bed health system, for example, the specialized Argos Health VA team collected $2.7 million more in VA reimbursement in the first half of 2020 than the internal team collected in all of 2019. When our dedicated VA specialists take over, it’s not unusual for a hospital or health system to see a 100% increase in overall VA payments, along with a 50% reduction in days to pay.
Further, while the VA team runs with the ball on follow-up, the health system can redirect other patient financial services staff members to focus on higher reimbursing payers. By shifting one internal PFS representative to Medicare Advantage, a hospital decreased overall Medicare Advantage AR by 50% and 180-aged accounts by 90%.
According to a recent Kaufman Hall survey, nearly 50% of hospital executives are seeing increases in bad debt and uncompensated care this year. If now is not a good time for your health system to leave VA reimbursement money on the table, a follow-up strategy may be what you need.
Learn More: We deconstruct the full VA claims process in our latest white paper. Download it here.
Argos Health is a KLAS top performer in the complex claims category and has been a revenue cycle partner for VA community care claims services longer than any other vendor. Learn more about our VA claims services by going here or filling out our contact form here.