|
Q&A: Why move to EFT to pay CHAMPVA claims?
|
|
Use of non-FDA approved Orthobiologics
|
Pulmonary therapist help Veterans strengthen breath
|
Medicare cannot be billed for VA care
|
|
|
V A 'G O O D N E W S' S T O R I E S
|
|
Make your move to EFT. If you have patients under VA’s Civilian Health and Medical Program (CHAMPVA), set up your electronic funds transfer (EFT) to get your claims paid. You may have questions about making the required move, and we have answers.
Is switching to EFT required or optional?
Getting paid by EFT is a federal requirement, and is not optional.
When did EFT become a requirement?
In August 2023, VA followed the Department of the Treasury’s requirement to use EFT for CHAMPVA claim payments.
What’s in it for me?
By enrolling in EFT payment, you help ensure CHAMPVA claim payments are secure, efficient, and compliant with federal mandates while safeguarding Veteran family members’ access to benefits.
How do I enroll in EFT?
We’ve made it easy for you to enroll in EFT. Visit the VA Financial Services Center (FSC) Customer Engagement Portal and complete the Payment Account Setup webform to enroll.
How can I get help filling out the webform?
The FSC help desk can help. Call 877-353-9791.
Getting paid by EFT isn’t optional, it’s a requirement. Make the move today.
Resources:
Department of the Treasury Direct Deposit (EFT)
VA FSC Customer Engagement Portal
Community Care Provider Payments
|
|
|
VA is recovering approximately $30 million paid to VA community providers who administered orthobiologics to Veteran patients; specifically, amniotic and placental derived products either injected or applied for musculoskeletal issues (these are products derived with a mother’s consent from C-sections of full-term babies, not abortive tissue or through other means).
Resources on Orthobiologics:
|
|
|
Pulmonary therapist Tami Peavy serves her Veteran patients by providing pulmonary rehabilitation to reduce shortness of breath and increase lung capacity through exercise, postural strengthening, breathing, and other techniques. Pulmonary therapy and rehabilitation improve the physical and psychological condition of people living with chronic respiratory disease, according to the National Library of Medicine. Read Tami’s story about delivering the health care services Veterans earned and deserve.
If you're a provider who loves caring for Veterans, let us know!
|
|
|
If you have Veteran patients who use Medicare along with their VA health care benefits, this is a reminder that Medicare should not be billed directly by you or your staff for Veteran care.
VA does bill Veterans’ private health insurance providers for care, supplies or medicine needed to treat non-service-connected conditions. But VA does not bill Medicare except in the case of Medicare supplemental health insurance for covered services. You should submit any claims for Veteran care that may include Medicare coverage, to your third-party administrator or through your Veteran Care Agreement. More information is available here.
|
|
|
Whole Health is everywhere – get connected! Whole Health is an approach to care that supports health and well-being for Veterans and health care providers. Whole Health centers around what matters to the Veteran, not what is the matter with the Veteran; incorporating the whole person – including their gender, culture, language preferences, and other factors that make them a unique individual. Please join us in celebrating Whole Health Month!
|
|
|
The VA Fee Schedule rates for calendar year 2024 went into effect on Feb. 1, 2024.
The way rates are calculated is explained in the Federal Register notice. Please note there is a change to how VA uses non-reimbursable codes to ensure consistent evaluation of claims for non-billable or non-reimbursable services.
Medical services, hospital care, and extended care services are reimbursed by VA up to the maximum allowable rate – generally the applicable rate published by Centers for Medicare and Medicaid Services (CMS). When there is no Medicare rate available, VA reimburses the lesser of the VA Fee Schedule or billed charges.
For the Community Care Network (CCN), when there is no Medicare rate available, the VA Fee Schedule sets the maximum allowable rate where applicable. In the event neither a Medicare nor VA Fee Schedule rate is available, third-party administrators (TPAs) reimburse a percentage of billed charges.
VA calculates rates using a combination of VA claims data, Medicare policies and fee schedules, Medicaid fee schedules, TRICARE fee schedules, and industry benchmarking data.
|
|
|
VA will conduct required recovery audits of potential overpayments to community providers during fiscal years 2022-2023. Cotiviti GOV Services (Cotiviti) will conduct the audit in June of this year. The audit contract is at no cost to VA or taxpayers; Cotiviti will be paid a percentage of the recovered funds.
Below are key questions and answers regarding this recovery audit.
Q: What is a Recovery Audit?
A: A recovery audit is a review of claims to identify potential overpayments to community providers.
Q: What types of claims will the audit include?
A: Claims paid to community providers for inpatient services, outpatient services, Skilled Nursing Facilities (SNF), and the CHAMPVA and Spina Bifida (SB) Health Care Benefits Programs.
Q: Are there any exclusions?
A: Yes. Claims paid to beneficiaries, claims where VA was a secondary payer, and pharmacy, bowel and bladder and dental claims are excluded. Since Community Care Network (CCN) contracts include their own requirements for recovery/recapture audits, CCN claims are excluded from the scope of this contract.
Q: Why is this audit being done?
A: The recovery audit meets a VA requirement to actively review payments to determine accuracy and if errors are noted, pursue corrections of any payment(s) determined to be in error. The audit complies with VA financial policies.
Q: Why is this audit required?
A: This audit fulfills the Payment Integrity Information Act of 2019 requirement to review payments to community providers during Fiscal Years 2022–2023. This is under Recovery Audit Authority: Payment Integrity Information Act of 2019.
Q: Is VA conducting the audit?
A: No. VHA awarded a no-cost contract to Cotiviti to provide recovery audit services. To ensure accuracy, VA will conduct quarterly audits of the auditor’s findings.
Q: How is the contract being funded?
A: The contractor will be paid from a percentage of recovered funds. The audit contract will be of no cost to taxpayers. A portion of the recovered funds will be returned to authorizing VA medical centers (VAMCs) but must be used for the original purpose and fiscal year it was originally obligated.
Q: Will VHA manage the debt collections from providers?
A: No. To ensure adherence to VA financial policy, the FSC will manage validated overpayment collections from affected providers.
Q: When does the audit take place?
A: Cotiviti will conduct and complete the audit in 2024.
Q: How will I know if I am impacted?
A: Notices of indebtedness (NOIs) to community providers associated with recovery audit findings will be sent beginning in June 2024.
Q: Are there appeal and payment options?
A: Yes. The recovery audit contract allows providers to request reconsideration of findings and alternative repayment option including compromise or payment plans. VA has retained final authority on all provider appeals. If a significant number of findings are reversed on appeal, Cotiviti is required to submit a corrective action plan to mitigate any further issues. VA will conduct quarterly reviews to validate accuracy of the audit findings.
Q: Are there options to comment?
A: Yes. Cotiviti will post a preliminary audit plan to their public-facing website for 30 calendar days for public review and comment. VA and Cotiviti will review comments and make appropriate adjustments before the plan is finalized. The final audit plans will be posted to Cotiviti’s public website before the audit begins.
Q: How do community providers find out more about the audit?
A: The contractor has established a toll-free customer service number to respond to provider queries. The Cotiviti Provider Services number is 855-287-1667, available Monday–Friday, 9:00 a.m.– 8:00 p.m. ET. The public website is https://www.cotiviti.com/varac.
|
|
|
|
E D U C A T I O N & T R A I N I N G
This training provides health care teams an overview of digital tools for managing substance use disorders. The audience is physicians, physician assistants, nurses, psychologists, pharmacists, counselors, rehabilitation counselors, and social workers.
Location: VHA TRAIN
ID: 1117751
Credit/hours: One (1)
Accreditations: AAPA, ACCME, ACCME-NP, ACPE, ANCC, APA, ASWB, CRCC, JA IPCE, NBCC, NYSED-P, NYSED-SW
Addressing Difficult Conversations: Death, Dying, Grief and Bereavement
This webinar helps health care teams reflect on their own individual presuppositions regarding difficult conversations, diverse cultural attitudes, and how these may influence patient’s overall health care experience. At the same time, the conversation will cover maintaining patient’s dignity, fostering respect, honoring privacy, and helping them find comfort and meaning. The audience is primary care physicians, nurses, pharmacists, social workers, psychologists, physical and occupational therapists.
Date: April 12 at 1 p.m. ET
Location: VHA TRAIN
ID#: 1118596
Credit/hours: One (1)
Accreditations: ACCME, ACCME-NP, ACPE, ANCC, AOTA, APA, APTA, ASWB, JAIPCE, NYSED-P, NYSED-SW
End-of-Life Nursing Education Consortium for Veterans: Pain Management
This presentation will focus on symptoms and management of physical pain with the Veteran population. There will be discussion on how to conduct a comprehensive pain assessment and treatments, including use of opioids and adjuvant therapies, the importance of identifying barriers to optimal pain management, and the role of the interdisciplinary clinical team in pain management. The audience is physicians, nurses, psychologists, pharmacists and social workers.
Date: April 16 at 3 p.m. ET
Location: VHA TRAIN
ID#: 1117811
Credit/hours: One (1)
Accreditations: ACCME, ACCME-NP, ACPE, ANCC, APA, ASWB, JAIPCE, NYSED-P, NYSED-SW
Preventing Suicide Through Lethal Means Safety and Safety Planning
This course provides updated lethal means safety training and resources for VHA facility suicide prevention coordinators and other mental-health/suicide-prevention clinicians.
Location: VHA TRAIN
ID#: 1075258
Accreditations: APA, ACCME, ACCME-NP, ANCC, APA, NBCC, ASWB, NYSED SW
Opioid Safety Initiative
This course discusses evidence-based management of Veterans with chronic pain to improve patient outcomes and decrease incidences of complications related to opioid prescribing. No accreditation offered.
Location: VHA TRAIN
ID#: 1086479
Credit/hours: One (1)
Trainings available through Optum and TriWest
Numerous live and on-demand webinars and trainings are offered by Optum and TriWest to fit your schedule. Check them out!
Questions? If you require assistance, please contact the VHA TRAIN Help Desk by email at vhatrain@va.gov.
How to obtain your credit completion certificate:
Once you complete a credited training, you can obtain your credential certificate(s) in four easy steps:
-
Log in to VHA Train - https://vha.train.org/vha/login
- Go to “Your Learning”
- Go to “Your Certificates”
-
Download your certificate
|
|
|
P O D C A S T
This episode continues the review of common myths surrounding post-traumatic stress disorder (PTSD) with featured guest, Dr. Lisa-Ann Cuccurullo, clinical psychologist and consultant for the National Center for PTSD’s “PTSD Consultation and Mentoring” programs. The discussion will include PTSD myths and facts. For example:
Myth: PTSD is all in your head.
Fact: PTSD is real and there are many PTSD symptoms beyond unhelpful thoughts and beliefs. While PTSD may include cognitive symptoms such as unhelpful thoughts, there are actually 20 possible PTSD symptoms.
Check out the full episode with host Dr. Colleen Becket-Davenport.
|
|
|
V E T E R A N S P O T L I G H T |
|
Janie L. Mines – Navy Veteran, from Aiken South Carolina, was a member of the National Honor Society and participated in Naval Junior Reserve Officer Training Corps (NJROTC) in high school. Mines was among the first group of women – and the first black woman - allowed to enroll at the Naval Academy in 1976. This was headline news; she was even featured in “All Hands,” a U.S. Navy magazine, alongside her sister, who was accepted by the Naval Academy in in 1978.
In her Navy career, Mines sailed the USS Emory S. Land (AS-39), was assigned to the Navy Annex of the Pentagon, and served as senior advisor for business processes for the Secretary of the Navy. After serving, she became an author and continued helping other female students in the Academy as she believed it was best to “pay it forward and be there for others.”
Check out more of Janie L. Mines story here.
|
Mihiel Gilormini-Pacheco - Air Force Veteran
Mihiel Gilormini-Pacheco – Air Force Veteran, was born August 3, 1918, in Yauco, Puerto Rico. He was among many Puerto Ricans at the time who enrolled in flight school to become an aviator. After training in San Diego, he enlisted into the Royal Canadian Air Force and served until 1942, when he was commissioned into the United States Army Air Forces.
Pacheco flew multiple missions over North Africa and Italy. In one instance, he was nearly struck down by enemy fire yet managed to stabilize the P-47 Thunderbolt he was piloting, rejoining his squadron and safely completing his mission. He was awarded the Silver Star in 1945 for his heroic actions in the North African and Italian theaters, including five Distinguished Flying Crosses.
In 1947, then Colonel Pacheco and fellow officers of Puerto Rican heritage founded the Puerto Rico Air National Guard. He retired from service in 1975 as a Brigadier General. Pacheco died in January 1988. He is interred in Puerto Rico National Cemetery.
Check out more of Mihiel Gilormini-Pacheco's story here.
We honor their service.
|
|
|
|
V A 'G O O D N E W S' S T O R I E S
All Veterans exposed to toxins and other hazards while serving in the military — at home or abroad — are now eligible to enroll directly in VA health care. This means all Veterans who served in the Vietnam War, Gulf War, Iraq, Afghanistan, the Global War on Terror, or any other combat zone after 9/11 are eligible to enroll directly in VA care without first applying for VA benefits. Veterans who never deployed but were exposed to toxins or hazards while training or on active duty in the United States are also eligible to enroll. Check out the full story here.
|
|
|
COMMUNITY PROVIDERS: Thank you for all you do to support our Veterans.
|
|
|
|
|
