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Office of General Counsel

 

VA Subrogation – Request VA Medical Bills

VA’s Federal Medical Care Recovery Program ensures that when a Veteran is injured, the responsible party pays for the injured Veteran’s medical care instead of the American taxpayers. Money recovered by this program helps each VA medical facility provide the excellent medical care and services that each Veteran deserves by supplementing funds appropriated to VA by Congress.  Please take the time to let us know what you think of this site by clicking here.

How do I get bills for treatment at VA facilities or treatment paid for by VA (includes Veterans Choice Program)? Click here

Please note that billing for injury-related care provided to a Veteran at a VA facility or provided to a Veteran at a non-VA facility and paid for by VA (includes Veterans Choice Program) must be created by VA at the time it receives a request. This process normally takes 60 days from when VA receives all information needed. VA’s Office of General Counsel’s Collections National Practice Group will provide a notice of claim and a ledger of billed charges for injury-related care once those charges have been created.

How do I get bills for care rendered to family members of Veterans and paid for by CHAMPVA?  Click here.

The CHAMPVA program provides benefits to family members of Veterans. For care paid for by the CHAMPVA program, please submit all of the indicated information with regards to the CHAMPVA beneficiary instead of the Veteran so that your request can be most expeditiously processed. Failure to submit complete information to the appropriate office may result in significant delays in processing your request. Please note this is not the proper office for processing requests for bills for care that was provided or paid for by a VA Medical Center, please send those requests as indicated above.

How do I get VA medical records?

Submit a request for VA Medical Records  to the VA Medical Center that provided the care. 

How can I follow up on the status of my request for bills?

Absent an urgent legal deadline such as a mediation or trial date or court order, please do not follow up before 60 days from the date your request was submitted in full.
If billing has not been received after 60 days from the date your request was submitted in full, please make inquiries to the Facility Revenue staff for the VA Medical Center that provided or paid for the care.

After receiving billing, your contact will be the Case Manager from the Collections National Practice Group identified on the notice of claim and ledger of billed charges.

Frequently Asked Questions:

I thought Veterans were entitled to medical care without charge. Why is VA seeking reimbursement?

Veterans are not provided care without charge for non-service connected disabilities if one or more of the following is responsible for the cost of that care:

·       Tortfeasor and/or their insurer (common examples are motor vehicle insurance, medical malpractice insurance, homeowners insurance)

·       Veteran's own insurance (common examples are motor vehicle insurance including no-fault or auto reparation insurance, underinsured or uninsured motorist coverage)

·       Workers' compensation insurance

·       Right to maintenance and cure in admiralty

Reimbursement to VA from these sources does not impact the responsibility of Veterans to pay applicable VA copayments. 38 U.S.C. § 1729, 42 U.S.C. § 2651, 38 C.F.R. § 17.47

I am service-connected for a condition that was aggravated or exacerbated in an accident or incident. How does this affect VA’s right to reimbursement?

Care of a service-connected disability is not reimbursable to VA under this program unless an accident or incident resulted in additional care for the condition. Under those circumstances, the responsible third-party payer would be responsible for reimbursement to VA for the additional cost of care that was related to the accident/injury. 38 U.S.C. § 1729, 42 U.S.C. § 2651.

Will VA file its own lawsuit?

Not usually. The government may independently institute an action for recovery in federal court; it may intervene in the underlying case and seek removal of the case to federal court; or, it may assert a subrogation claim in the underlying case. Unless otherwise advised, VA asserts a subrogation claim rather than exercising the government’s right to institute an action or intervene. In so doing, VA works collaboratively with the Veteran and the Veteran retains control of the personal injury/workers compensation case. 38 U.S.C. § 1729, 42 U.S.C. § 2651.

How are VA’s medical charges determined?

VA’s “reasonable charges” are determined in accordance with federal law and regulation. The regulation contains formulas to determine the charge for the care which take into account the type of care and other variables such as the geographic area where the service was provided. All rates are published in the Federal Register. 38 C.F.R. § 17.101(a)(2). 

VA billing rates “shall be” judicially noticed. 44 U.S.C. § 1507. State courts are subject to and bound by judicial notice of federal laws and regulations. See Associated East Mortgage Co., v. Young, 163 N.J. Super. 315, 394 A. 2d 899 (Oct. 1978) and Lange v. Nelson-Ryan Flight Service, Inc., 259 Minn. 460, 466, 108 N.W.2d 428 (1961). Further, the government is not required to litigate reasonableness of administratively fixed rates as compared to prevailing rates at local civilian facilities. VA billing rates are not subject to challenge for unreasonableness or arbitrariness. U.S. v. Jones, 264 F.Supp. 11 (E.D. Va. 1967) and Phillips v. Trame, 252 F.Supp. 948 (E.D.Ill.1966).  38 U.S.C. § 1729, 42 U.S.C. § 2651, and 38 C.F.R. § 17.101

I need help understanding the billed charges on the ledger…

Account ID - This column contains the identifier for the billed charge on that line.  The first three numbers denote the VA Medical Center that provided or paid for the treatment, followed by a dash and a K and then a randomized alphanumeric sequence. The VA Medical Center where treatment was rendered is of importance because the zip code wherein the facility is located is used along with the national base rate for the CPT/HCPCS code or DRG to determine the amount of the billed charges as formulated in 38 C.F.R. § 17.101.

Service Date - This column contains the date the services were rendered for inpatient and outpatient professional charges and outpatient facility charges, the date of admission for inpatient hospitalization facility charges, and the prescribing date for prescription drug charges.

LOS – LOS stands for Length of Stay and this column contains the number of days. This information is of primary interest for inpatient hospitalization facility charges as they are calculated on a per diem basis as formulated in 38 C.F.R. § 17.101.

Bill Classification - This column contains a shorthand for the classification of the bill. Common classifications include RX for pharmacy, OUTP for Outpatient, and INP for Inpatient.

Bill Type - This column contains the type of billed charges. Common types are Pharmacy (which denotes prescription drug charges), Outpatient (which denotes Outpatient Facility charges), Profee-Hospital/Profee-Clinic (which both denote Professional charges and indicate the setting where services were provided - hospital or clinic), and Inpatient (which denotes Inpatient Facility charges). Note that for most services, there will be both facility and professional charges and these will have separate Account IDs as they are determined using separate formulas under 38 C.F.R. § 17.101.

Provider Name - This column contains the name of the VA provider who provided the services or, in the case of care paid for by VA, the name of the VA provider who made the referral for the services.

Provider Taxonomy - This column contains the specialty of the provider indicated in the column titled Provider Name.

Primary Diagnosis - This column contains the diagnosis determined to be primary using industry standard medical coding software programs following standard medical coding of the medical records for this service. Please note that other diagnoses made during this service will not be listed on this ledger as the ledger only contains that diagnosis determined to be primary under industry standard medical coding. The primary diagnosis along with all other diagnoses made during this service are together as a group used in standard medical coding software programs to determine the applicable CPT/HCPCS code or DRG.

Billed CPT/HCPCS Code(s) – formerly titled Claim Procedures - This column contains the CPT/HCPCS code(s) as determined by industry standard medical coding software programs. The CPT/HCPCS codes are used along with the zip code of the treating VA Medical Center to determine the billed charge for inpatient and outpatient professional charges and outpatient facility charges as formulated in 38 C.F.R. § 17.101. Some CPT codes may have a three digit code preceding the CPT code, please note that these three digit codes are facility codes that are not used for purposes of creating charges.

Billed DRG - This column contains the DRG as determined by industry standard medical coding software programs. The DRG is used along with the zip code of the treating VA Medical Center to determine the billed charge for inpatient hospitalization facility charges as formulated in 38 C.F.R. § 17.101.

Billed Charges - This column contains the charges as determined by federal regulation based on the type of service provided when the service was provided at a VA Medical Center. See 38 C.F.R. § 17.101 for formula details. 38 U.S.C. § 1729, 42 U.S.C. § 2651, and 38 C.F.R. § 17.101

Who do I contact if there is billing included in VA’s notice of claim that I wish to dispute?

If a Veteran or his or her attorney or other representative believes any billing included in the VA’s notice of claim should be removed from the reimbursement amount, timely written documentation supporting that position must be sent directly to the Collections National Practice Group team member identified in VA’s notice of claim.

Upon completion of its dispute review process, the Collections National Practice Group will notify all authorized parties of the resolution of the dispute.

My case has settled.  Is there a process for requesting a compromise or waiver of a VA subrogation (reimbursement) claim?

To request a compromise or waiver of a VA subrogation claim when there is not enough money from settlement/judgment to satisfy all claims, provide the following information to Collections National Practice Group team member identified in VA’s notice of claim so that VA may ensure there is an equitable distribution of proceeds.

·       Amount of settlement

·       Details of amounts and types of insurance coverage (should this information not have already been provided)

·       Amount of attorney’s costs and fees, please indicate if any reductions were taken

·       Amount of other medical claims and reductions negotiated

·       Any other factors you wish VA to consider (for example: a Veteran’s payment of VA copayments)

Please be advised that the Department of Justice must approve all requests for compromise or waiver on claims between $300,000 and one million dollars.  The Office of the Attorney General must approve all requests for compromise or waiver on claims greater than one million dollars.

Upon completion of the compromise/waiver review process, the Collections National Practice Group will notify the Veteran or his or her attorney or other representative of the decision.

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