Rounds to VA: Fix reimbursements for community care providers

U.S. Sen. Mike Rounds (R-SD) aims to ensure American military veterans receive continued access to quality health care in their local communities.

Toward that goal, Sen. Rounds on April 4 requested that the U.S. Department of Veterans Affairs (VA) review its reimbursements process for community healthcare providers taking part in the Veterans Choice Program and pay old claims formerly determined to be ineligible for reimbursement.

“According to the VA’s policy, claims from September 30, 2016, and older are no longer eligible for reimbursement. This is disappointing and unacceptable. Community providers deserve to be reimbursed for services provided at the VA’s direction, and TPAs [Third Party Administrators] must have clear and simple processes for community providers to follow for prompt payment,” Sen. Rounds wrote in an April 4 letter to Robert L. Wilkie Jr., Acting Secretary of the VA.

Sen. Rounds cited concerns with provisions of VA policies handed down on Jan. 3 that are targeted at making more timely payments to community providers. The policy established new deadlines for claims made through the Veterans Choice Program (VCP) and the Patient-Centered Community Care program. “In response, several constituent providers made efforts to re-submit old claims prior to the deadline. However, some providers had claims rejected again or did not receive feedback following a submission,” according to the senator’s letter.

Community providers may be reluctant to participate in the next VA community provider network due to such negative experiences with the VCP, wrote Sen. Rounds. “This may, in turn, impact our nation’s veterans’ ability to access health care, especially rural veterans.”

During a March 21 U.S. Senate Veterans Affairs Committee hearing, former VA Secretary David Shulkin said the department would use “Rapid Response Teams” to help community providers address outstanding claims.

However, Sen. Rounds wrote Wilkie on April 4 that he had “not heard from a constituent community provider that has had contact with a VA Rapid Response Team to troubleshoot outstanding claims.”

Additionally, the senator pointed out that constituent community providers have shared negative experiences about unsuccessfully dealing with their TPA contacts to rectify claims. “To compound this struggle, providers have been limited to troubleshooting only three claims at a time with a TPA representative, struggled with long wait times to reach a TPA representative and received deposits for services they did not provide. These issues must be remedied,” Rounds wrote.

Secretary Wilkie should “proactively reach out” to community providers to extend an opportunity for reimbursement of claims from Sept. 30, 2016, or earlier, wrote Sen. Rounds, who also requested that the VA provide “clear feedback” about why any claims are eligible for reimbursement, as well as steps to remedy the situation.

“I understand the VA is looking forward to the next version of community care, but I insist that the current community care program is still in need of considerable attention,” he wrote.