Veterans can now work directly with the Department of Veterans Affairs to resolve debt collection issues resulting from inappropriate or delayed billing under the Veterans Choice Program. A Community Care Call Center has been set up for veterans experiencing adverse credit reporting or debt collection resulting from inappropriately billed Choice Program claims. Veterans experiencing these problems can call 1-877-881-7618 (7 a.m. to 3 p.m. MDT) for assistance. “As a result of the Veterans Choice Program, community providers have seen thousands of veterans. We continue to work to make the program more veteran-friendly,” said Dr. David Shulkin, undersecretary for health. “There should be no bureaucratic burden that stands in the way of veterans getting care.” The Choice Program, meant to provide veterans living more than 40 miles from a VA hospital with access to care in their communities, has been fraught with problems, including long waits for return calls and difficulty getting appointments. In some instances, contract administrators of the program have not made timely payments. The VA said the new call center will work to resolve instances of improper billing and to assist community care medical providers with delayed payments. VA staff are also trained to work with the medical providers to expunge adverse credit reporting on veterans resulting from delayed payments to providers. VA is urging veterans to continue working with their VA primary care team to obtain necessary health care services regardless of adverse credit reporting or debt collection activity. VA acknowledges that delayed payments and inappropriately billed claims are unacceptable and have caused stress for veterans and providers alike. The call center is the first step in addressing these issues.
Errors in insurance claims are costing the healthcare industry billions in wasteful spending, and both the payers and the providers are at fault, experts say. Errors in insurance claims are costing the healthcare industry billions in wasteful spending, and both the payers and the providers are at fault, experts say. “What the payer wants from the provider is a clean claim,” said Bruce Hallowell, managing director in the healthcare practice at Navigant Consulting. “If I submit a clean claim, I’ll get paid in five days.” While error rates for commercial health insurers for paid medical claims dropped significantly from nearly 20 percent in 2010, to 7.1 percent in 2013, more than $43 billion could have been saved if commercial insurers consistently paid claims correctly, according to the American Medical Association National Health Insurer Report Card, citing figures from 2010 to 2013, the latest available data. In 2013, Medicare led all insurers with an accuracy rating of 98.1 percent, followed by UnitedHealthcare at 97.5 percent, Humana and Cigna at 96.5 percent each, Aetna at 96 percent, Anthem at 90 percent and Regence at 85 percent, according to the AMA. [Also: CMS proposes sharing claims data with providers, employers to improve care] According to Hallowell, accuracy depends on clean claims, but the problem is the definition of a clean claim can be fuzzy. Despite the adoption of the national uniform bill in 1982, creating a single billing form and standard data set for handling claims, insurers often have their own rules and providers don’t always know what they are, Hallowell said. “Payers don’t understand why the hospital can’t follow the basic rules,” Hallowell said. “There’s poor data quality from the provider and poor answers from the payer.” The best recommendation is for payers to communicate what they need so that providers can get paid right away.
One out of three American adults who have private health insurance coverage nevertheless receive what “Time Magazine” calls a “surprise” medical bill, according to a survey conducted by “Consumer Reports”. The unwelcome surprise is for procedures they think are covered by insurance but are not, ranging from a few hundred dollars for an emergency room visit to tens of thousands of dollars for an operation. Reporter Haley Sweetland Edwards wrote the story “You Only Think You’re Covered” for this week’s issue of “Time Magazine” and she joins me now from Miami to discuss it. So, what is the trap that people are getting caught into? You basically break it down to this in-network versus out-of-network chasm. HALEY SWEETLAND EDWARDS, TIME MAGAZINE REPORTER: Right. So, people will go to an in-network hospital, see an in-network provider, and over the course of that medical visit, interact with other medical providers who are out of network. So, an in-network hospital will contract with out-of-network providers — radiologists, anesthesiologists, lab technicians. All of those people, even though they’re working at an in-network hospital, can be out of network and often are. HARI SREENIVASAN: There’s no way for a consumer to know when you walk in who is in network. It’s not like they’re wearing different colored uniforms? HALEY SWEETLAND EDWARDS: Right, right. And even when patients ask ahead of time, they say, you know, “I’m going in for this procedure, is my doctor in network, is my anesthesiologist in network?” They don’t know to ask other questions like, is the consulting surgeon on duty that day who may or may not be in the operating theater, is he also in network? HARI SREENIVASAN: Now, the Affordable Care Act is supposed to make it, that as you say in the story, if I break my arm and I go the ER, I’m supposed to basically get in-network rates. But that’s not the whole story.