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Designing a Program

Next Reply: Re:Palliative Care for Veterans
Previous Message: billing for a SNF
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Post Palliative Care for Veterans
Author: LKrall
Date: Jun 10, 2010 10:51 pm
Would like to hear from anyone who has attempted or has successfully extended OPPC to Veterans with VA as the primary payer.

Another possible scenario is for those with Medicare A/B AND VA. Under hospice, they have the choice of choosing which benefit to elect.

If someone had Medicare B secondary to VA, has anyone billed Medicare B for services when denied by VA?

Would love to hear yeahs and nahs on this topic. All help appreciated or leads. Have tried of course the VA.gov site but it is not clearly addressed. PA is clumped with hospice as if it one in the same.

Thank you!
Replies: order by [Date] [Author] [Subject]
Re:Palliative Care for Veterans (by sjcrump on 06/15/2010)
Hello:
In regards to billing. The VA is obligated to pay for needed services that cannot be reasonably provided for by their own providers. In regards to what I assume is outpatient Palliative Care Services the issue is going to be if the service is not able to be provided by the VA. For home hospice since not allowed to provide that is clear for other less well defined services like home health then would be under skill, home based primary care may also be an issue since if they have this service in the same area I would think that this would be the first choice for VA

For a service like radiation. They might want to do most in house but be willing to provide out of area service if veteran lives far enough away to need to travel a local service this is a case by case issue.

It would seem that the issue is more that the service is not as clearly definable as home hospice or XRT

The other issue was the language the VA “denied.” The VA is like an HMO or a PPO in that they should be approved to provide a service not provide a service and then bill unless an emergency like going to local ER with medical crisis.

Joyce Crump, Program Manager,
on behalf of
Amos Bailey MD, Associate Professor and Director of Palliative Care Services -Birmingham VA Medical Center
Palliative Care Leadership CentersTM
The University of Alabama at Birmingham

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