You are welcome.

 

In my opinion, it seems like folks get a little confused between qualifying criteria requirements vs. billing requirements, with many just throwing out a blanket statement like, “you follow all Medicare rules.”  This statement is true for billing practices only in this situation.

 

I should add that if a veteran DOES meet HB and skilled need requirements, then, as a provider, it is our responsibility to bill Medicare before VA - if the veteran has Medicare eligibility.

 

 

 

 

Thank you. This is how it was explained to me. However why did Sheri contradict this? I am just trying to clarify all of this confusion.

 

 

The Medicare qualifying criteria does not apply to the veteran services paid by TriWest.

 

Home bound and skilled need are not requirements of VA funded RN visits paid by TriWest.  SNV are being authorized by VA community care nurses who are fully aware of the veterans’ HB status and their needs, not to mention VA has always paid for RN med sets and other tasks that Medicare does not cover.

 

TriWest is the ONLY available means to get paid for SNV/PT/OT, which are prior approved, and therefore TriWest has no discretion to determine whether client is in “need” of the service or not.  They are simply a middle man who processes claims, against the authorization.

 

 

 

Response below from MPLS VA auth division..

 

 

 

Hi Julie,

Your statement below is correct.

Thank you,

 

 

Anyone hear from VA MPLS if you are suppose to bill TRIWEST for skilled need only?  Basically if they qualify for Medicare, they qualify for Triwest?

 

Be Compassionate. Be Accountable. Be Respectful. Be Excellent!

 

Julie Embry

Director of Business Administrations

Guardian Angels Elim Home Care and Hospice

403 Main Street, Elk River, MN 55330

Direct 763-452-4104

Main 763-241-0654

Fax 763-241-0274

Email jembry@gaehc.org

www.gaehomecarehospice.org

 

 

 

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