Have you ever experienced the frustration of trying to navigate the intricate VA billing maze, only to be met with the disappointment of having your claims denied?
Well, you're not alone!
Denied VA billing is a common challenge faced by many home care providers, and the risks of rejections and having to resubmit billing are simply too high for most to bear.
To help you tackle this challenge, we've put together a helpful list of the main reasons why claims get denied.
At Paradigm, our technology natively handles these issues, but we want to share this information with you, so you can avoid potential pitfalls.
The Top 5 Reasons For Claim Denials
Claim rejections have a direct effect on your revenue cycle as well as the client experience. Here are a few of the most common reasons for denials and rejections.
1. Delayed Claim Filing
A common issue specific to VA billing is the failure to file claims in a timely manner.
The deadline for timely filing is 180 days and billing submitted after this will not get paid by the VA, Optum, or TriWest.
This problem is especially difficult for providers who missed billing during the transition from Veteran Care Agreements (VCA) to the Community Care Network (CCN) and the move from working directly with their local VA Medical Centers (VAMCs) to working with Optum or TriWest.
Paradigm has been working with the Home Care Association of America (HCAOA) to help providers who are in this specific predicament.
It is extremely difficult to appeal claims denied for this reason, so home care organizations need to be careful to bill within the timeline.
2. Issues With Claim Specificity And Information
For a successful claim, it is essential to enter the correct HSPCS codes. Incorrect codes are a common issue in VA billing, arising from various factors such as bad advice, outdated instructions, human error, and typos.
It's essential for home care providers to stay vigilant and double-check all codes before submission to avoid the disappointment and financial setbacks of claim rejections.
3. Errors In Patient Identification Information
These include the patient's name, Veteran ICN (Integrated Control Numbers), date of birth, and gender. Even one letter wrong or one day off can lead to denied billing.
This can have an impact on cash flow as you will need to resubmit this billing at a later stage with the correct information in order to get paid.
4. Duplicate Charges Or Claims Detected
Duplicate billing is a common mistake where a claim is unintentionally submitted multiple times without being removed from the patient's account, or, when you bill two shifts on the same day and don’t indicate that they are two separate shifts.
Claims processing systems have automated checks in place to identify duplicate claims.
5. Requirements For Referrals
In all cases, a referral (VA form 1070-80) is essential for the approval and payment of a claim.
Make sure you have a new auth in when an old one is expired, so your client doesn't have a lapse in coverage, and you don’t have any payment gaps.
Remember, you must have the referral in hand before starting care.
Common VA Denial Codes & Reasoning
If you would like more information on specific denial codes visit the VA rejected claims page.
How To Prevent Billing Rejections
1. Create A Thorough System
To prevent claim denials, it's crucial to establish a comprehensive process that involves verifying each client's information, coverage, referrals, and authorizations during every visit.
Additionally, it's important to ensure the accurate use of codes and to stay updated with any changes in codes or regulations.
Moreover, implementing an effective review process for rejected claims is essential. This allows for timely amendments and resubmissions of claims that have been denied.
2. Use Paradigm
The better option by far is to simply outsource your revenue cycle management processes. Paradigm has an all-in-one solution designed to automate your billing processes, unlock your cash flow, and supercharge your revenue.
Our cutting-edge technology and dedicated team will work tirelessly to collect any outstanding ARs, putting money back where it belongs: in your pocket.
And let's not forget about authorizations. Paradigm streamlines and simplifies the authorization management process, ensuring you have the necessary approvals in place to provide the care your clients need.
Partner with us today and skip the hassle of VA billing rejections
Destination: Zero Denials
We hope our list of common reasons for claim denials helps you understand, recognize, and address these issues swiftly.
However, if you still find yourself in need of guidance, don't hesitate to reach out to us. We're here to lend a helping hand by offering automated billing, AR collections, credentialing, and authorization management, helping you streamline your processes and boost your bottom line.
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