by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Feb 15th, 2022
Representing the methodologies used in the VA's pricing determinations is better understood coming directly from the source or an attorney who is familiar with the laws. Our responsibility is to educate you with information directly from the source, where you can find your answers or contact them directly. We are happy to let you know where we get our data and the VA has made public how their benchmarks are set, along with the methodologies used to provide the fees. However, we are not qualified to give out legal advice or attempt to explain the methods and rules used in the final fee selection. We have done our best in an attempt to educate our customers with the information used by the VA and have consolidated the information on our UCR TOPIC Page, free for your viewing.
Find-A-Code is happy to offer the VA's UCR fees to our customers, however, since interpreting the methodologies is a complex process, we have gathered information directly from the VA to help our customers in understanding how the pricing is determined.
Data sources used to calculate actual charge amounts can be on the found Federal Register or on the Internet site of the Veterans Health Administration Office of Community Care, currently at https://www.va.gov/COMMUNITYCARE, under “Payer Rates and Charges."
The following information has been provided by Cornell Law and interpreted by an attorney and has published an article for public viewing.
38 CFR § 17.101 - Collection or recovery by VA for medical care or services provided or furnished to a veteran for a non-service-connected disability.
"Data for calculating actual charge amounts based on the methodologies set forth in this section will either be published in a notice in the Federal Register or will be posted on the Internet site of the Veterans Health Administration Office of Community Care, currently at https://www.va.gov/COMMUNITYCARE, under 'Payer Rates and Charges.' For care for which VA has established a charge, VA will bill using it's most recent published or posted charge. For care for which VA has not established a charge, VA will bill according to the methodology set forth in paragraph (a)(8) of this section."
About Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Christine Woolstenhulme, CPC, QCC, CMCS, CMRS, is a Certified coder and Medical Biller currently employed with Find-A-Code. Bringing over 30 years of insight, business knowledge, and innovation to the healthcare industry. Establishing a successful Medical Billing Company from 1994 to 2015, during this time, Christine has had the opportunity to learn all aspects of revenue cycle management while working with independent practitioners and in clinic settings. Christine was a VAR for AltaPoint EHR software sales, along with management positions and medical practice consulting. Understanding the complete patient engagement cycle and developing efficient processes to coordinate teams ensuring best practice standards in healthcare. Working with payers on coding and interpreting ACA policies according to state benchmarks and insurance filings and implementing company procedures and policies to coordinate teams and payer benefits.