Billing Resolution Center
Last updated
Share PrintIn July of 2020, we began to initiate a process to resolve these concerns both prior to the Veteran receiving the bill or collections notice with the vendor and outreach to the vendor directly resulting in over $2.5 million dollars in erroneous claims have been resolved for over 300 Veterans to date. Vendor outreach and monthly meetings with our top 5 local vendors encouraging the use of HSRM has allowed them to facilitate information on their own accord to resolve these concerns without further intervention from the VA. CPAC staff focused on VA copayment education and repayment options have been well received.
Origin:
June 2020, Chalmers P. Wylie Veterans Outpatient Clinic (Columbus, Ohio)
Adoptions:
3 successful
Awards and Recognition:
VHA Shark Tank Winner
Partners:
Veterans Experience Office
Recent Updates
Overview
The problem
Images
Above:
PATS concerns related to billing
Above:
SHEP handling of bills
The solution
Images
Above:
SHEP information about billing
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SHEP out-of-pocket expenses
The results
Metrics
- Over $2.5 million dollars in erronous Veteran bills redirected to appropriate party or resolved and a decrease in
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
-
2019
-1455 documented concerns in PATS related to ambulance/private hospital/private care payment and non-va care bills-281 documented concerns related to billing for service/pharmacy co-payment-lost largest GI non-va care provider due to lack of payment -
April 2019
-Went live with deployment of community care contact center deployment of support for community care billing on April 19th at 3:00 PM. -
2020
-Local workgroup including Chief of Community Care, Facility Revenue Manager, Social Worker in CBOC, Home Based Primary Care Social Worker, Health Systems Specialist and Veteran Experience formed to begin to discuss all payment processes being performed in clinic. -
July 2020
-Began process of resolving concerns about billing prior to the Veteran receiving a bill or collections notice by reaching out directly to vendors on behalf of Veterans utilizing HSRM, CPRS, and the Optum Portal.-Began monthly meetings with top 5 (by disbursed amount) vendors encouraging vendors utilization of available resources including HSRM.-Weekly meetings with all staff involved in billing to ensure resolution of issues and addressing of erroneous billing situations.-Community Care hired billing resolution specialist as AMSA and committed to filling team with RN and LPN.-CPAC committed to returning on site -
February 2021
-Space opened on first floor of clinic for billing resolution center.-Five offices approved. Three offices currently utilized with room to facilitate further community care growth in the future. -
March 2022- September 2022
-Central Alabama Veterans Health Care System- able to save the veterans $750K in erroneous billing from Community Care Providers. In turn, we were also able to assist Community Care providers in recouping $750K in denied billing -
October 2022- January 2023
-Central Alabama Veterans Health Care System- we were able to assist our veteran with another $250K in erroneous billing and also assist Community Care Providers in recouping $250K in denied claims-Previously tracking 200 patients per month for billing resolution, currently 50 per month
Departments
- Finance department
- Billing
- Patient advocates
Core Resources
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PROCESSES |
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TOOLS |
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Files
- Billing Resolution Center Implementation Guide Billing Resolution Center Implementation Guide
Contact
Comment
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Email vhacosbillingresolution@va.gov with questions about this innovation.
About
Origin story
Original team
Tia Chaffin
Chief of Community Care
James Lee
Health Systems Specialist
Edwin Jones
Health Systems Specialist
Cynthia Mullins
Facility Revenue Manager
Andrea Barthlow
Nurse Manager Community Care
Hillary Sponsler
Social Worker
Katherine Garretson
Social Worker
Maria Patterson
Community Care Billing Specialist (AMSA)
Dustin Doebert
Veteran Experience Specialist
Thank you for updating the information to reflect the progress and success we have had here at CAVHCS. with the Billing Resolution Center (BRC). With an increase in billing issues being documented from veteran complaints it made sense that CAVHCS should be a participating site in the Diffusion of Excellence. We have been able to assist our veterans in resolving roughly $1M in erroneous billing issues with Community vendors as well as assisting our Community vendors in recouping these funds due to denied claims. We have seen a large decrease in erroneous billing issues since the implementation in March 2022. We will continue assisting both veterans and vendors in their billing resolution issues. It has been a pleasure working with the team from Columbus, Ohio and the Diffusion of Excellence staff. I am looking forward to continuing our success with the BRC.
We are very excited that our bid was accepted and that we will start our journey with this innovative program at the Central Alabama Veterans Health Care System.
We are looking forward to working with you all as well!
Looking forward to working with your Team Mr. Farooqi to assist in successfully implementing Billing Resolution Center!
This a big a HUGE impact on our veteran's in multiple ways with reducing a ton of stress from their lives. They all have been so grateful for all our help in resolving this billing concern with letters, phone calls and words of gratitude to all of our billing staff. They are very appreciative that there's now a billing resource center because now they are getting one on one attention regarding billing concerns and it gives us an opportunity to educate the veterans on billing concerns.