Ernie Sadau
House Committee on Veterans’ Affairs
Subcommittee on Health
Assessing VA’s Ability to Promptly Pay Non-VA Providers
Written Testimony for the Record
Ernie Sadau, Chief Executive Officer
CHRISTUS Health
June 3, 2015
CHRISTUS Health is an international, faith-based, not-for-profit health system comprised of nearly 350 services and facilities, including more than 50 hospitals, primarily located in Texas, Louisiana, and New Mexico. We applaud the Subcommittee for examining the Department of Veterans Affairs’ (VA’s) ability to promptly pay non-VA providers for health care services provided to veterans.
As a mission-driven organization, CHRISTUS Health strives to provide high quality services and to create healthy communities for the patients we serve. Part of our vision is to increase access to care, and CHRISTUS Health is one of the largest providers of uncompensated care among Catholic-related health systems. To advance our mission, it is extremely important to obtain reimbursement from government payers for services provided in a timely manner.
Numerous CHRISTUS hospital facilities have proudly provided emergency services to veterans in the communities we serve. Most of these claims are for non-service related treatment and qualify for payment by the VA under federal law. CHRISTUS has subsequently and correctly billed the corresponding Veterans Integrated Service Network (VISN) for payment. All services provided in central and south Texas have been billed to VISN 17, located in Bonham, Texas. All services provided in north Texas, southeast Texas, and Louisiana have been billed to VISN 16, located in Flowood, Mississippi.
Our repeated attempts to collect payments through VISNs 16 and 17 have required significant staff efforts at additional administrative cost. To date, approximately 3,122 outstanding and unpaid claims remain, totaling $5,491,600.76. CHRISTUS Health respectfully requests the Subcommittee’s assistance in directing the VA to expedite reimbursement for all outstanding claims properly submitted for payment by non-VA providers.
Through its experience as a non-VA provider, CHRISTUS Health has identified the following issues that make collecting payment from the VA particularly time and labor-intensive: (1) extended wait times and non-responsiveness by VA staff; and (2) excessive claims processing times.
I. Extended Wait Times and Lack of Staff Response
CHRISTUS Health’s claims collection staff have experienced excessive hold times of between one to four hours. Once a CHRISTUS staff member is able to speak to VA staff regarding outstanding and unpaid claims, the VISN limits its response to a maximum of four accounts during particularly busy times. On several occasions, VA staff members have instructed CHRISTUS to fax a list of outstanding claims to obtain information regarding the status of these claims.
On occasions, several VA staff members have offered to provide assistance in ensuring timely reimbursement for unpaid claims. After reaching out by fax or to a specific VA staff person, however, CHRISTUS Health has been unable to obtain a status update or payment of outstanding claims.
Once a claim is submitted, if CHRISTUS is able to obtain an update on the claim’s status, VA staff report only that the claim is being reviewed. This status is typically communicated at each request for an update, prolonging the delays in claims processing.
II. Excessive Claims Processing Times
Reimbursement is delayed by the VISN through various means. For example, CHRISTUS Health has had difficulty in confirming that medical records information was timely received even though we have proof of delivery by certified mail. If the VISN reports that it has not received the claim, we send the claim a second time and sometimes a third time by certified mail.
When CHRISTUS Health provides the VISN staff with the certified tracking number for a claim, often the staff will report that although the VA received the claim, it has not been scanned and uploaded to the VISN’s system. We have found that the time between when the VISN receives the claim and uploads it into its system can be several weeks. Claims that VISN staff acknowledge as received and complete with the associated documentation are sometimes delayed for medical review, which also takes several weeks.
CHRISTUS Health routinely provides the VISN with the complete medical record associated with a claim. However, the VA commonly requests that CHRISTUS Health provide a specific document from the medical record (i.e., progress notes, nurse notes, emergency room summary). This request prolongs the payment cycle despite the fact that the documentation was provided as part of the medical record that was sent by certified mail to the VISN. We also have experienced difficulty in obtaining information on our accounts for various reasons such as patient names that are missing a middle initial. Finally, VA representatives have confided to CHRISTUS Health that the VA has a backlog of unpaid claims, and insufficient staffing results in delays in claims processing.
In conclusion, CHRISTUS Health remains deeply committed to serving veterans as a non-VA health care provider. We simply cannot afford the continuing burden of delayed and unpaid claims that were properly submitted to the VA for payment, however. We therefore respectfully request the Subcommittee’s continued and active oversight to ensure that the VA resolves the backlog of overdue claims in a timely manner. Thank you again for your leadership on these issues and your consideration of our views.
OUR MISSION “To Extend the Healing Ministry of Jesus Christ”
CHRISTUS Health
919 Hidden Ridge, Irving, TX 75038
Tel 469.282.2000