[Federal Register Volume 71, Number 162 (Tuesday, August 22, 2006)]
[Notices]
[Pages 48979-48980]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-13801]


-----------------------------------------------------------------------

DEPARTMENT OF VETERANS AFFAIRS


Medicare-Equivalent Remittance Advice; Use by the Department of 
Veterans Affairs

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: The Department of Veterans Affairs (VA) is making a change in 
its procedures for seeking reimbursement from third-party insurers for 
certain medical care and services provided to Medicare-eligible 
veterans for nonservice-connected disabilities, to add a Medicare-
equivalent remittance advice (MRA) as an attachment to each bill for 
such care and services provided by VA, with the exception of those 
services noted in the SUPPLEMENTARY INFORMATION section below.

FOR FURTHER INFORMATION CONTACT: Barbara C. Mayerick, VHA Chief 
Business Office (161), Veterans Health Administration, Department of 
Veterans Affairs, 810 Vermont Ave., NW., Washington, DC 20420, 
Telephone: (202) 254-0337. (This is not a toll free number.)

DATES: Effective:
    August 22, 2006.

SUPPLEMENTARY INFORMATION: Section 1729, Title 38, United States Code, 
is VA's authority to seek reimbursement from third-party insurers, 
including Medigap and other Medicare supplemental insurers, for the 
cost of medical care or services furnished to veterans for nonservice-
connected disabilities as described below. Section 17.101 of title 38 
of the Code of Federal Regulations sets forth VA's methodology for 
``reasonable charges'' for medical care or services provided or 
furnished by VA to a veteran for nonservice-connected disabilities:

--For a nonservice-connected disability for which the veteran is 
entitled to care (or the payment of expenses of care) under a health 
plan contract;
--For a nonservice-connected disability incurred incident to the 
veteran's employment and covered under a workers' compensation law or 
plan that provides reimbursement or indemnification for such care and 
services; or
--For a nonservice-connected disability incurred as a result of a motor 
vehicle accident in a State that requires automobile accident insurance 
in a State that requires automobile reparations insurance.

    VA has entered into an interagency agreement (IA) with the Centers 
for Medicare and Medicaid Services (CMS) which allows VA to work with 
the CMS fiscal intermediary and carrier, currently TrailBlazer Health 
Enterprises (TrailBlazer), in processing VA claims on a no-pay basis 
and produce Medicare-equivalent Remittance Advice (MRA) notices for the 
cost of medical care furnished to Medicare-eligible veterans for 
nonservice-connected treatment. The MRA reflects the payment that 
Medicare would have made, along with the deductible and coinsurance 
amounts applicable, for an equivalent service rendered by a Medicare 
provider. VA's bills are processed according to Medicare's coverage and 
payment policies, as well as claims processing guidelines and 
timeframes. Supplemental insurers will use this information to 
reimburse the VA coinsurance and deductible amounts they would have 
paid had the claims been payable by Medicare.
    VA attaches the MRA provided by TrailBlazer to VA's secondary claim 
and both are submitted to the Medigap or other Medicare supplemental 
insurer either via the standard 837 transaction or via a print/mail 
function at the clearinghouse.
    The attachment of the MRA to VA's bills submitted to Medigap or 
other Medicare supplemental insurers will improve VA's collection from 
these insurers. The MRA will correct the practice of overstating VA's 
outstanding accounts receivable by recording the expected supplemental 
payment rather than 100 percent of VA's billed charges. The submission 
of the MRA with a claim to Medigap or other Medicare supplemental 
insurers is expected to reduce the number of denials VA receives from 
supplemental insurers, since it will be obvious from the bill and the 
MRA that VA intends to collect only the supplemental payment.
    Effective August 22, 2006, with the exception of the following 
services, all VA Medical Centers will submit an

[[Page 48980]]

MRA along with bills to Medigap or other Medicare supplemental 
insurers:

------------------------------------------------------------------------
      [radic]               Claim type            Reason for exclusion
------------------------------------------------------------------------
1.................  Purchased Services (fee-   Centers for Medicare and
                     basis, contracted out).    Medicaid (CMS) and VA
                                                policy differences.
2.................  Mammography Services.....  CMS and VA policy
                                                differences.
3.................  Institutional (Part A)     Updates in process:
                     Adjustments.               Expected to be included
                                                October 2006.
4.................  Skilled Nursing            Not currently covered by
                     Facilities (SNF).          CMS/VA Interagency
                                                Agreement.
5.................  Ambulance................  CMS and VA policy
                                                differences.
6.................  Rehab Services...........  Not currently covered by
                                                CMS/VA Interagency
                                                Agreement.
7.................  Professional (Part B)      Not currently covered by
                     Durable Medical            CMS/VA Interagency
                     Equipment (DME) and        Agreement.
                     Prosthetics & Orthotics
                     (P&O).
8.................  Hospice/Respite Care.....  Not currently covered by
                                                CMS/VA Interagency
                                                Agreement.
9.................  Home Health Care (HHC)...  Not currently covered by
                                                CMS/VA Interagency
                                                Agreement.
10................  Maintenance/Routine        Not currently covered by
                     Dialysis.                  CMS/VA Interagency
                                                Agreement.
11................  Patients with Medicare     Not currently covered by
                     Health Maintenance         CMS/VA Interagency
                     Organization (HMO)         Agreement.
                     Policies.
12................  Independent Laboratories.  Not currently covered by
                                                CMS/VA Interagency
                                                Agreement.
13................  Ambulatory Surgical        Not currently covered by
                     Centers.                   CMS/VA Interagency
                                                Agreement.
------------------------------------------------------------------------

    VA continues to work with CMS to add these claim types to our 
program; in the interim, we expect that all Medicare supplemental 
insurers will continue to process these claims for payment under their 
previous methodology and based on the provisions of 38 U.S.C. 1729.

    Authority: 38 U.S.C. 1729.

    Approved: August 10, 2006.
Gordon H. Mansfield,
Deputy Secretary of Veterans Affairs.
[FR Doc. E6-13801 Filed 8-21-06; 8:45 am]
BILLING CODE 8320-01-P