Health Care

Florida hospitals: VA owes $134 million in unpaid claims

Florida hospitals say the Department of Veterans Affairs has delayed payment of claims for services to veterans. In this November 2014 photo, Ronald Beasley, a veteran Army Airborne Ranger with diabetes, performs a walking test with Dr. Hermes Florez, professor of medicine with the Geriatrics Research Education and Clinical Center at the Miami Veterans Affairs Healthcare System in Allapattah.
Florida hospitals say the Department of Veterans Affairs has delayed payment of claims for services to veterans. In this November 2014 photo, Ronald Beasley, a veteran Army Airborne Ranger with diabetes, performs a walking test with Dr. Hermes Florez, professor of medicine with the Geriatrics Research Education and Clinical Center at the Miami Veterans Affairs Healthcare System in Allapattah. FOR THE MIAMI HERALD

Florida hospitals are trying to get the Department of Veterans Affairs to pay about $134.4 million in outstanding claims for medical services they provided to veterans who faced long wait times or far distances for care at a VA healthcare facility, according to a survey by the Florida Hospital Association.

In the survey, which was conducted in September and October, 95 percent of the 89 FHA member hospitals reported having unpaid claims with the VA, some outstanding for more than two years.

Bruce Rueben, FHA president, said the group conducted the survey to provide a House congressional committee with information on the scope of the outstanding VA claims. But the findings, he said, will not stop the hospitals from caring for veterans.

“This issue of timely payment is one that will be resolved in time . . . but it is not going to have an impact on access to care for veterans,” Rueben said.

Delayed payments to non-VA hospitals continue to be “a major issue,” according to U.S. Rep. Jeff Miller, a Florida Republican and chairman of the Committee on Veterans’ Affairs. The committee held a hearing on the issue in June, when VA officials promised to fix the problem.

It is not going to have an impact on access to care for veterans.

Bruce Rueben, president of Florida Hospital Association

But the issue persists. In a letter to VA Secretary Robert McDonald dated Nov. 13, Miller warned that delayed payments loomed large over the department’s efforts to transform a healthcare system rocked by scandals over veterans’ long waits for care.

“If left unaddressed, this problem threatens to severely inhibit VA’s ability to foster productive partnerships with private-sector health care providers,” Miller wrote in the letter to McDonald.

But Mary Kay Hollingsworth, communications manager for the VA’s statewide healthcare network, said in a written statement that the department has been doing a pretty good job of paying Florida hospitals on time.

Hollingsworth said that so far this year, the statewide VA healthcare system has referred nearly 100,000 patients to private hospitals and doctors, generating 1.7 million claims. The VA has processed 1.64 million of those claims, or about 95 percent of them, she wrote.

In total, Florida hospitals have received about $506 million in claims payments from the VA this year, she wrote.

“We will always have a balance of unpaid claims,” Hollingsworth noted, adding that roughly 80 percent of claims are processed within 30 days for authorized treatment or within 45 days for unauthorized or emergency care.

The remaining 20 percent of claims from non-VA hospitals and doctors can be delayed, she said, “for any number of reasons such as denial due to ineligibility” or lack of documentation.

But the hospitals tell a different story in the survey, with nearly 60 percent reporting issues involving claims to the VA being “lost.” Half of the hospitals surveyed reported that they submit claims electronically, but even in those cases the VA requires that additional medical records be sent non-electronically with every claim.

Federal Prompt Payment rule states that the period available to an agency to make a timely payment without incurring an interest penalty begins on date of receipt of a proper invoice.

“Medical records cannot be sent electronically and are frequently lost or labeled ‘not received,’ which exacerbates the denial issue,” according to the survey findings.

The $134.4 million in total unpaid claims reported by FHA member hospitals likely includes a combination of hospital charges — the rack rate — and negotiated prices, Rueben said.

Despite unpaid claims for non-VA care, veterans’ access to the Miami VA Healthcare System continues to be good, said Shane Suzuki, a spokesman.

Suzuki said the Miami VA’s nine facilities from Key West to Deerfield Beach have completed 677,481 appointments since November 2014. He cited VA data that shows 98 to 99 percent of all appointments since July have been completed within 30 days.

The data helps measure a push to reduce wait times initiated early last year after reports surfaced that some veterans may be dying while waiting to see a doctor. The controversy helped spark passage of the Veterans Access, Choice and Accountability Act of 2014, which established a system under which veterans could seek healthcare services from a non-VA hospital or doctor if that veteran was unable to schedule an appointment within 30 days with a VA provider.

Passage of the act likely has contributed to increased use of non-VA hospitals by veterans, according to data reported to the state’s Agency for Health Care Administration, which shows that VA patient use of Florida’s private-sector hospitals has increased 26 percent for the eight months ending March 2015.

29,670 Total outstanding claims from Florida hospitals to VA

Suzuki of the Miami VA said that a total of 4,405 local veterans have qualified so far for the Choice Act, and that 783 have opted to use the program. But to date, only 420 local veterans had actually been seen by a provider under the Choice Act.

Ryan Foley, a fellow at the University of Miami Health Rights Clinic, works with veterans and said he has not seen improvement in wait times for the Miami VA despite the Choice Act program.

“I feel like I’m hearing more and more complaints from veterans about the super long wait to get in there,” he said. “Most of the complaints are from clients who are just entering. They’re waiting months to get their first appointment, and then also for follow-up appointments.”

Daniel Chang: 305-376-2012, @dchangmiami

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