Payer Relations

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F|A|P provides strategic program and analytic support to the VHA Payer Relations Office, leveraging our deep understanding of the complexities involved in the Veteran’s Health Administration (VHA) revenue cycle and our expertise in commercial revenue cycle and payer contracting. F|A|P has led strategic initiatives targeted at customizing data extraction methodologies, validating and cross-referencing databases, and building rigorous data integrity and analytic protocols. Code of Federal Regulations Title 38 17.101 stipulates payers must pay VA billed charges or the amount they pay commercial providers for the same services in the same geographic area, which is subject to verification by VA.

Through F|A|P’s provision of data analytics and revenue cycle knowledge, VHA’s Revenue Operations Payer Relations Office is able to adapt new rate verification methodologies and strategies to compare VHA and non-VHA reimbursements. These methods include conducting a series of claims analytics for inpatient, outpatient, professional, and pharmacy services along with detailed rate exhibit and agreement reviews. This enables VHA to make informed decisions on future third party agreements, understand rate changes, alternative payment models, and forecast financial impacts. These services assist VA to maximize collections, mitigate refunds, and provide entity-level understanding of the effects of the Affordable Care Act (ACA) and new reimbursement models.