In 2014, the US Department of Veterans Affairs (VA) conducted a systematic review of the safety and effectiveness of acupuncture. In their assessment, they wrote:
Acupuncture is often associated with pain management, but it is also may be useful for other conditions, and the body of literature for acupuncture effectiveness is growing. Acupuncture may be effective as a stand-alone treatment or as an adjunctive treatment to other medical interventions. An evidence map of acupuncture was developed by VA Health Services Research & Development (HSR&D) in 2014. This systematic review identified evidence of potentially positive effect for several pain conditions, including chronic pain and headaches, mental health conditions such as depression, anxiety and PTSD, and wellness indicators such as insomnia.
From va.gov
A Critical Opportunity
Typically, acupuncture is considered a proven method for the treatment of pain and nausea. Billing for mental health conditions has a much lower success rate; it is often considered experimental.
Keep in mind that acupuncture was not always accepted as a viable medical intervention. Decades ago, acupuncturists could only render treatment under the direct supervision of an MD. They painstakingly set precedent for the alternative care coverage we enjoy today.
The VA’s broad interpretation of the potential health benefits of acupuncture is surprising. There is little precedent for acupuncture as a viable form of treatment for mental health conditions. By treating veterans, you can provide a valuable service to a vulnerable population — and you have an opportunity to show that acupuncture has uses beyond pain management.
Of course, there’s a downside. And it’s this:
VA Billing Can Be Tricky
Veterans are painfully underserved, and the VA is often the only healthcare option available to them. Providing them with the care they need is a great kindness. It’s not easy, though.
Four Hoops
It’s important to jump through the hoops correctly. Roughly speaking, there are four hoops:
Registration
You must register with the VA. The catch: sometimes registration goes poorly, even when you do everything correctly. We’ve seen Triwest repeatedly deny a provider’s claims because of a tax ID mismatch — but, on multiple occasions, VA representatives have confirmed that the provider’s tax ID is correct.
Authorization
You must secure authorization in order to treat VA patients. Authorizations are valid for a specific date range and number of units or visits. Each claim must be filed under a valid authorization number.
Coding
Only bill procedures and diagnosis codes listed on the authorization. Modality codes like 97140 or 97016 should be billed with modifier codes GP and 59.
Bad Information
The VA will tell your patient that claims can be filed under their VA-issued identification number or the last four digits of their SSN. Unfortunately, that’s incorrect. For over a decade, we have only been able to research VA claims using a patient’s full SSN.
Keep in mind that, when billing VA claims, multiple entities are involved — and they might provide conflicting information. For example, VA Community Care has told our clients that they can bill diagnosis codes even if they are not listed on the authorization form. However, Community Care is not the entity that processes the claims. Our data confirms that billing unauthorized diagnoses for a VA patient will result in denial.
Frequently Asked Questions
You’ll notice a theme here.
- What if I bill without authorization? No pay.
- What if I bill unauthorized diagnoses or procedures? No pay.
- What if I bill outside of the authorization period? No pay.
- What if I file a paper claim, but don’t use a red CMS-1500 form? No pay.
- What if I file corrected claims to removed unauthorized diagnoses or procedures? In the best case scenario, the correction counts against the visit limit.
- What if I don’t use the patient’s full SSN? If a dispute arises, VA representatives will be unable to locate the patient’s claims.
- What if I call the VA? We’ve experienced hold times of up to six hours. Chat options may be available, but will also involve lengthy holds.
- Why does Triwest tell me to use the patient’s VA Member ID or the last 4 digits of their SSN? Apparently, they don’t know any better.
Quality Control
Ultimately, there is no trick to filing VA claims. For optimal results, implement a quality control program. Your best bet is to submit claims correctly the first time.
Before you file, double-check the following:
- Authorization number and date range. File VA claims under a valid authorization number. Note the authorization date range in the patient’s record.
- Approved procedures and diagnoses. Only bill procedures and diagnosis codes if they are listed on the authorization form.
- Correct patient ID. Use the patient’s full SSN.
- Correct modifier codes. Use modifiers GP+59 when using codes like 97140 or 97016 to bill for modalities.
- Correct payer ID. If you’re in New England, VA claims may be processed via Optum. If you’re anywhere else in the US, Triwest is likely the correct payer.
- Correct forms. If you have to mail claims, use a red HCFA CMS-1500 2/12 form.