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VA Meeting in Shreveport last month. Claims Fact Sheet to Increase Transparency Timeline to process- goal is 30 days, but in reality anywhere between.

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Presentation on theme: "VA Meeting in Shreveport last month. Claims Fact Sheet to Increase Transparency Timeline to process- goal is 30 days, but in reality anywhere between."— Presentation transcript:

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2 VA Meeting in Shreveport last month. Claims Fact Sheet to Increase Transparency Timeline to process- goal is 30 days, but in reality anywhere between days. Contact Sandra Brown if there are any problems. (318) ; Tips from the VA If claim sent to Shreveport VA and was supposed to be sent to VISN 16, Mrs. Brown will forward it to VISN 16.

3  Providers can appeal denied claims. There is no need to get consent from the patient.  Randy Colvin, non-VA reimbursement manager, informed me that providers should submit paper claims in lieu of sending them electronically. He said that this should cut down on some problems providers are having, such as lost medical records or trip notes.  Another advantage to sending paper claims is that these claims can be reopened, but this option is not available for electronically submitted claims.  Colvin also stated that trip notes should be the only medical documentation that VISN 16 should need from the provider. However, VISN 16 does not agree with this and continues to request hospital/ER medical records

4 The meeting in Pineville was led by Joe Enderle, director of operations for the VA Chief Business Office (CBO). He started off by stating the different types of changes that will be implemented since the passing of the Veterans Access, Choice, and Accountability Act of When the bill was signed into law, the authority to pay for hospital care, medical services, and other health care through non-VA medical care providers was formally transferred to the CBO. Enderle admitted that one of the biggest problems with claims processing throughout the country is that there was a lack of standardization, and that each regional center was not following the national standardized process. Also, there is a new supervisory structure in place for the VISN’s. The supervisory structure. One of the biggest changes is that the CBO will provide direct oversight over the claims process. Enderle informed us that his team was going to VISN 16 at the end of November, and they were going to go through all the boxes of claims and medical records that were stagnant and not processed. He informed everyone that the last time they cleaned out a VISN’s old file cabinets and boxes, the process took over four months. He assured everyone that there will be more responsibility and liability on the claims processing staff and there will be repercussions for individuals not performing up to expectations. Enderle also shared that the CBO is trying to speed up the appeals process.

5  When asked what type of metrics he will use to gauge success, Enderle stated that he will judge success by the amount of new claims that are processed within a 30 day period.  I specifically asked Enderle, how far back was the VA willing to go when processing claims because some providers have claims that are 7-10 years old, and no response was given by the VA. He stated that he knows the problem goes back to a couple years after the passing of the Millennium Bill so he will push for the VA to go back to 2000 when processing outstanding claims.

6  Emily Copeland -- (318)  If requesting information about a claim, she will need several facts before she can give an update.  These include: 1) patient’s name 2) last four digits of the patient’s social 3) the amount charged/owed 4) originating site of the transport 5) destination 6) date of service.

7  Bayou Health- the new managed care system will go into effect on February 1,  Five Companies where recommended by DHH after the bids were reviewed: 1) Aetna Better Health of Louisiana 2) Amerigroup Louisiana, Inc. 3) Amerihealth Charitas Louisiana, Inc., 4) Louisiana Healthcare Connections 5) UnitedHealthcare Community Plan.  Conference Calls Every Wednesday from 12 pm – 1pm (Starting Today Until Implementation Date)  Number:  Access Code:  Providers can also questions to

8  LR 31:3163 states that “the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing discontinues the requirement for completion of the medical transportation certification form for reimbursement of emergency ambulance services.”  This same language was also passed in a state plan amendment which has not been repealed or superseded.  Emergency response is defined as “a BLS or ALS1 level of service that has been provided in immediate response to a 911 call or the equivalent. An immediate response is one in which the ambulance provider/supplier begins as quickly as possible to take the steps necessary to respond to the call.” (Medicare Benefit Policy Manual Chapter 10 - Ambulance Services p ).

9  Reimbursement for Non-Emergency Medical Transports  La. Admin. Code Title 50, part XXVII, Sec. 571 states “reimbursement for non-emergency ambulance transportation claims shall be allowed only when accompanied by the medical certification form justifying the need for ambulance services.”  However, this certification form is not mentioned in the section regarding reimbursement for land- based emergency ambulance transportation. La. Admin. Code Title 50, part XXVII, Sec. 325.

10  Louisiana law does offer protection to certain documents which are created by a healthcare practitioner’s quality review committee/panel. These protections are provided by La. R.S. 13: The statute states “all records, notes, data, studies, analyses, exhibits, and proceedings of: … the peer review committees of any… ambulance service company… or healthcare provider as defined in R.S. 40: (A), or extended care facility committee, including but not limited to the credentials committee, the medical staff executive committee, the risk management committee, or the quality assurance committee, any committee determining a root cause analysis of a sentinel event, established by the peer review committees of … ambulance service company or healthcare provider as defined in R.S. 40: (A), or private hospital licensed under the provisions of R.S. 40:2100 et seq.,

11  shall be confidential wherever located and shall be used by such committee and the members thereof only in the exercise of the proper functions of the committee and shall not be available for discovery or court subpoena regardless of where located. (emphasis added). La. R.S. 13:3715.3(A)

12  Not every single fact brought before a peer review/quality assurance committee is protected by the privilege.  “[W]hen a plaintiff seeks information relevant to his case that is not information regarding the action taken by a committee or its exchange of honest self-critical study but merely factual accountings of otherwise discoverable facts, such information is not protected by any privilege as it does not come within the scope of information entitled to that privilege.”  Smith v. Lincoln General Hosp., 605 So.2d 1347, 1348 (La. 1992).

13  In short, there are several requirements that must be met in order for the protections under La. R.S. 13: to apply. First, your service must be listed in the statute. Ambulance Service Company is listed in the statute. Second, the document or notes must be created by a peer review committee or a quality assurance committee. Third, the document or notes must contain information of an “honest self-critical study” in order to be protected and considered confidential.

14  Louisiana Ambulance Alliance makes no warranties express or implied in this language for use. This is in no way meant to serve as legal or professional advice. Viewing this language and using information from it does not create any type of professional relationship.  There is no warranty or guarantee that using this language will be in compliance with legal standards. Louisiana Ambulance Alliance is not responsible for any reliance on this language.


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