Provider Pulse – January 2024
2024 VA Fee Schedule Now Available
The 2024 Department of Veterans Affairs (VA) Fee Schedule (VAFS) is now published.
VA reimburses medical services, hospital care and extended care services up to the maximum allowable rate. The maximum allowable reimbursement rate is generally the applicable Medicare rate published by the Centers for Medicare and Medicaid Services. When there is no Medicare rate available, VA reimburses the lesser of VAFS or billed charges.
VA continues to modernize the reimbursement methodology to ensure maximum allowable VAFS rates are consistent with industry reimbursement benchmarks and ensure that most services have maximum allowable rates. The goal of VAFS is to ensure fair reimbursement for all providers when Medicare maximum allowable rates are not available.
Reimbursement rates are subject to change.
More information for providers can be found at the VA Fee Schedule webpage.
A Refresher on Other Health Insurance (OHI) Framework
As a reminder, TriWest Healthcare Alliance (TriWest) always pays primary for pre-authorized services for Veterans treated under the Department of Veterans Affairs (VA) Community Care Network (CCN). VA benefits do not coordinate with other commercial or federal programs (TRICARE, Medicare, Medicaid, etc.).
OHI Billing Process
TriWest will always pay primary on service-related or service-connected treatments, regardless of a Veteran’s OHI. Always be sure to bill TriWest even if the Veteran has Medicare or Medicaid as TriWest cannot pay secondary.
Please remind billing teams that if a provider has an approved referral/authorization on file from TriWest the provider should bill TriWest.
Include JZ and JW Modifiers on Single-Dose Drug Containers to Mitigate Denials
In accordance with Medicare requirements, TriWest Healthcare Alliance (TriWest) requires modifier JZ on all professional claims billing for drugs in a single-dose container when there are no discarded amounts.
As of October 1, 2023, TriWest began returning professional claims to the provider when a drug in a single-dose container is billed without the appropriate modifier.
To submit claims for a non-discarded drug, submit one claim line for the drug with modifier JZ indicating no waste.
TriWest will also require discarded drugs be reported with modifier JW on a separate line with the total number of discarded units. Both of these requirements are consistent with Medicare guidelines.
The above requirements will be subject to audit and corrective action if not billed appropriately.
- Code & Description:
- JW: Drug amount discarded/not administered to any patient
- JZ: Zero drug amount discarded/not administered to any patient
For more information, please reference the Center for Medicare & Medicaid Services JW and JZ Modifier Billing Guidelines.
Look Up Military Exposure with VA’s Exposure Ed 2.0 App
Exposure Ed 2.0 is the Department of Veterans Affairs’ free app that provides information on military-related exposures to Veterans. It also helps locate nearby VA facilities where Veterans can access benefits and services.
With the app you can find military exposures by a specific exposure name, conflict, or date and location of military service. You can also learn about exposure-related VA programs and policies, access tips for asking questions and communicating risks to Veterans, get help creating a care plan, and build customizable notes. Resources are also available to share with your Veteran patients through email or printing.
Several enhancements were made for version 2.0 of the app:
- Nearby VA facilities are easier to find: The app now incorporates location services so users can easily find VA facilities close to their current location.
- VA Contact Info: Conveniently locate points of contact at VA facilities to share with patients.
- VA HOME Announcements: VA’s Health Outcomes Military Exposures (HOME) administers various programs related to environmental and occupational exposures of Veterans during their military service. Announcements focus on military exposure issues, including recently published HOME newsletters.
- PACT Act: Access information on benefits provided by the PACT Act and the purpose of toxic exposure screening.
Exposure Ed 2.0 is available on Android and iOS devices. To learn more about the app and to download it on your mobile device, please visit Exposure Ed | VA Mobile.
U.S. Marine Corps Veteran Amputee on a Mission to Improve Prosthetics
As a former U.S. Marine Corps Reserve Captain (O-3), Jon Kuniholm deployed to Iraq as a Combat Engineer and Platoon Leader after receiving orders to activate less than 48 hours after swearing in for Reserve service. Jon’s lower right arm was nearly severed in an improvised explosive device (IED) explosion while on patrol in Anbar Province in support of Operation Iraqi Freedom on New Year’s Day 2005, and was later amputated. Now he works to improve prosthetics for others.
Provider Handbook Updates