Medical Billing Procedures for VA

The Department of Veterans Affairs has medical billing concerning patient's medical services. VA's medical billing, also called claims processing, results in fee collection so providers like the VA can receive payments for the physician's provided treatment. Such payments need to be collected and processed in a timely manner for all rendered services.

Billing

• Billers process each encounter when patients see a physician. The staff will review the patient insurance to take note of any coinsurance payments by second and third-party providers to proceed with the correct payment procedure. VA billing staff will coordinate benefits on what procedures are covered by VA payment polices, and verify coverage limits on how much payment can be provided.

Medical Codes

• The necessary medical codes need to be documented so the VA pays for the correct services that had been provided. Medical coding consists of International Statistical Classification of Diseases and Related Health Problems (ICD-9), Healthcare Common Procedure Coding System (HCPCS), and Current Procedure Terminology (CPT). Medical information such as the physician's diagnosis, treatment and followup care is condensed into small specific codes, with each code telling the billing staff what type of payment needs to be accounted on the claim bill.

Automatic Claims Processing

• The VA uses an automatic claims processing called an Auto Biller with Integrated Billing. Once the billing staff has reviewed and verified insurance and benefits for the patient, the Auto Biller will gather the remaining information to create the claim form. Information for in-patients will become gathered from patient treatment file (PTF) records as additional information will be collected regarding all outpatient rendered services.