Transcript Slide 1

• VA Meeting in Shreveport last month.
• Claims Fact Sheet to Increase Transparency
• Timeline to process- goal is 30 days, but in
reality anywhere between 30-60 days.
• Contact Sandra Brown if there are any
problems. (318) 9900-4778; Email:
[email protected].
• Tips from the VA
• If claim sent to Shreveport VA and was
supposed to be sent to VISN 16, Mrs. Brown
will forward it to VISN 16.




Providers can appeal denied claims. There is no need to
get consent from the patient.
Randy Colvin, non-VA reimbursement manager,
informed me that providers should submit paper claims
in lieu of sending them electronically. He said that this
should cut down on some problems providers are
having, such as lost medical records or trip notes.
Another advantage to sending paper claims is that these
claims can be reopened, but this option is not available
for electronically submitted claims.
Colvin also stated that trip notes should be the only
medical documentation that VISN 16 should need from
the provider. However, VISN 16 does not agree with this
and continues to request hospital/ER medical records
• The meeting in Pineville was led by Joe Enderle, director of operations for the
VA Chief Business Office (CBO). He started off by stating the different types of
changes that will be implemented since the passing of the Veterans Access,
Choice, and Accountability Act of 2014. When the bill was signed into law, the
authority to pay for hospital care, medical services, and other health care
through non-VA medical care providers was formally transferred to the CBO.
Enderle admitted that one of the biggest problems with claims processing
throughout the country is that there was a lack of standardization, and that
each regional center was not following the national standardized process.
• Also, there is a new supervisory structure in place for the VISN’s. The
supervisory structure. One of the biggest changes is that the CBO will provide
direct oversight over the claims process.
• Enderle informed us that his team was going to VISN 16 at the end of
November, and they were going to go through all the boxes of claims and
medical records that were stagnant and not processed. He informed everyone
that the last time they cleaned out a VISN’s old file cabinets and boxes, the
process took over four months. He assured everyone that there will be more
responsibility and liability on the claims processing staff and there will be
repercussions for individuals not performing up to expectations. Enderle also
shared that the CBO is trying to speed up the appeals process.


When asked what type of metrics he will use to
gauge success, Enderle stated that he will judge
success by the amount of new claims that are
processed within a 30 day period.
I specifically asked Enderle, how far back was the
VA willing to go when processing claims because
some providers have claims that are 7-10 years
old, and no response was given by the VA. He
stated that he knows the problem goes back to a
couple years after the passing of the Millennium
Bill so he will push for the VA to go back to 2000
when processing outstanding claims.



Emily Copeland -- [email protected];
(318) 466-2424
If requesting information about a claim, she
will need several facts before she can give an
update.
These include: 1) patient’s name 2) last four
digits of the patient’s social 3) the amount
charged/owed 4) originating site of the
transport 5) destination 6) date of service.






Bayou Health- the new managed care system will go into
effect on February 1, 2015.
Five Companies where recommended by DHH after the
bids were reviewed: 1) Aetna Better Health of Louisiana 2)
Amerigroup Louisiana, Inc. 3) Amerihealth Charitas
Louisiana, Inc., 4) Louisiana Healthcare Connections 5)
UnitedHealthcare Community Plan.
Conference Calls Every Wednesday from 12 pm – 1pm
(Starting Today Until Implementation Date)
Number:1-888-278-0296
Access Code: 2833686
Providers can also email questions to [email protected]



2005 -- LR 31:3163 states that “the Department of Health
and Hospitals, Office of the Secretary, Bureau of Health
Services Financing discontinues the requirement for
completion of the medical transportation certification form
for reimbursement of emergency ambulance services.”
This same language was also passed in a state plan
amendment which has not been repealed or superseded.
Emergency response is defined as “a BLS or ALS1 level of
service that has been provided in immediate response to a
911 call or the equivalent. An immediate response is one
in which the ambulance provider/supplier begins as
quickly as possible to take the steps necessary to respond
to the call.” (Medicare Benefit Policy Manual Chapter 10 Ambulance Services p. 29-30).



2014- Reimbursement for Non-Emergency
Medical Transports
La. Admin. Code Title 50, part XXVII, Sec. 571
states “reimbursement for non-emergency
ambulance transportation claims shall be allowed
only when accompanied by the medical
certification form justifying the need for
ambulance services.”
However, this certification form is not mentioned
in the section regarding reimbursement for landbased emergency ambulance transportation. La.
Admin. Code Title 50, part XXVII, Sec. 325.

Louisiana law does offer protection to certain documents
which are created by a healthcare practitioner’s quality
review committee/panel. These protections are provided
by La. R.S. 13:3715.3. The statute states “all records,
notes, data, studies, analyses, exhibits, and proceedings
of: … the peer review committees of any… ambulance
service company… or healthcare provider as defined in
R.S. 40:1299.41(A), or extended care facility committee,
including but not limited to the credentials committee, the
medical staff executive committee, the risk management
committee, or the quality assurance committee, any
committee determining a root cause analysis of a sentinel
event, established by the peer review committees of …
ambulance service company or healthcare provider as
defined in R.S. 40:1299.41(A), or private hospital licensed
under the provisions of R.S. 40:2100 et seq.,

shall be confidential wherever located and
shall be used by such committee and the
members thereof only in the exercise of the
proper functions of the committee and shall
not be available for discovery or court
subpoena regardless of where located.
(emphasis added). La. R.S. 13:3715.3(A)



Not every single fact brought before a peer
review/quality assurance committee is protected
by the privilege.
“[W]hen a plaintiff seeks information relevant to
his case that is not information regarding the
action taken by a committee or its exchange of
honest self-critical study but merely factual
accountings of otherwise discoverable facts, such
information is not protected by any privilege as it
does not come within the scope of information
entitled to that privilege.”
Smith v. Lincoln General Hosp., 605 So.2d 1347,
1348 (La. 1992).

In short, there are several requirements that
must be met in order for the protections
under La. R.S. 13:3715.3 to apply. First, your
service must be listed in the statute.
Ambulance Service Company is listed in the
statute. Second, the document or notes must
be created by a peer review committee or a
quality assurance committee. Third, the
document or notes must contain information
of an “honest self-critical study” in order to
be protected and considered confidential.


Louisiana Ambulance Alliance makes no warranties express or implied in this
language for use. This is in no way meant to serve as legal or professional
advice. Viewing this language and using information from it does not create
any type of professional relationship.
There is no warranty or guarantee that using this language will be in
compliance with legal standards. Louisiana Ambulance Alliance is not
responsible for any reliance on this language.