In a nutshell:

To stay compliant with VA billing rules, home care agencies must follow the SEOC authorization exactly, bill the correct hours and codes, document each visit thoroughly, and stay current on VA-specific requirements like reauthorization timelines and HSRM use.

The (slightly) longer version:

The VA Community Care Network (CCN) has strict billing guidelines that differ from Medicaid or private pay. Compliance is about more than submitting claims—it’s about aligning every billed hour with an approved authorization, documenting care according to VA standards, and avoiding issues that lead to denials, recoupments, or audits.

Key Practices for VA Billing Compliance

Follow the SEOC authorization exactly. Bill only for approved dates, service codes (e.g., HHA vs. homemaker), and hours. Don't round up or bill outside the scope.

Monitor expirations and reauthorization deadlines. Many SEOCs expire after 6–12 months or once hours are used. Missing reauths leads to denied claims and payment holds.

Document each visit thoroughly. Include caregiver name, time in/out, tasks completed, and client signature (digital or physical). Avoid generic or incomplete notes.

‍Use the correct billing codes and units. VA billing often requires different HCPCS codes, modifiers, or hour types (e.g., overtime, holidays).

‍Track All Submissions in HSRM or Optum Portals. Ensure claims align with portal activity, authorizations, and remittance data.

‍Respond Promptly to Payer Requests. CCNs may ask for additional documentation or clarification post-submission—delays can hold up payment.

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Pro Tip: A major cause of VA denials is billing outside the SEOC. Build internal checks to catch authorization mismatches before claims go out.

For agencies working with Paradigm, we manage every part of the VA billing process—including SEOC tracking, visit reconciliation, and compliance audits—so you stay aligned with VA rules and avoid revenue disruption.

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