Rounds Urges VA to Make Timely Payments to Community Providers
PIERRE—U.S. Sen. Mike Rounds (R-S.D.), a member of the Senate Veterans’ Affairs Committee, today sent a letter to Acting Secretary of the Department of Veterans Affairs (VA) Robert Wilkie to request the VA address its reimbursement process for community providers, and to reimburse old claims dating back to September 30, 2016, and older that the VA has rejected as ineligible.
“According to the VA’s policy, claims from September 30, 2016, and older are no longer eligible for reimbursement,” wrote Rounds in his letter. “This is disappointing and unacceptable. Community providers deserve to be reimbursed for services provided at the VA’s direction, and TPAs [Third Party Administrators] must have clear and simple processes for community providers to follow for prompt payment.”
“Despite a strong, patriotic desire to serve veterans, I am concerned that community providers may be reluctant to participate in the next VA community provider network due to their negative past experiences with the Veterans Choice Program. This may, in turn, impact our nation’s veterans’ ability to access health care, especially rural veterans.”
Full text of the letter:
April 4, 2018
The Honorable Robert L. Wilkie Jr.
Department of Veterans Affairs
810 Vermont Avenue NW
Washington, DC 20420
Dear Acting Secretary Wilkie:
I write to you today with great concern over the Department of Veterans Affairs’ (VA) efforts to improve timely payments to community providers.
On January 3, 2018, the VA announced a series of immediate actions to improve the timeliness of payments to community providers. I welcomed this announcement as several South Dakota-based community providers have continuously struggled with receiving prompt reimbursements from the VA’s contracted Third Party Administrator (TPA) for services provided at the VA’s direction. However, I learned that a part of this VA effort included setting deadlines for Veterans Choice Program and Patient-Centered Community Care (VCP/PC3) claims from years past. I understand those deadlines were November 13, 2017, and October 2, 2017, for VCP/PC3 claims from January 1, 2016 - September 30, 2016, and VCP/PC3 claims with dates of service prior to January 1, 2016, respectively. In response, several constituent providers made efforts to resubmit old claims prior to the deadline. However, some providers had claims rejected again or did not receive feedback following a submission. During my exchange with then-Secretary Shulkin at the March 21, 2018, Senate Veterans’ Affairs Committee hearing, he stated that as a part of VA’s January 3, 2018, announcement, VA deployed “Rapid Response Teams” to assist community providers with outstanding claims. To date, I have not heard from a constituent community provider that has had contact with a VA Rapid Response Team to troubleshoot outstanding claims.
Prior to this deadline, constituent community providers have anecdotally shared with me and my staff their countless efforts to troubleshoot and fix these older claims with their TPA contact, but without success. To compound this struggle, providers have been limited to troubleshooting only three claims at a time with a TPA representative, struggled with long wait times to reach a TPA representative and received deposits for services they did not provide. These issues must be remedied. According to the VA’s policy, claims from September 30, 2016, and older are no longer eligible for reimbursement. This is disappointing and unacceptable. Community providers deserve to be reimbursed for services provided at the VA’s direction, and TPAs must have clear and simple processes for community providers to follow for prompt payment.
Due to the aforementioned issues experienced by community providers, I ask that the VA proactively reach out to community providers and provide an opportunity for them to be reimbursed for claims from September 30, 2016, and older. Further, I request that the VA provide clear feedback as to why a claim is not eligible for reimbursement and, if applicable, convey what needs to be corrected for reimbursement. Also, the TPA processes remain unclear, slow, bureaucratic and broken (e.g. deposits to providers for services they did not provide). These processes also need to be reviewed and improved. I understand the VA is looking forward to the next version of community care, but I insist that the current community care program is still in need of considerable attention.
Despite a strong, patriotic desire to serve veterans, I am concerned that community providers may be reluctant to participate in the next VA community provider network due to their negative past experiences with the Veterans Choice Program. This may, in turn, impact our nation’s veterans’ ability to access health care, especially rural veterans. Thank you in advance for your prompt consideration to this request.
M. Michael Rounds
United States Senator
CC Thomas G. Bowman, Deputy Secretary of Veterans Affairs
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