The 2022 Department of Veterans Affairs Fee Schedule (VAFS) is now published.  

The Department of Veterans Affairs (VA) reimburses medical services, hospital care and extended care services up to the maximum allowable rate. The maximum allowable reimbursement rate is generally the applicable Medicare rate published by the Centers for Medicare and Medicaid Services (CMS). When there is no Medicare rate available, VA reimburses the lesser of VAFS or billed charges.

Historically, VAFS was set at the 75th percentile of billed charges which resulted in much higher maximum allowable rates than commercial insurers and other federal health programs allowed for the same services. Previous versions of VAFS also did not include maximum allowable rates for over 1,000 procedure codes which resulted in reimbursement defaulting to billed charges for these services.

VA is modernizing the reimbursement methodology to ensure maximum allowable VAFS rates are consistent with industry reimbursement benchmarks (Fair Health, Truven, etc.) and ensure that most services have maximum allowable rates. VA is implementing these changes over two years to minimize impact to providers. For CY22, VAFS fee will be the average of the 75th percentile of billed charges and the industry median allowable rate. For CY23, VAFS will be based on the industry median allowable rate wherever possible. The goal of VAFS is to ensure fair reimbursement for all providers when Medicare maximum allowable rates are not available.

Reimbursement rates are subject to change annually and more often if required.  

More information for providers can be found at VA Fee Schedule webpage.

VA is launching a new payment recovery audit program in early 2022. The audits will review claims paid to community providers for inpatient and outpatient services, Civilian Health and Medical Program of VA (CHAMPVA), and the Spina Bifida Health Care Benefits Program.  The audits will cover past payments beginning in FY2018 and continue for payments made through FY2023.

VA awarded a contract to Cotiviti GOV Services (Cotiviti) to provide the audit services, and VA’s Debt Management Center (DMC) will manage collections from providers. Cotiviti is an experienced recovery auditor that has provided audit services to other government agencies.

Before beginning an audit, Cotiviti will post the audit plan to a public website for 30 calendar days for review and comment. VA encourages providers to use the comment period to share any questions or concerns they may have about the audits.

VA will publish a bulletin with a link to Cotiviti’s web site when the first audit plan is available for comment; we anticipate that happening later in December or in January.

Providers will have the ability to request clarification on audit findings from Cotiviti and appeal audit results to VA. VA will make the final determination on all appeal decisions. Providers will also be able to request debt compromises and payment plans. The DMC will inform providers with overpayments of their rights and responsibilities for repaying all overpayments.

Additional information on the recovery audit specifics will be shared as it becomes available. 

VA recently relaunched the Community Administration of Vaccine Encounters (CAVE) process with the release of version 1.2 on Nov. 3, 2021. CAVE allows records of vaccines administered by community providers to automatically publish to Veterans’ VA immunization files.

Specifically, CAVE writes vaccinations identified from claims submitted by community providers to the Veterans’ VA immunization file. The goal is to prevent duplicative vaccinations, reduce the need for manual entry of vaccinations and the associated effort and errors, and to allow providers at the VA medical facility to streamline their workflow by providing vaccination information in one place. The process also reduces the need for Veterans to provide detailed information to their VA providers. Veterans should still be asked if they received any vaccines since their last visit to ensure a complete record.

CAVE implementation is seamless to in-network community providers and retail pharmacies because it does not change the claims process or required data. The CAVE process occurs when in-network community providers or retail pharmacies administer immunizations that are part of the VA’s approved formulary to eligible Veterans and send reimbursement claims to a VA third-party administrator (TPA).

Community administered immunizations are added to the record 30 days after they are administered, except for COVID-19 vaccinations, which are added 10 days after they are administered.

CAVE writes the following information into the Veteran’s VistA patient care encounter (PCE) immunization file:

• Immunization name – based on the Centers for Disease Control and Prevention (CDC)

• The associated CDC CVX code
• Date the Veteran received the immunization
• Administering provider and associated NPI #

Please note that only immunizations which are part of the VA formulary will be added to the medical record. When a new immunization is released, the formulary is updated and the vaccination records can be written.

Immunizations administered to Veterans in community emergency departments, urgent care or inpatient settings are not included in this CAVE release and will still need to be added to the health record manually following current procedures.

For questions, please send a message to VHAOCCCIFOLeadership@va.gov.

When HealthShare Referral Manager (HSRM), VA’s online referral processing platform, completed its national rollout during the summer of 2019, the system had only been introduced to a select few community providers. In the more than two years since, the number of provisioned community provider users has grown to 46,000! 

In addition, VA is proud to announce that through the dedication and hard work of all community providers and VA staff across the country, HSRM processed its 10 millionth referral this fall! With these 10 million referrals, community care has been initiated for more than 3 million Veterans through HSRM. VA continues to work diligently to bring community provider end users new features and improvements.

Why are so many community providers using HSRM?

• HSRM provides access to all active VA referrals via a user-friendly interface in your web browser, and it’s available at no cost!
• Users can easily find referrals with the Referral Search feature, which includes filters such as Category of Care, Date Added, Referral Status, and more.
• The Clinical Viewer portal within HSRM offers users a comprehensive view of a Veteran’s medical history, including a clinical summary of the patient’s allergies, immunizations, medications, lab results, procedures, and more.
• Bidirectional communication with the referring VA Medical Center is faster and more convenient in HSRM, and it reduces reliance on fax, phone, and email.

Are you interested in joining the ranks of HSRM’s community provider end user base? Check out the numerous informational and training resources available to community providers. You can select from a variety of educational resources to prepare for the use of HSRM, and help is available at every step of the registration process.  

Important: Please make sure to log into your HSRM account at least one every 60 days to keep your account active. If your account becomes inactive, email hsrmsupport@va.gov.

Resources 

• HSRM Support Points of Contact
• Office of Community Care Webpage – HSRM Information
• HSRM eLearning Lessons
• Have a question? Contact us at ccra@va.gov.

Military Sexual Trauma (MST) is an experience, not a diagnosis or a mental health condition, and as with other forms of trauma, there are a variety of reactions that someone can have in response to MST.

VA is strongly committed to giving Veteran’s access to the help they need in order to recover from MST, which is any sexual activity that you are involved with against your will. For some people, the experience of MST may continue to affect their mental and physical health in significant ways, even many years later.

But you as community provider can help! 

Take advantage of educational and training resources for community providers that discuss different aspects of Veterans with MST, including the following:

• MISSION Act 133: A Core Training on Military Sexual Trauma (MST) for Community Medical Professionals; 1.5 hr./1.5 CEU’s (via VHA TRAIN)
• MISSION Act 133: Core Training for Military Sexual Trauma (MST) for Community Mental Health Providers; .5 hr./.5 CEU’s (via VHA TRAIN)
• MST Resources: download brochures, educational tools and articles to stay informed
• Have a question about VHA TRAIN? Contact vhatrain@va.gov.

You learned it - and you can earn the credits by completing the End of Course Evaluations in VHA TRAIN!

How common is MST? VA’s national screening program asks each Veteran seeking health care whether he or she experienced MST which provides data on how common MST is among Veterans seen in VA. National data from this program reveals that about 1 in 3 women and 1 in 50 men report that they experienced MST. Rates of MST are higher among women, because more men than women serve, but significant numbers of women and men seen in VA report an experience with MST.

Check out the latest community care articles posted to VA’s official VAntage Point blog: 

• Community providers: Please tell Veterans about easy, no-cost flu shot options through VA (December 1, 2021)
• Retail pharmacies, urgent care providers: How to provide flu shots to eligible Veterans this flu season (November 22, 2021)
• Providers: New to community care? This webinar is for you. (November 17, 2021)
• Veterans: Four steps to get your community flu shot (October 12, 2021)

Webinar: Deployment-Related Exposure Assessments and the ILER (Individual Longitudinal Exposure and Record)  -  (January 11, 2022, 12–1:00 pm ET)  

Some providers may have limited knowledge about military deployment-related exposure assessments. This webinar will educate providers on the VA/DoD Military Occupational and Exposure Assessments, the Individual Longitudinal Exposure Record (ILER) and how to use it.  

Register for the webinar through VHA TRAIN. If you do not have an account create one.  

Go to WRIISC Provider Training for more provider education and training opportunities.