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SERVING VETERANSA Small Practice Guidea resource presented by
Table of ContentsBecoming a Non-VA Community Provider1Provider Registration. 2Claims Processing and Funds Transfer. 6Appointments and Referrals. 7?Resources. 8Also from Kareo.11www.kareo.com
What Is the Accelerating Care Initiative?Becoming a Non-VA Community ProviderThe Department of Veterans Affairs (VA) provides a nationwide system of healthcareservices for America’s 5 million veterans. Despite having more than 1,400 facilities acrossthe country, the VA is seeking ways to provide timely care to veterans. Currently, there isa program that allows you to become a Non-VA Community Provider and offer servicesto veterans in certain circumstances. The VA is seeking to expand this program throughthe Accelerating Care Initiative.Participation emables your practice to support veterans by providingtimely access to quality healthcare services. In addition, it promoteslong-term relationships between veterans and local providers.Once your practice is registered and set up to provide services as a Non-VA CommunityProvider, the process of submitting claims and getting paid is similar to working withMedicare: claims are submitted and funds are deposited electronically, and reimbursementis made at Medicare rates.There is a growing need for medical services for veterans—your practice can help to fill thisgap. The Accelerating Care Initiative is a way to both grow your practice and play an essentialrole for the nation.www.kareo.com1
Serving VeteransProvider RegistrationTo participate as a Non-VA provider, your practice will need to do five things:1.Sign up with your local VA Medical Center2.Register in the VA payment system3.Enroll with the Emdeon Clearinghouse4.Register in the federal Central Contractor Registration Database5.Set up electronic funds transferCONTACT YOUR LOCAL VA MEDICAL CENTERFind your local VA Medical Center through the VA directory and speak to the Non-VA carevendor point of contact. Request to be added to the list of local Non-VA CommunityProviders that is given to a Veteran when he or she receives a Non-VA care authorization.Be prepared to provide the following: Name Address Tax ID Medicare ID Social Security Number (SSN) Drug Enforcement Administration (DEA) Number (for provider, not facility) National Provider Identifier (NPI) Number Type of facility (e.g., small, large, veteran-owned, woman-owned, and specialty)REGISTER IN THE VA PAYMENT SYSTEMTo provide care to veterans through this program, your practice needs to register in theVA payment system. If you are a Kareo customer, you can get enrollment assistance bycontacting enrollments@kareo.com. To register, a Standard Form 3881 and Form W-9 needto be completed. Download the forms here:2 Standard Form 3881 W-9www.kareo.com
Provider RegistrationOnce completed, return the forms via mail to your local VA Medical Center, where they willupload your information into their computer system and forward your form to the centerthat processes the reimbursement. Get the appropriate address when you call to be addedto the list of local providers.ENROLL WITH THE EMDEON CLEARINGHOUSEVA contracts with the Emdeon clearinghouse for electronic healthcare claims. If you are aKareo customer, you can get enrollment assistance by contacting enrollments@kareo.com.To enroll to submit EDI claims, call 1-800-845-6592 or visit www.emdeon.com/payerlists/.While registering you will need the VA Fee Program payer ID, which is 12115 for submissionof medical claims.CENTRAL CONTRACTOR REGISTRATION DATABASETo receive payments from the federal government, you’ll need to register with the CentralContractor Registration Database. This process is done online and only takes a fewminutes. You’ll need to have most of the same information handy to complete the form.Once you are done, you’ll receive a Data Universal Numbering System (DUNS) number andconfirmation that your request has been processed.SIGN UP FOR ELECTRONIC PAYMENTSTo enroll in electronic funds transfer, you’ll need to fax your completed Standard Form 3881to (512) 460-5221. If you have questions or need to follow up, call the VA Financial ServicesCenter at (512) 460-5049.www.kareo.com3
Serving VeteransClaims Processingand Funds TransferOnce you are registered as a Non-VA CommunityProvider, you can begin seeing veterans who arereferred to you by the VA.Prior to the visit, be sure you have received the referral form from the VA or the patient.You will need this referral form to submit your claims. Claims are submitted electronicallyfor these visits and the federal government requires all payments to be made electronicallyas well.CLAIMS SUBMISSIONThe VA encourages providers to submit HIPAA-compliant electronic claims. Complete theappropriate form, and provide the codes or the treatment rendered just as you would whencompleting a Medicare claim.Claims submitted to VA for payment consideration must include a completed originalCMS 1500 and/or UB-04 billing form(s) with, at a minimum, the following information:6 Patient Name (include middle initial) Patient Address (include zip code) Patient Full Social Security Number Provider Name National Provider Identifier (NPI) Number Provider taxonomy code(s), if known Tax Identification Number (TIN/EIN) Professional status of provider (MD, PhD, CRNA, etc.) Physical address where care was provided Remit to mailing address where payment should be sent All appropriate medical coding All other health insurance informationwww.kareo.com
Claims Processing and Funds TransferPAPER CLAIMSYou can also submit paper claims. All the same forms and instructions apply.Paper claims for payment of healthcare services provided to veterans should be submittedto the Fee Office of the VA Facility that authorized payment of care in advance.PAYMENTSPayments will be made using EFT. Payment by VA is considered payment in full; providersmay not bill Veterans for any claimed amount above the payment received from VA. The VAreimburses using the Medicare Physician Fee Schedule. So payments for services renderedwill be comparable to what you receive for current patients who are covered by Medicare.In situations where a Veteran has coverage under Medicare or any other health plan, federallaw prohibits providers from receiving payment from both VA and the other health planfor the same services. Non-VA Community Providers may not bill any other payer for careauthorized by VA.ELECTRONIC EXPLANATION OF BENEFITSVA has made electronic explanation of benefits (EOB) statements available for all non-VACommunity Providers. Please go to www.vahcps.fsc.va.gov/login.aspx for login instructions.DENIALS AND DISAGREEMENTSProviders who disagree with the VA decision to deny payment for a claim have the rightto request reconsideration. Providers disagreeing with the initial decision to deny the claimin whole or in part may submit a reconsideration request in writing to the referring VA FeeOffice within one year. The request must state why the provider believes the decisionis in error and must include any new and relevant information not previously considered.After reviewing the matter, the immediate supervisor of the initial VA decision-maker shallissue a written decision that affirms, reverses, or modifies the initial decision.The final decision of the immediate supervisor of the initial VA decision-maker will informthe claimant of further appellate rights for an appeal to the Board of Veterans’ Appeals.www.kareo.com7
Serving VeteransAppointments and ReferralsVeterans who need care and can’t access it through the VA can be referred to Non-VACommunity Providers. Once you are registered, your local VA facility can refer patientsto you. A referral or preauthorization is required for all care for veterans who receive careat a Non-VA Community Provider.When the VA or the veteran calls to make the appointment, remind them that you needthe referral form for the visit so that you can bill the VA for the care provided.MEDICAL DOCUMENTATIONPrior to the appointment, please inform the referring contact and/or the veteran if he or sheneeds to provide you with medical information to support your treatment such as films, labs,and medical records.Any documentation sent back to the VA should contain the patient’s name and last fourdigits of the patient’s social security number or date of birth on each page. Relevant clinicaldocumentation includes, as applicable, the information listed below. Initial assessment and reassessments appropriate for clinical condition,including (but not limited to) Relevant medical history and physical examination, including inventoryof body systems Vital signs Pain assessment (using 0-10 scale) Initial and final diagnoses/diagnostic impressions List of all medications and recommended/ordered durable medicalequipment/prosthetics8 Instructions given to patient Recommended follow-upwww.kareo.com
Resources?ResourcesNational Non-VA Medical Care Program OfficeNon-VA Care Provider GuideVA Facility DirectoryEDI Claims Registration InformationEFT Registration Informationwww.kareo.com9
Serving VeteransAlso from KareoExplore more of Kareo’s brief, informative guides by visiting www.kareo.com/resources.Meaningful Use:A Small Practice Guide(April 2014)ICD-10 Guide:A Small Practice Guide(January 2014)EHR Implementation:A Small Practice Guide(July 2013)Engage! 10 Powerful Waysto Engage Patients in EveryAspect of Your Practice(January 2014)Selecting the Right EHRfor Your Practice:A Guide for Small Practices(June 2013)TO HIREORA BILL NOT TO HIREING SERVICEthe RightHow toMakeChoicea resourcefor YourPracticepresentedbyTo Hire or Not to Hirea Billing Service:How to Make the RightChoice for your Practice(February 2013)5Simple StepYour Patie s to Creating a Webnts Will Lovesite4Sponsored bySteps to Building and ManagingYour Practice’s Online Reputation5 Simple Steps to Creatinga Website Your PatientsWill Love(May 2014)4 Steps to Building andManaging Your Practice’sOnline Reputation(June 2014)Watch for more coming soon!10www.kareo.com
NotesLOCAL NON-VA NAME AND PHONEDUNS NUMBERCLAIMS ADDRESS (PAPER)
ABOUT KAREOKareo is the only cloud-based medical office software and services platformdedicated to small practices. At Kareo, we believe that, with the right toolsand support, small practices can do big things. We offer an integrated suiteof products and services designed to help physicians get paid faster, run theirbusiness smarter, and provide better care. Our Practice Managementsoftware, Billing Services, and free, full-featured award-winning EHR help morethan 20,000 medical providers more efficiently manage the business and clinicalsides of their practice. Headquartered in Irvine, California, Kareo’s missionis to help providers spend their time focused on patients, not paperwork.For more information, visit www.kareo.com3353 Michelson Drive, Suite 400, Irvine, CA 92612(888) 775-2736 www.kareo.com 2014 Kareo, Inc.June 2014
Download the forms here: Standard Form 3881 W-9 Provider Registration. Provider Registration. . EHR Implementation: A Small Practice Guide (July 2013) Selecting the Right EHR . Kareo is the only cloud-based medical office software and services platform
