Citation Nr: A21019393
Decision Date: 12/06/21	Archive Date: 12/06/21

DOCKET NO. 210210-185363
DATE: December 6, 2021

ORDER

The appeal concerning entitlement to payment for non-VA medical services provided to the Veteran on March 4, 2020 is dismissed.

FINDING OF FACT

Subsequent to the appeal of the denial of payment for non-VA medical services provided to the Veteran on March 4, 2020, the Agency of Original Jurisdiction (AOJ) administratively reversed the denial and approved the episode of care for payment.

CONCLUSION OF LAW

As the benefit sought on appeal has been granted and resolved by administrative action, there remains no allegation of error of fact or law concerning the issue on appeal; the appeal is therefore moot, and dismissal is appropriate.  38 U.S.C. § 7104; 38 C.F.R. § 20.104.

REASONS AND BASES FOR FINDING AND CONCLUSION

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2020 decision by a Department of Veterans Affairs (VA) Medical Center (VAMC); this constitutes an initial decision, and the modernized review system, also known as the Appeals Modernization Act (AMA), applies.  On the January 2021 VA Form 10182, Decision Review Request: Board Appeal, the appellant elected the Direct Review docket. The appellant is the vendor who provided the non-VA medical services to the Veteran on March 4, 2020.

The appeal concerning entitlement to payment for non-VA medical services provided to the Veteran on March 4, 2020 is dismissed.

In the October 2020 administrative decision on appeal, the AOJ denied payment of the charges ($1,864.00) billed by the appellant for medical services provided to the Veteran on March 4, 2020 on the basis that the time limit for filing had expired.  In an October 2020 correspondence, the appellant argued that the claim should not have been denied based on timely filing requirements.  The appellant further indicated that the claim was originally submitted on March 5, 2020 (the day after services were rendered to the Veteran) and then resubmitted again in July 2020 and August 2020 after the appellant was informed by VA that information pertinent to the payment of the claim was either missing or invalid. 

In December 2020, prior to the Board issuing a decision on this appeal, the claim for payment was approved under 38 U.S.C. § 1703.  An August 2021 Report of Contact and eCAMS screenshot prepared by a Veterans Health Administration (VHA) Proactive Outreach Manager (POM) shows that the claim was paid on December 31, 2020 in the amount of $1,608.93.  Presumably, the difference between the amount billed and the amount paid is the amount that was covered yb the Veteran's Medicare A coverage.

In this case, the record indicates that the AOJ has reviewed and administratively approved payment for the non-VA medical services provided to the Veteran on March 4, 2020, representing a full grant of the benefits sought in this appeal.  As a result, there is no remaining allegation of error of fact or law for appellate consideration in the present appeal.  See 38 C.F.R. § 20.104.  Accordingly, the Board no longer has jurisdiction over the appeal, and it is therefore dismissed.  See 38 U.S.C. § 7104.

If later decisions/explanations of payment (EOPs) concerning this episode of care result in payment by VA in an amount disagreeable to the appellant, the vendor may file separate/additional appeals of those subsequent decisions.

 

John J. Crowley

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Michael L. Marcum, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.