BC Advantage - 2019 Issue 11

VA: How UCR Charges are Determined

How does the VA determine charges billed to third party payers for Veterans with private health insurance?According to the VA. "38 C.F.R 17.101 stipulates the basic methodology by which VA bills third party insurance carriers. In order to generate a charge for medical services, VA establishes reasonable charges for five categories of charges:- Inpatient facility- Skilled nursing facility (SNF)/sub-acute inpatient facility- Outpatient facility- Physicians- Nonphysician providersReasonable charges are developed nationally and then adjusted locally by each VA medical center based on their Geographical Area Adjustment Factor (GAAF). Billing for inpatient facilities and skilled nursing...

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