Veterans Choice Program Reimbursement Requirements to be Adjusted

Veterans Affairs officials announced changes this week to the reimbursement requirements for the Veterans Choice program, changes they say will hopefully speed payments to physicians, but they also urged Congress to support legislation that would let VA have greater flexibility to fix the troubled health program.

In order to receive payments from the VA, physicians involved with the Veterans Choice program were previously required to submit a copy of a veteran’s medical records.

According to VA, doctors will still be required to provide the medical information to make sure the VA knows what services were provided, but submission of that information will no longer be required for payment.

“This administrative step just makes sense,” VA Undersecretary for Health Dr. David Shulkin said in regards to the change in requirements. “It ensures veteran access, timely payments and strengthens our partnerships with our Choice providers.”

Long delays in reimbursements have discouraged many physicians from participating in the Veterans Choice program, which allows veterans to seek care from a private doctor if they can not get an appointment at a VA facility within 30 days or live more than 40 miles from the nearest VA hospital or clinic.

In some cases, the delays in payment have destroyed veterans’ credit, because physicians have sought payment from their patients or forwarded bills to collection agencies.

During a hearing on the VA budget on Thursday, Senate appropriators reproached the VA for the mismanaged roll-out of the Veterans Choice program, which has been plagued with access problems and delays in care and payments.

Sen. Lisa Murkowski, R-Alaska, said Veterans Choice destroyed a carefully built system of community care for Alaska veterans and urged Shulkin to fix it.

“‘Somewhat problematic’ is not what I’m hearing from veterans,” Murkowski said. “They are saying it is fouled up, it is screwed up. It is unacceptable. […] We had corrected it and you came in and created chaos.”

“The intent of the Choice act was to give veterans more opportunities to seek timely care in their communities, but as we all know, in practice, it simply is not happening,” stated Sen. Jon Tester, D-Mont., who placed the blame on the VA, the original legislation and Health Net Federal Services, the contractor overseeing VA Choice appointments and the provider network in his state.

“Health Net is inept, and until they step up and do the job they were hired to do, and paid to do, I’m going remain being very, very critical of the work they do,” said Tester.

The VA has made multiple changes to the program, including measures to hire more claims processing staff and establishing new productivity standards.

It also asked Congress for legislation to allow the administration to streamline several community care programs into a single entity that will have better defined eligibility rules and smoother access to appointments and medical care – legislation introduced recently by Tester and co-sponsored by four other Democratic senators.

The legislation, S 2633, would consolidate seven VA community care programs and include physician and contractor participation requirements.

Shulkin stated that the program has good intentions, but legislation is needed to fix it.

“The Choice program is not working the way anyone wanted. […] We are going to stick at this until we can get this working better for veterans,” Shulkin said.

The Archuleta Law Firm handles injury, death, and veterans medical malpractice claims under the Federal Tort Claims Act. We handle claims in all 50 States and Worldwide. Our focus is helping Veterans, and the families of Veterans and Military Service Members in their claims involving Veterans (VA) Hospitals, Doctors and Clinics and Military Hospitals, Doctors and Clinics. We handle claims involving the Department of Veterans Affairs, the U.S. Army, the U.S. Navy, and the U.S. Air Force.

Source: Military Times