MANCHESTER — The VA still owes New Hampshire health care providers an estimated $134 million, as the administration digs out from a backlog of claims.
Kevin Forrest, interim director of the Department of Veterans Affairs Manchester Medical Center, said the delayed payments dated back to a contractor who used to administer the VA Community Care Network program.
The network lets Veterans use their VA insurance to pay for treatment outside VA hospitals — from other hospitals and small providers like home health aides, therapists and acupuncturists.
Providers complained of widespread delays and errors in payments last year, and the VA brought in a new contractor to process those claims. But the administration is still working through the nationwide payment backlog.
In the two years since Kathy Twombly’s Laconia acupuncture business has been part of the network, she said the VA has at times left her waiting for as much as $10,000. To make matters worse, the VA has switched contractors three times in two years, she said, meaning the way she files claims keeps changing.
“Once you get used to one way of doing things, they change it,” she said.
Without the guidance of an expert biller, Twombly said she likely would have left the VA network and stopped treating people with VA insurance.
But Twombly said since the latest contractor started in the summer of 2019, payments have been coming much faster. She said she has been getting paid around 30 days after she sends a bill — about on par with private insurance, she said. Forrest said the VA has gotten the average payment time down to 11 days for new claims, and is now plowing into that $134 million backlog.
The VA has to make sure sure community care network members like Twombly get paid for the care they provided.
To help hospitals and other providers sort through their claims, Forrest said the VA will send staff to work in person with billing departments to sort through the claims and get paperwork in order so that the VA can make those reimbursements.
“There’s no substitute to meeting face-to-face and working through this challenge,” Forrest said.
He said he hoped the work would help rebuild providers’ trust in the VA, and keep them in the community care network.
“We depend on the network to care for our Veterans,” Forrest said.
The VA is also meeting with patients face-to-face around New Hampshire, Forrest said, with forums around the state to hear concerns, and make sure Veterans are aware of some newer offerings like telehealth.
Steve Norton, chief strategy officer for Elliot Hospital’s parent company SolutionHealth, said he has seen improvement since the beginning of the year.
“We’ve seen some significant positive steps forward,” Norton said. “There’s general optimism about how things are going to go.”
Elliot Hospital is still waiting for $3 million to $4 million in payments from the VA, he said. But Norton said the hospital system has enough of a financial cushion to wait for payment while the VA focuses its immediate attention on smaller providers whose businesses survive hand-to-mouth.
He said he expects a “significant portion” of the claims would be resolved in the next two months.
“Claims processing is a complicated thing, especially when you change vendors,” Norton said.
Catching up on the backlog is even more grown complex, he said, because it involves both the current and former contractors.
“While this is painful, it’s somewhat of a success story,” he said. “The right people got in the same room at the same time, and there seems to be a solution.”
Rep. Chris Pappas (D-NH) has been working on the issue as chair of the Oversight and Investigations Subcommittee of the House Committee on Veterans’ Affairs. The committee held a hearing on the reimbursement issue on Feb. 12, and Pappas met with Forrest and local providers in Manchester last Thursday.
He said he planned to focus his attention on making sure the VA had the budget to run the community care program. He said providers asked for more VA staff to help them sort through the outstanding claims, like the teams Forrest has pledged to send to help providers.
“It’s really unacceptable that things have languished this long,” Pappas said. “The VA has long been under-staffed ad under-resourced, especially in the community care department.”
The VA’s budget request is set to be presented in Washington this week, and Pappas said he wanted to make sure the budget could fund a larger community care staff at the VA.
Matt Mayberry, one of the Republicans running to challenge Pappas in November, said he thinks Pappas should have intervened earlier.
“It should never have gotten to this point to begin with,” Mayberry said.
Mayberry said he has met Veterans whose mental health care providers stopped taking VA clients because the VA was not paying its bills, leaving them without mental health care. Even though the backlog is getting smaller, Mayberry said, better oversight would have caught the problem earlier or prevented it from happening.
“He took his eye off the ball, and it dropped,” he said.
“This whole situation is unacceptable,” said Matt Mowers, another Republican candidate for the congressional seat, who said the issue was personal because he has family members who use the VA system in New Hampshire.
Despite the billing troubles, acupuncturist Twombly said she wanted to stay in the network and keep serving Veterans. Treating Veterans’ ailments, from chronic pain to post-traumatic stress, has pushed Twombly to learn more, she said.
“Working with the Vets has really changed my life,” she said. “Of course getting paid is a big thing. But I want to see the Veterans not have to fight for their services so much.”
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