Department of Veterans Affairs

Over-paying outside providers for Veteran care referred by VA

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When the VA refers a Veteran to a community provider for care that can’t be performed at a local or nearby VA medical center (either the service can’t be provided within the VA in a timely manner, or the service is not available at the VA medical center), the VA staff already complete a referral and authorization process, including entering an authorization for a specific service in the VA’s claims processing and payment system.

 

The dollar amounts that the community providers subsequently submit for payment for those services is often double or triple the standard Medicare reimbursement rates for those same services.

 

When the VA staff complete the authorization for payment for the care, they could also be entering a dollar amount that is authorized for the service using standard, regional, Medicare reimbursement rates that are readily available, resulting in a cost savings. By notifying the provider of the amount that will be paid for the care provided at the time of authorization will improve the quality and timeliness of the payment process.

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Idea No. 8103