The U.S. Department of Veterans Affairs is taking action to improve the timeliness of payments to community providers, which has historically been an issue within the agency.
Included in the announced short- and long-term fixes are plans to publish a list of providers with large dollar amounts of unpaid claims and a new rapid response team, which will work directly with providers to come up with a financial settlement within 90 days.
Officials plan to improve the number of processed claims by 300 percent this month and by 600 percent in April, with the goal of 90 percent clean claims processed in less than 30 days. Further, the agency is setting up multiple sites for providers to check the status of claims.
"It's vital to the health of our network of providers that we provide payment in a timely and consistent fashion," VA Secretary David Shulkin, MD, said in a statement. "Our outside providers are an essential part of our network and we need to improve our system of payments for their services."
The goal, officials said, is to address issues of delayed payments to providers outside of the VA and create a sustainable method to ensure reimbursement. The agency has struggled for years to keep up with payments to doctors who provide services to veterans outside of the VA health system.
In fact, a 2015 report from the Government Accountability Office found that only two-thirds of payments were processed on-time. And the processing rate is likely even worse, given issues with VA data. And even worse, medical practices told the GAO that they had to repeatedly contact the VA about pending claims. Often, they were told they had to re-submit documents.
In several Congressional hearings in 2017, Shulkin referenced the growing number of claims that needed to be processed and that he was working on a fix. Wednesday's action is meant to combat this growing issue.
In the long term, the VA will launch several IT improvements to streamline claims submission and payment processing in the first half of this year. The agency will also award four new contracts to create the Community Care Network, which will include functions to improve claims payments. The platform is scheduled to launch in 2019.
The VA will also work with Congress to consolidate all of the agency's community care programs. Currently, the agency is working with third-party administrators Health Net Federal Services and TriWest Healthcare Alliance to improve its payment processing.