U.S. Department of Veterans Affairs Implements New Referral and Payment Procedures
Written by Editor   
Friday, August 22, 2014 10:46 PM

Recognizing the difficulty that veterans were encountering in receiving treatment through the U.S. Department of Veterans’ Affairs (VA) Fee Care Program, which had expanded by over 300 percent over 9 years, the VA has been implementing two new initiatives, the Non-VA Care Coordination (NVCC) Program and the Patient Centered Community Care (PCCC or PC3) Program. These two initiatives are meant to address the challenges of the Fee program and ensure veterans receive effective and efficient non-VA care in a seamless manner.

NVCC is VA’s internal program to improve and standardize processes for referrals to non-VA care. The NVCC model centers on referral management and consistency in documenting, tracking, and coordinating patients in community health facilities. Through NVCC, non-VA care program staff will use standardized processes and templates for the administrative functions associated with non-VA care, including when a veteran is admitted to a non-VA health care facility for emergency treatment.

One of the non-VA care programs the NVCC oversees is the PCCC (PC3) program, a nationwide network of health care contracts to provide eligible veterans access to specialty care. Under PC3, VA contracts with Health Net and TriWest which have developed networks of providers who deliver the covered care, including chiropractic. The goal is to ensure veterans receive care from qualified community providers that is timely and accessible, while honoring Veterans’ preferences.

Under these new VAPC3 contracts, the VA is seeking standardized quality metrics, timely return of medical documentation, cost avoidance with fixed rates for services, guaranteed access to care, and enhanced tracking and reporting of non-VA medical care expenditures over traditional non-VA medical care services.

You may have heard from either EmpowerChiro, the administrator of the chiropractic benefit for

TriWest, or MultiPlan, the company recruiting providers for Health Net’s chiropractic program.

It is important to note that while you do not have to enroll with the EmpowerChiro or Health Net networks to treat veterans, in order to receive referrals and payment from the VA, you must enroll in the program in your region.

EmpowerChiro and Health Net will use a fee schedule based upon a discount off the local Medicare fee schedule covering all services that a DC is licensed to perform in their particular state. Currently, VA payment rates for chiropractic services are the lesser of 85% of the Medicare reimbursement rate or 60% of billed charges. If a Medicare reimbursement rate has not been established, reimbursement shall be the lesser of 85% of the VA Medical Center Fee Schedule or 60% of billed charges.

To find out more about the PC3 program, visit the VA Patient-Centered Community Care homepage. A fact sheet on the PC3 program may be found here.