VA Will Use Medicare Payment Rates                                                                          The Department of Veterans Affairs has announced that it will begin using Medicare's standard payment rates for certain medical procedures performed by non-VA providers on February 16, 2011. The new adjustment will affect the following treatments VA officials provide to veterans through contracted care: ambulatory surgical center care, anesthesia, clinical laboratory, hospital outpatient perspective payment systems and end stage renal disease. VA officials are providing written notifications to Veterans and non-VA providers.                                                         What is Non-VA Care:  Non-VA Care is medical care provided to eligible Veterans outside of the VA when VA facilities are not available. Known as ‘Fee Basis’, all VA medical centers can use this program when needed. The use of Fee Basis as a means to provide Non-VA care to Veterans, is governed by federal laws containing eligibility criteria and other policies specifying when and why it can be used. A pre-authorization for treatment in the community is required to use Fee Basis care -- unless the medical event is an emergency. Emergency events may be reimbursed on behalf of the Veteran in certain cases.                                                                                     Unavailability of VA Medical Facilities or Services:  Fee Basis is used when VA medical facilities are not ‘feasibly available’. The local VA medical facility has criteria they use to determine whether Fee Basis may be used. If a Veteran is eligible for certain medical care the VA hospital or clinic should provide it as the first option. If they can’t -- due to a lack of available specialists, long wait times, or extraordinary distances from the Veterans home the VA may consider Fee Basis care in the Veteran’s community. Fee Basis care is not an entitlement program or a permanent treatment option.                        For questions concerning Medicare payment rates please contact your Veterans Service Officer (VSO).                           Note:  The Medicare/VA rate program will vary from state to state.

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