VA Payer Follow-Up and Reconciliation

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Commercial healthcare facilities and hospital systems often find themselves treating US Department of Veterans Affairs (VA) patients, especially in areas where no VA facility exists, or where the VA facility cannot provide the needed service, or where the veteran does not understand where to receive care or if when they need it immediately.  While most facilities are happy to provide the care, getting paid by the VA can sometimes be a lengthy process and it is becoming increasingly more challenging.

Let Benefit Recovery circumvent the process for you and keep your VA claims flowing.

Because VA billing procedures can be very complicated, the average hospital reimbursement wait has been known to be over two years for VA claims to be resolved. These bills are typically fairly large, which means substantial uncollected revenue. The difficulty of maintaining the knowledge of policies and procedures, the complexity of the billing process, and not even being able to contact anyone at the VA, are often cited as some of the challenges custodians of revenue cycle face.

Is your CBO experiencing?

· A large amount of unpaid VA claims, aged past 180 days?

· Inefficient use of FTE time and resources applied to slow-paying VA claims?

· Seeing an increase of VA accounts being “rolled over” to bad debt?

· Struggling to determine the proper documentation and location to correspond?

· Constantly encountering VA denials bogging down your appeals staff?

· Remaining compliant with constantly changing regulations and processes?

· Wishing your CBO could be more focused and concentrated on core competencies such as Medicare, Medicaid, and commercial claims, resulting in more revenue in those areas?

Given VA claims complexity and a guarantee of continuing regulatory change, VA claims are a perfect candidate for outsourcing. Experience shows much of the VA payment process is manual and managed by humans who understandably make mistakes. Fixing errors with the VA when they occur is a difficult task at best. Believe us – it’s not just a matter of asking the VA to cut a new check. Benefit Recovery knows how to address the problems – and WE PERFORM, even if it takes months of regular contact with the VA to ultimately succeed.

The US Department of Veterans Affairs (VA) also augments its healthcare resources by “purchasing” care from non-VA community providers. These are veterans that choose to visit your hospital (or they did not know otherwise to retain healthcare from an actual VA location). This necessitates a variety of overlapping programs that combine to create a complex environment in which community providers (local hospitals) must operate. In addition to the inherent complexity, there is constant, substantial uncertainty related to the future of the VA purchased care programs and how hospitals will be reimbursed in the future.

Benefit Recovery is the most trusted, relied-on, VA community care claims service provider since 1992.  In fact, many VA locations and military hospitals run our propriety software, ARMS PRO, for their own follow-up and denial workflow.

Our history and references will attest to a significant increase in overall VA payments, effectively reducing days in AR by as much as 50% as it relates to VA payer claims. Benefit Recovery works VA claims with persistence and efficiency to get more VA claims paid, faster.

What are some of the common, time consuming challenges you face?
No prior authorization exists? – We are diligent to provide the evidence that it does
Medical records need to be sent or resent? – We provide and document confirmation to the right location/department
Patient has relocated? – We engage the responsible VA location

Recovering revenue for VA claims means you must work under a complex set of rules unique to the VA, not to mention the VA’s distinct denial and appeals process, which is often difficult to navigate. At Benefit Recovery, we know when to call, who to call, and we know exactly what their reps need to resolve the claim. Knowing where to properly file the claim initially, when, where, and how to send the required documentation, and who to talk to if something goes wrong, creates our successful results. You may find your less experienced CBO staff members tend to avoid VA claims in their queue and may just give up, just to move on to other easier accounts.

When your staff gives up, we do not.

In the constant effort to increase efficiencies, and lessen costs, providers continue to consolidate, desperate to retain highly skilled employees; all the while ensuring their talents and motivation are properly focused and relevant. Being that VA claims make up a small portion of a hospital’s AR, it is not cost effective to develop, train, and maintain the necessary billing expertise needed for VA programs. Benefit Recovery retains a large, talented, dedicated team specializing in VA related claims. We partner with hospitals to manage these complicated cases successfully and obtain accurate payment as quickly as possible.

The Benefit Recovery Advantage

Know that Benefit Recovery sets itself apart from the competition by our years of experience with the VA to accurately and diligently work all claims from beginning to end, regardless of the ultimate source of payment or challenges along the way. Add complete, customizable, and transparent reporting that keeps you aware of our findings, and you will have a true partner in us.

Get VA Claims Resolved Faster

Hospitals are constantly under pressure to keep their accounts receivable under control and well within KPI best practices. However, VA claims can wreak havoc on that goal and take up to 200 days to even a year to pay or get resolved. Even when the claims are adjudicated, it could still take persistent follow-up and months to actually get paid. If the hospital’s policy is to write off a claim and is required to record it as a bad-debt, the account could be sent to the incorrect department, making for an even more lengthy time for resolution. Benefit Recovery works within a hospital’s established processes and policies to customize a workflow that’s the best fit for the health system based on industry best practices.

Assign Benefit Recovery the claim on the day of discharge and rest assured that our team will verify claim receipt with the VA, diligently monitor its process, and when necessary, perform timely follow-up on every claim to expedite resolution. Our strategic process paves the way for VA claims to be adjudicated and be paid in the shortest time possible.

It is best not to send your aging VA claims to just any general healthcare AR recovery firm; it is proven their resources in obtaining reimbursement on VA claims is limited as best. Rather, send them to a specialized, hyper focused staff of experienced VA claims representatives.

Have Older VA Accounts Receivables?

Let Benefit Recovery clean up your old VA AR, while stabilizing your current VA intake. Simply reactivate the claims and assign them to us. Collect on unclaimed revenue. No matter when you place the claim with us, we will diligently and effectively work the claims until resolution. 

Our Success is Your Success

Our contingency pricing model means you won’t pay unless we are successful. Additionally, your bottom line will start to realize a return on investment when your business office staff now has the dedicated time to be more focused on other, faster-paying government and commercial accounts, thus collecting more revenue.

As we work together and our partnership grows, we transfer our extensive knowledge of the VA’s scheduling, authorization process and reimbursement with your front-end departments while also offering training for the back-end process. This can reduce common, up front reasons for rejected claims that originate at the front end of your revenue cycle process, ultimately resulting in claims being paid faster.

Win – Win – Win

Experience

Benefit Recovery partners with several large hospitals and health systems across the country. We are responsible for collecting on millions and millions of dollars of VA claims annually. Over the years, we’ve developed and retained the knowledge and relationships within the VA that are necessary to work these claims effectively. We have been doing this longer than any other vendor.

Our Technology

The key to efficiency when working with disparate VA systems and procedures is technology. Benefit Recovery has developed, and licenses, proprietary software and processes that focuses on the unique realities of dealing with the VA.

Ask About Our Other Complex Claims Services

Although VA revenue recovery is our forte, Benefit Recovery offers other complex claims and RCM related services, allowing a hospital to centralize the management of multiple types of AR challenges with a single vendor.  We pursue whichever payer is appropriate until all revenue is recovered.

Frequently Asked Questions

Why should my organization take a hard look at this challenge?

It has been found that, although most likely a small percentage of your hospital’s total AR, untouched, ignored, unpaid VA claims can amount to a significant dollar amount; reflecting poorly and negatively impacting your days in AR. Giving Benefit Recovery an opportunity to pursue this portion of your AR could result in discovering what was thought to be a significant amount of lost revenue.  Not to mention monies saved through more effective use of FTE time.

Are there any implementation fees for your service?

We did not have implementation fees or start-up costs, and our success is billed on a contingency fee basis.

How fast can we implement your service?

Our processes, both technology and people, are well-established and “on the ready” to service any sized volume of accounts.

Is there a minimum volume?

There is no minimum or client size requirements; it is our pleasure to be of service to any sized hospital in need of help with this challenge.

Can you help us, help you?

More often than not, our success comes from training, educating and consulting on our clients’ process related to VA claims. This could mean on-site education sessions, or making introductions to our VA contacts, or reviewing and revamping relevant registration paperwork, etc.

Is it normal for my staff to be on the phone for hours with the VA?

Unfortunately, yes it is and is what most hospitals experience. Our investments in “state of the art” telecommunication systems, proprietary, home grown software, and our strategic processes help us address this issue.

How do you get better results?

You get dedication and a dedicated team focused only on VA claims. We have been the VA outsourcing vendor of choice for VA claim billing and follow-up work since 1992. We have a pretty good idea of any complexity the VA can throw at processing claims. Over these years, we have established relationships within the VA that help with us with the most challenging accounts. Our knowledge and expertise has been proven to even help the VA’s own internal staff with their claims processing and procedures. Another way we help hospitals get paid faster.

Do you have references?

Of course!  Our clients find it a privilege to share stories of our partnership and success; we have clients dating back as far as twenty years.

What other RCM related services do you provide?

We offer a full range of RCM related services, most notably:

· Insurance billing

· High volume / small balance Early-out follow up

· AR clean ups

· Systems and AR transitions

· Phased in mergers and/or acquisitions transitions

Please feel free to contact Max Smith with any questions, for a free assessment your situation, and/or an in-depth discussion about how Benefit Recovery can help your organization with this issue, or any other RCM related challenge you are facing.

Max Smith
Client Solutions Executive – 678-429-0207 – max.smith@benefitrecovery.com

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