VA vs Medicare
John Wall PT,CPO
Description
Collection
Title:
VA vs Medicare
Creator:
John Wall PT,CPO
Date:
11/27/2004
Text:
Thank you to all who replied. All responses noted the veteran has the right to serviced by the provider of his choice. I apologize for the delay, I had to wait till my daughter came home to show me how to do it. Some of the response came from people worked for the VA.
Original questiom...
I have been asked by a family member of a WWII vet to evaluate him. According to this family member he has been unsatisfied with the services through the VA lately. I have explained to her that I do not have a VA contract. She felt that Medicare may be able to cover the services.
Is it possible to bill Medicare for a service related disability?
Thanks in advance for your help. I will try to forward all answers to the list serve.
John Wall PT CPO FAAOP
Here are the responses...
I met you at the Neg Reg meetings in Pikesville. As policy, this veteran isentitled to have his needs met through the VA. The VA really has theresponsibility to trouble-shoot the prosthesis.
If there is a legitimate prosthetic issue, then it sounds to me that thisgentleman has lacked sufficiently strong advocacy to get services within theVA.
This is an interesting situation. First, even though you don't have a VA contract, you can do va work. You will have to accept the va contracted amount, usually about 5% below MCA. Otherwise, you may well be able to bill medicare for prosthetic care. I've had the same problem here where the VA sees a patient and decides to keep them in the system and not send them out to the community of contracted vendors (gotta love that word). Thank you for sharing the responses.
John... I have been providing services to several Veterans for years without a contract. If the Veteran wishes to come to you, he needs to make that clear to his area VA representative or to the Chief MD of the Clinic he attends. His wishes should be honored, as should be the case for all those who have given in service to our country and our freedom! My best to you and the Veteran you are trying to help!!....
John, Absolutely you can bill Medicare. Whether you know it or not, the VA bills Medicare for reimbursement when patients are covered. I've seen this done and seen the EOB's that Medicare sent to the patients after treatment by the VA. Also, the veterans have a right to choose their prosthetic provider. Your patient may get some information to the contrary but this is true. Your patient has to stick to their guns. There also may be some stipulations as to whether the care needed is service connected. This information is based on experience that I have from 4 years ago to 15 years ago. I do have a VA contract and don't get any referrals because the VA is trying to do everything in house. They have spent millions of dollars to do this and try to save money. In short, I believe the patient or veteran can choose. Please keep me informed as to the progress of this situation since I spent considerable time to get the VA contract which has yielded no referrals, I am very interested. You may respond to me directly. Thank you for your question and please keep me abreast.
John, as a service connected veteran he has the right to choose any prosthetic provider he wishes. All he has to do is tell the VA he wants to got to you and they must comply. That is written into the VA regulations.
John -- we have a VA contract.We'll bill either the VA or Medicare but not both. We contact the VA firstto see if they will authorize.
The VA simply has told us (not in writing) if they are to be involved(meaning to pay anything at all) they want to be 100% involved ... thistranslates to mean we may or MAY NOT pay the 20% co-pay if Medicare isprimary but we will pay 100% if we are primary. This gives the VA all thecontrol.
At least this is how it seems to work in our region.
To answer your question, I think it is possible to bill Medicare for aservice related injury... MC doesn't exclude people for pre-existingconditions and so long as it is medically necessary I think you are okay.But I wouldn't suggest eating the 20% co-pay either.
I hope this helps.John,This does not directly address your question but youmight wish to discuss this patient with Jim Mullarkey.Jim is the Clinical Manager for VA in the notheastand a CPO. I am certain that he would be interestedin assisting this vet to get what he needs and howeverthat can best be accomplished. Jim can be reached at617 323 7700 and I believe his extension is 6306. Yes, if the patient is on medicare.All you need is a prescription and all the necessary paperwork, of course!
You don't usually need a contract. You can submit a bid with the appropriate Medicare type codes, the fees for which would be discounted 15% from the Medicare schedule and provide for this client, or any other, on a case by case basis. Contact your local VA prosthetics dept. You may also charge the client the 15%, but it's very rarely done.
At our VA, the pts have a right to go to an outside facility and still bepaid by the VA if the facility accepts the contract price. Usually, somefacilities have contracts with the VA that they bid. Facilities that don'thave contracts must accept the average accepted bid (usually some percentagebelow medicare) Why the government doesn't accept the standard medicarepricing is beyond me
Yes you can bill medicare and leave the VA out of it. The patient will be responsible for the copay. The VA can be good or bad depending on which hospital you go to. I've been using the VA mostly for meds and durable medical and been treated well.
the va bills m/credo itJohn,There are several ways to approach this problem. First, if the veteran isService Connected for the specific disability, he has the ABSOLUTE RIGHTto treatment from any source he wishes (so long as they meet V.A.requirements), not necessarily a contractor. He needs to get the refusal inwritting, or at least in front of a witness of his choosing.Secondly, he can contact his local Service Officer, from the DisabledAmerican Veterans, V. F. W., or American Legion Post. Any of them canassist him in getting treatment of his choice at no cost to him, ormembership requirements.Third, contact his U.S. Representative and U.S. Senators seeking help ingetting his due benefits from the local V. A.I have been both a contractor, and a non-contractor, over the years. Theonly benefit to being a contractor is that the paperwork goes throughquicker. Chances are that the local V.A. will try to discount your quote bythe highest percent in your area, fight back, demand the lowest (or no)discount and negotiate from there.I speak from long experience.
I've done it and it works. You also won't need to absorb the discount you offer the VA if a secondary payor is available.
A very good question and one which several of us veterans will be awaiting the replies.
Original questiom...
I have been asked by a family member of a WWII vet to evaluate him. According to this family member he has been unsatisfied with the services through the VA lately. I have explained to her that I do not have a VA contract. She felt that Medicare may be able to cover the services.
Is it possible to bill Medicare for a service related disability?
Thanks in advance for your help. I will try to forward all answers to the list serve.
John Wall PT CPO FAAOP
Here are the responses...
I met you at the Neg Reg meetings in Pikesville. As policy, this veteran isentitled to have his needs met through the VA. The VA really has theresponsibility to trouble-shoot the prosthesis.
If there is a legitimate prosthetic issue, then it sounds to me that thisgentleman has lacked sufficiently strong advocacy to get services within theVA.
This is an interesting situation. First, even though you don't have a VA contract, you can do va work. You will have to accept the va contracted amount, usually about 5% below MCA. Otherwise, you may well be able to bill medicare for prosthetic care. I've had the same problem here where the VA sees a patient and decides to keep them in the system and not send them out to the community of contracted vendors (gotta love that word). Thank you for sharing the responses.
John... I have been providing services to several Veterans for years without a contract. If the Veteran wishes to come to you, he needs to make that clear to his area VA representative or to the Chief MD of the Clinic he attends. His wishes should be honored, as should be the case for all those who have given in service to our country and our freedom! My best to you and the Veteran you are trying to help!!....
John, Absolutely you can bill Medicare. Whether you know it or not, the VA bills Medicare for reimbursement when patients are covered. I've seen this done and seen the EOB's that Medicare sent to the patients after treatment by the VA. Also, the veterans have a right to choose their prosthetic provider. Your patient may get some information to the contrary but this is true. Your patient has to stick to their guns. There also may be some stipulations as to whether the care needed is service connected. This information is based on experience that I have from 4 years ago to 15 years ago. I do have a VA contract and don't get any referrals because the VA is trying to do everything in house. They have spent millions of dollars to do this and try to save money. In short, I believe the patient or veteran can choose. Please keep me informed as to the progress of this situation since I spent considerable time to get the VA contract which has yielded no referrals, I am very interested. You may respond to me directly. Thank you for your question and please keep me abreast.
John, as a service connected veteran he has the right to choose any prosthetic provider he wishes. All he has to do is tell the VA he wants to got to you and they must comply. That is written into the VA regulations.
John -- we have a VA contract.We'll bill either the VA or Medicare but not both. We contact the VA firstto see if they will authorize.
The VA simply has told us (not in writing) if they are to be involved(meaning to pay anything at all) they want to be 100% involved ... thistranslates to mean we may or MAY NOT pay the 20% co-pay if Medicare isprimary but we will pay 100% if we are primary. This gives the VA all thecontrol.
At least this is how it seems to work in our region.
To answer your question, I think it is possible to bill Medicare for aservice related injury... MC doesn't exclude people for pre-existingconditions and so long as it is medically necessary I think you are okay.But I wouldn't suggest eating the 20% co-pay either.
I hope this helps.John,This does not directly address your question but youmight wish to discuss this patient with Jim Mullarkey.Jim is the Clinical Manager for VA in the notheastand a CPO. I am certain that he would be interestedin assisting this vet to get what he needs and howeverthat can best be accomplished. Jim can be reached at617 323 7700 and I believe his extension is 6306. Yes, if the patient is on medicare.All you need is a prescription and all the necessary paperwork, of course!
You don't usually need a contract. You can submit a bid with the appropriate Medicare type codes, the fees for which would be discounted 15% from the Medicare schedule and provide for this client, or any other, on a case by case basis. Contact your local VA prosthetics dept. You may also charge the client the 15%, but it's very rarely done.
At our VA, the pts have a right to go to an outside facility and still bepaid by the VA if the facility accepts the contract price. Usually, somefacilities have contracts with the VA that they bid. Facilities that don'thave contracts must accept the average accepted bid (usually some percentagebelow medicare) Why the government doesn't accept the standard medicarepricing is beyond me
Yes you can bill medicare and leave the VA out of it. The patient will be responsible for the copay. The VA can be good or bad depending on which hospital you go to. I've been using the VA mostly for meds and durable medical and been treated well.
the va bills m/credo itJohn,There are several ways to approach this problem. First, if the veteran isService Connected for the specific disability, he has the ABSOLUTE RIGHTto treatment from any source he wishes (so long as they meet V.A.requirements), not necessarily a contractor. He needs to get the refusal inwritting, or at least in front of a witness of his choosing.Secondly, he can contact his local Service Officer, from the DisabledAmerican Veterans, V. F. W., or American Legion Post. Any of them canassist him in getting treatment of his choice at no cost to him, ormembership requirements.Third, contact his U.S. Representative and U.S. Senators seeking help ingetting his due benefits from the local V. A.I have been both a contractor, and a non-contractor, over the years. Theonly benefit to being a contractor is that the paperwork goes throughquicker. Chances are that the local V.A. will try to discount your quote bythe highest percent in your area, fight back, demand the lowest (or no)discount and negotiate from there.I speak from long experience.
I've done it and it works. You also won't need to absorb the discount you offer the VA if a secondary payor is available.
A very good question and one which several of us veterans will be awaiting the replies.
Citation
John Wall PT,CPO, “VA vs Medicare,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/223981.
