Veterans' Health Care: Preliminary Observations on VHA's Claims Processing Delays and Efforts to Improve the Timeliness of Payments to Community Providers
Abstract
Due to increases in expenditures and utilization of VA care in the community services in recent years, VHA has had difficulty processing claims in a timely manner. In planning to consolidate its existing VA care in the community programs, as required by law, the agency said it will examine strategies for improving the timeliness and accuracy of its payments to community providers.This statement, which is based on ongoing work, summarizes GAOs preliminary observations about (1) VHAs, Medicares, and TRICAREs claims processing timeliness in fiscal year 2015; (2) factors that have impeded VHAs timeliness in processing claims; (3) community providers experiences; and (4) VHAs recent actions and plans to improve its claims processing and payment timeliness. To conduct its ongoing work, GAO obtained fiscal year 2015 data on the timeliness of VHAs, Medicares, and TRICAREs claims processing. GAO visited 4 of 95 VHA claims processing locations (selected on the basis of variation in geographic location, performance, and workload); reviewed VHA documents and 156 claims from those 4 locations; and interviewed officials from VHA, Medicare, TRICARE, and selected community providers and state hospital associations. Results from GAOs analysis are not generalizable to all VHA claims processing locations or community providers. GAO shared the information provided in this statement with VHA, Medicare, and TRICARE officials and incorporated their comments as appropriate. Because this work is ongoing, GAO is not making recommendations at this time.
Document Details
- Document Type
- Technical Report
- Publication Date
- Feb 11, 2016
- Accession Number
- AD1106076
Entities
People
- Randall B. Williamson
Organizations
- United States Government Accountability Office