Acupuncture is the old Chinese method to treat pain, fever, anxiety, and many other problems. Also, this method is still in practice in this era and has great treatment outcomes. The Department of Veterans Affairs (VA) also included this method in its list of medical services rendered to veterans. Veterans can get acupuncture treatment benefits from any healthcare providing sector, and the Department of Veteran Affairs will pay the bill.
In this article, we will learn about the VA billing process by which healthcare-providing sectors can claim reimbursement. We will learn more about the challenges faced by the acupuncturist while claiming the reimbursement.
What is VA Billing?
VA billing is how healthcare providers bill the US Department of Veteran Affairs for the services given to qualified and approved veterans. Only the approved or those healthcare providers who are part of the VA community can bill the Department.
Some prerequisites should be followed to claim reimbursement. VA has fixed a fee that healthcare providers must pay to be part of the VA community. In case of wrong information about the veteran or unauthorized veteran treatment, payment can be delayed or denied. Below are four steps mentioned to go through the process of VA billing efficiently.
Step 1: Understand the VA Policies
To proceed with the VA billing, it is necessary to remain updated with the VA policies; in September 2021, VA, a federal program, recognized or added acupuncture treatment to its medical service for veterans.
Approved veterans can get acupuncture treatment from the VA primary care provider. Veterans can also get acupuncture treatment from community providers if VA primary care service is unavailable. You, as a community provider, should be affiliated with the Community Care Network (CCN) of the VA. If you are affiliated with CNN, you can provide acupuncture to the veteran and proceed with VA billing.
Acupuncture is mainly a pain management treatment, and it can help a person’s overall well-being. To avoid uncertainty, as a healthcare provider, you should give on-and-off visits to the VA office in your territory to get recent policy updates.
Step 2: Credentialing and Contracting
To do the VA billing for acupuncture, you should be affiliated with the VA community as an approved healthcare provider. You need to understand their affiliation requirements and do the contracting with VA. This involves verification of your qualification, experience, certification, and licenses to become an approved VA acupuncture provider.
First, you need to obtain the application form from their website or the VA office in your area. Then, you must read all the instructions. Fill out the application form and attach the required copies of documents like a state license, malpractice insurance, work experience certificate, curriculum vitae, and many other relevant certificates.
VA will verify your documents, and upon verification, they will give you a date for a meeting in which you will negotiate the reimbursement rates for your service. VA and you will sign a mutual contract for providing acupuncture service to the veterans, and in return, they will make payment transactions within the agreed days after a claim. Now, you are an approved member of the VA community and can start providing services to the veterans.
Step 3: Treatment and Billing Process
Once you are an approved VA healthcare provider, you can start treating the veterans. When veterans come to the clinic, they come with a VA authorization for the treatment. You need to verify their information to avoid any scams or issues. Verify all the information, including the preferred treatment plan, number of visits, and personal information of the veterans. Generally, an authorization includes 12 visits and 90 days.
When billing, using the correct Current Procedural Terminology (CPT) codes is mandatory. For acupuncture, CPT codes start from 97810 to 97814, including two sets of acupuncture per visit. Evaluation and management (E&M) services 99201-99215 are also covered. There will be no out-of-pocket cost to patients. The VA billing should be written in detail with the date of service, service rendered, diagnosis, and CPT codes mentioned. Mistakes in any of the above information can lead to disputes among acupuncturists and VA staff.
Acupuncturists cover the following acupuncture billing codes:
- 97810 – Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes.
- 97811 – Acupuncture, one or more needles, without electrical stimulation, each additional 15 minutes. With re-insertion.
- 97813 – Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes.
- 97814 – Acupuncture, one or more needles, with electrical stimulation, each additional 15 minutes. With re-insertion.
Step 4: Submitting the Claim
The final step is submitting the claim. As a healthcare provider, you should have all the correct information about the veteran, treatment, and diagnosis. You can submit the claim through the Online Community Care Network (CNN) portal. You can also submit the claim manually through paperwork mentioning all the information and records of treatment. These documents will be sent to the VA office through the post. CNN portal method is the most preferred and efficient one.
After submission, VA staff will review your claim and verify all the details. It takes some days, but after the verification, reimbursement will be sent to your mentioned official bank account, and the final receipt will be sent to you. VA staff can ask for additional and clear details if any confusion or information needs to be clarified. Therefore, keeping all information on record is recommended to cope up wi6h all the disputes that can arise during the billing process.
Potential Challenges in AV Billing
- Credentialing delays
This is the challenge many healthcare providers face while obtaining credentials and approvals from the VA. It takes some time, and it will cause delays in payments. Therefore, it is very necessary to keep all these things in mind while going to affiliate with VA.
- Reimbursement rates
VA has different rates depending on the geographical location and your clinical standards. These rates can be lower than your expectations. Therefore, you must have an idea of VA reimbursement rates, and if you are comfortable with their rates, then go for the AV billing process.
- Documentation Standards
VA has strict documentation requirements, and you must be careful while submitting the claim or getting the reimbursement. VA staff can ask for many details and records while proceeding with this process. Any delay in documentation submission can cause either delay or denial of payment.
Conclusion
Acupuncture is the necessary treatment for pain management, mental health support, and overall body fitness. That’s why the VA also approved this treatment in veteran medical services. To successfully bill the VA for acupuncture, acupuncturists should follow the easy steps, including understanding the policies and standards of the VA, signing a contract with the VA for the acupuncture service, providing treatment, and proceeding with VA billing and submitting the claim.
If acupuncturists follow all the steps efficiently, they are more than welcome to become part of the VA community and enjoy the reimbursement. But there are some things they need to take care of. They should verify all the veteran’s details before starting the treatment and submit the claim by providing an accurate and useful record of the veteran and treatment to the VA.