3/6/2017. Health Net Federal Service Veterans Choice Program. Minnesota Chiropractic Association 69 th Annual Convention March 9-11, 2017

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1 Minnesota Chiropractic Association 69 th Annual Convention March 9-11, 2017 Billing Procedures Presented by Joan Olson, Chiropractic Assistant Nona Peterson, Chiropractic Assistant What is (VCP)? In August 2014, President Obama signed into law the Veterans Access, Choice and Accountability Act (VACAA) of 2014, which directed the establishment of a new program to better meet the health care needs of our nation's Veterans. The law directs the establishment of a Veterans Choice Card benefit that allows eligible Veterans who live more than 40 miles from a VA facility or are unable to get a VA appointment within 30 days of their preferred date, or within 30 days of the date determined medically necessary by their physicians, to obtain approved care in their community instead. 1

2 What is s (HNFS)? s (HNFS) partners with the U.S. Department of Veterans Affairs (VA) to provide health care and community support to veterans through the Patient-Centered Community Care (PCCC) and Veterans Choice (VCP) programs, as well as Community- Based Outpatient Clinics (CBOC). Collectively, these programs and clinics improve and expand access to timely, quality health care to more than 1.7 million eligible veterans. (HNFS has provided managed care support for 28 years in the TRICARE North Region offices.) What regions does s (HNFS) support? HNFS supports the VA by providing care to Veterans in Regions 1, 2 and 4 which encompasses all or part of 37 states, plus the District of Columbia, Puerto Rico and the US Virgin Islands. How do I become a (VCP) provider? Register to become a VCP provider at: 2

3 How do I contact (VCP)? Monday Friday 9:00 am to 5:00 pm ET How do I view provider rates? Provider rates can be viewed online at the Centers for Medicare and Medicaid website. results.aspx?y=0&t=0&ht=2&ct=2&h1=98940&h2=98943 &C=69&M=5 Please read the license agreement and select 'Accept' at the bottom of the page. Enter search criteria and go to Non Facility Price Non-Facility Price 3

4 Copays, Cost-Shares and Deductibles Veterans have no cost-shares, deductibles or out-of-pocket expenses. Providers will receive their payments from HNFS. Providers are prohibited from billing Veterans, VA or HNFS for services rendered for which no authorization was obtained. What do I do when a Veteran presents in my office with the Veterans Choice Card? Eligibility to use the Choice Card must be verified by HNFS and any services approved before a Veteran can seek care with the Choice Card. Once eligibility is verified, treatment is approved, and the appointment scheduled, the Veteran should present the following information on the day of their appointment: Choice Card Any other insurance card Photo Identification What does a Veterans Choice Card look like? All Veterans received a Choice Card but not all are eligible for Choice benefits. 4

5 How is care authorized for Veterans in VCP? The Veteran must first contact s, LLC (HNFS) to obtain authorization. Please note: Any services that have not been authorized by HNFS will not be paid for under VCP. After the Veteran obtains authorization, Health Net will contact your office to schedule. How is care authorized for Veterans in VCP (cont.)? You will receive a provider packet from HNFS via fax. This will include the VA's authorization and any clinical notes/medical documentation from the VA as well as information specific to filing the claim such as the due date for returning required medical documentation and instructions for ongoing treatment and/or extended service requests. Appointment Confirmation and Medical Documentation Reminder HNFS Cover Sheet 5

6 HNFS Appointment Authorization/Verification Required Medical Documentation Content form How long is authorization valid? An episode of care authorization may be valid up to one year from the date of the first appointment. However, providers should refer to the approved date(s) on the provider packet for specific details. If the provider determines it is necessary to continue care after the approved date(s) of service or additional services are needed, they must complete the Request for Additional Services form. VA Programs Request for Additional Services from: 6

7 Does the authorization cover other providers required in the episode of care? To the extent you utilize any other provider(s) to render services for the same episode of care for which you have accepted authorization, you must: 1. Share the conditions and authorization with the other provider(s) 2. Obtain assurance the other provider(s) will abide by the terms and conditions of the VCP program 3. Inform HNFS of the other provider(s) info This slide is under construction How do I get reimbursed under VCP? Providers must submit clean claims via EDI or manually by mailing in paper claims to HNFS after rendering services authorized under VCP within 120 day timely filing. If submitting by mail: VACAA PO Box 2748 Virginia Beach, VA If filing via EDI: Payor ID: Health Net VA Patient Centered Community Care Program - VACAA 7

8 What is a clean claim? A clean claim is a claim that complies with billing guidelines and requirements without defects that would require special processing that would prevent timely payment. A clean claim includes the VA authorization number in the appropriate segment, exactly as it appears on the authorization. Health Net will process clean claims within 30 days, clean claims aged more than 30 days will be paid interest in addition to the payable amount. Where do I send medical documentation? With submitting a claim either by EDI or by mail on a HCFA form, fax the complete medical documentation signed by the treating provider within 60 calendar days after completion of the initial appointment, or after the conclusion of any series of authorized care to Use the bar coded letterhead fax provided by s Do not combine medical documentation for multiple authorizations or different Veterans Do not submit claims with medical documentation Should I bill the Veteran or HNFS for no-show appointments? Providers must report all no-shows, missed or cancelled appointments to HNFS at or by returning the Appointment Confirmation and Medical Authorization form to fax number Providers must not bill the Veteran, VA or HNFS for no-shows, missed or cancelled appointments. Providers must not bill the Veteran for any unauthorized service(s) within the authorization time frame. 8

9 Appointment Confirmation and Medical Documentation Reminder Visit Login/registration is required Where do I check Claims Status? Once logged in, click on the ERA Enrollment box: Payer name: ERAHEALTHNET Payer ID: Select Claims Status Inquiry under Claims Management. Choose Patient-Centered Community Care in the payer field (for VCP and PCCC claims) Search by patient identification number or claim number What are Multiple Procedure Payment Reductions? October 29, 2016, HNFS began applying the Medicare Multiple Procedure Payment Reduction (MPPR) for VCP services billed on the same claim with the same date of service that fall within the same family. This applies to diagnostic imaging services and therapy services. To learn more about MPPRs, please visit www. cms.gov 9

10 How do I request a claims adjustment? Claims adjustment procedures are program-specific and requests must be made in writing by fax or by mail and clearly indicate corrected claim on all re-submittals to HNFS or the claim may be denied as duplicate. Adjustment determinations are made on a claim-by-claim basis. Before submitting a request for a claim adjustment, first review your HNFS Preferred Provider Network Participation Agreement and the applicable rate exhibits. What do I do with incorrect payments? If you receive an incorrect payment for a claim, return it to HNFS. Please specify the error (example, Attn: Finance Department: Incorrect provider paid ) or clearly detail what portion of the payment was incorrect. Return address: s, LLC PO Box 2890 Rancho Cordova, CA Please note these important billing points! Faxed claims will not be accepted by VACAA All care under VCP must be authorized in advance of delivery by a VA doctor NO visits/care/charges outside the authorized time frame will be considered for payment...no matter how many phone calls you make! 10

11 'Good to Know' Billing Procedure notes: No modifier needed on CMTs 98940, 98941, is not on the CMS fee schedule - Therapy codes are accepted with or without a GP modifier - Typically only one unit of therapy is authorized - Use the G code for EMS G0283-GP 'Good to Know' Billing Procedure notes (continued): - X-rays are only paid with authorization - SOAP notes MUST be signed by the treating provider - The 1 st position ICD-10 diagnosis code MUST be exactly as it is in the authorization packet. - If more visits are needed, the request MUST be made before the current authorization expires - does not coordinate with other health insurance (OHI), TRICARE, Medicare, Medicaid nor with supplemental plans. 'Good to Know' Billing Procedure notes (continued): - Use your nine digit ZIP code (ZIP + 4). Without it your claims cannot be priced for payment - Your claims will process faster when you fax notes within 24 hours of submitting EDI billing, using the bar-coded fax provided by Health Net - 25 modifier is required when an examination is billed on the same day as a CMT. Unauthorized examinations will not be paid 11

12 To whom do I report critical findings for a Veteran? Critical findings on outpatient imaging or laboratory testing, or during evaluation and treatment must be transmitted to the VA point of contact by phone within 24 hours upon completion of the test/evaluation/treatment and also reported in the Required Medical Documentation Consent checklist. Veterans Crisis Support Military Culture Training for Community Providers: It is important that all who care for Veterans have a basic understanding of military culture. In the interest of the highest quality, most compassionate health care for our Nation s Veterans, the Department of Veterans Affairs (VA) provides accredited training resources at no cost to all Veteran care providers at Veterans Crisis Support Crisis support for your patients who are U.S. Veterans: Press 1 Confidential chat at VeteransCrisisLine.net or text to Because one small act can make a difference. 12

13 Veterans Crisis Support Presenter Contact Information: Joan Olson, Chiropractic Assistant Nona Peterson, Chiropractic Assistant 13