Operating a hospital or health system means layers upon layers of challenges, from managing staff to developing the right clinical programs and improving patient experiences. Among those challenges, navigating complex Veterans Administration (VA) claims stands out as a particularly intricate task. For healthcare providers managing their claims in-house, it’s crucial to understand the complexities inherent in working with the VA and how to effectively address the pain points associated with these claims.
The Complexity of VA Claims: A Multifaceted Challenge
If the VA does not have room to treat a veteran or if there is not a facility within a veteran’s community, eligible veterans can seek care at “community providers”—hospitals that sign up and meet minimum requirements to serve veterans.
There are often obstacles, however, to receiving the necessary treatment. Providing care to veterans can present challenges for community providers seeking reimbursement and payment. Unlike private insurers, the VA operates within a web of regulations, policies, and guidelines that can be daunting to navigate. Pain points associated with VA claims often include:
- Denied claims and appeals: The rate of claim denials from the VA can be higher than that of private insurers, and the appeals process is particularly difficult.
- Regulatory changes: The VA is subject to constant regulatory changes and policy updates. Staying compliant requires dedicated efforts and resources.
- Coding and billing challenges: VA claims have unique coding requirements that differ from those of other payers. Incorrect coding can lead to denials or delayed or incorrect reimbursement. Proper coding, particularly for service-connected conditions, requires expert knowledge and attention to detail.
- Inconsistent payment rates: Reimbursement rates from the VA differ from those paid by Medicare, Medicaid, and private insurers.
- Limited network agreements: For cases where VA facilities lack the necessary resources or capacity, veterans may seek treatment from community providers. This brings its own set of challenges, including authorizations, documentation and reimbursement.
As a government agency, the VA is in a constant state of expansion, modification of procedures, and ever-changing regulations and policies. Many revenue cycle teams don’t have the bandwidth or expertise to keep up with changing regulations or chase after denied claims or underpayments. The last thing a hospital or health system wants is for a patient’s claim to be denied, forcing them to pursue payment from the patient or send the claim to charity care—especially when that patient is an active-duty or retired service member relying on them for care.
That’s why a partner that specializes in complex claims is invaluable. Handing VA claims to a trusted partner that specializes in complex claims means your revenue cycle team can reallocate staff to focus on other, more important tasks.
Overcoming the Challenges: Partnering With EnableComp
Addressing these complexities requires a strategic approach and the right partner. This is where EnableComp comes in. With a team of experienced revenue cycle management professionals, clinicians and legal experts, EnableComp is well-equipped to handle the intricacies of complex VA claims. Our proprietary technology, Enforcer360, streamlines the claims filing process, expediting payments and improving cash flow for healthcare organizations.
By entrusting the management of complex VA claims to EnableComp, hospitals and health systems can redirect their resources and attention. The integrated support provided by EnableComp’s expert team can empower revenue cycle management teams to become heroes within their own organizations, generating the revenue needed to enhance patient care and support services.
Ready to dive deeper into complex VA claims? Discover expert insights, strategies and success stories that will empower your team to navigate the intricate world of complex claims with confidence. Download our free e-book today.