As a home care agency, interfacing with the Department of Veterans Affairs (VA) and complying with its many standards is incredibly complex. Without the right documentation, getting paid can quickly spiral into a headache – so if the VA represents even a small portion of your payer mix, it’s important to set yourself up for billing success. Many agencies also wonder, “does VA pay for in-home care?” Understanding the specifics of VA coverage for in-home care services is key to navigating this process effectively.
From meeting VA compliance requirements to following best practices for claim submission, here’s everything you need to know about getting paid on time and in full.
Understanding VA In-Home Care Benefits and Eligibility
The VA helps veterans access in-home care services through various programs. One such program is Homemaker and Home Health Aide Services (H/HHA), which provides personal care assistance and helps with activities of daily living for veterans of any age. Instead of maintaining its own roster of caregivers and aides, the VA contracts these services out to home care agencies.
Veteran-Directed Care (VDC) aims to provide the same breadth of services to eligible clients, but in this framework, veterans are given a certain budget, which they can manage at their discretion. They can directly hire care staff according to their needs instead of having the VA coordinate their care.
Aid and Attendance (AA) is a pension benefit for veterans who need help with daily tasks; the amount is added directly to the individual’s pension payout rather than subsidizing a direct home care program (like Homemaker and Home Health Aide).
The Home-Based Primary Care (HBPC) program offers in-home medical support for veterans with complex health conditions, while Skilled Home Health Care (SHHC) provides short-term nursing and therapy services as recommended by a physician.
Eligibility for these programs depends on factors including disability status, financial need, and the type of care required. Covered services can include personal care (bathing, dressing, cooking), respite care for family caregivers, therapy, skilled nursing, and, in some cases, assistance with household tasks. To bill the VA, agencies must be a formally contracted provider or receive direct payments through programs like VDC.
How VA Billing and Reimbursement Works for Home Care Agencies
Agencies must follow specific procedures when billing the VA for in-home care services. The process will vary based on the program in which the agency is enrolled.
Submitting VA Claims
H/HHA and SHHC require agencies to have a contract in place with the VA and submit claims through the Veterans Health Administration (VHA) Office of Community Care. For VDC, veterans cover their care out of pocket, and claims are typically submitted electronically via the VA’s eCAMS Provider Portal or through a clearinghouse approved by the VA. In some cases, paper claims can be filed using the CMS-1500 or UB-04 forms.
To get your claims approved as quickly as possible, always submit complete documentation, including caregiver notes and correct billing codes. Electronic submissions get processed faster, and regularly following up with the VA’s billing department is a smart way to keep things moving.
If a claim is denied, the VA will provide an Explanation of Benefits (EOB). Common reasons for denials include incorrect billing codes, missing documentation, or surpassing service limits. That’s not always the end of the road, though: agencies can appeal a denial by submitting a Request for Reconsideration within a certain timeframe. This must include supporting proof, such as care notes and authorization records. If the appeal is denied, the agency can file a Formal Appeal as a last line of defense.
Understanding VA Billing Codes and Rates
Billing codes are used to identify and categorize home care services, and agencies must use the correct codes when submitting their claims to the VA. Commonly used codes include T1019 (personal care services per 15 minutes) and G0156 (home health aide services per visit). The associated reimbursement rates will vary based on location and are determined by VA fee schedules. Payments are typically processed on a biweekly or monthly basis, depending on what is written in your contract.
While private insurance often requires clients to pay a deductible, VA-covered services do not typically require out-of-pocket expenditures. However, clients may have to pay extra for additional service hours or any care that is not covered by VA authorization.
Leveraging Technology to Streamline VA Home Care Management
With such strict protocols in place, agencies that serve VA clients should leave no room for human error. Automating workflows with home care software is the best way to stay compliant, get paid on time, and avoid denials or lengthy appeal processes.
Benefits of Using Home Care Software for VA Clients
Seamless scheduling: Caregivers are intelligently matched with patients based on skills-needs alignment and availability, ensuring VA-authorized hours are met while reducing missed appointments and scheduling conflicts.
Document management: Organize care notes, service authorizations, and billing records in a single digital hub to maintain complete records and prevent essential documentation from getting lost.
Accurate billing: Apply the correct VA billing codes before submitting each claim to reduce errors, denials, and your overall administrative burden.
Airtight compliance: Home care software automates the reporting necessary for routine audits. With the VA’s detailed regulations, it’s essential to have software that ensures your agency consistently meets standards, making it easier to produce the necessary documentation for audits and avoid payment delays.
How AxisCare Simplifies VA Documentation and Billing
Navigating the VA’s regulations and processes can be challenging, and mistakes along the way could result in months without payment or no payment at all. AxisCare VA Billing reduces the administrative burden for your agency and handles every aspect of the claim filing process. From setting up your clients’ billing tabs correctly to managing submissions and appeals, we ensure your agency submits clean claims that get you paid faster with fewer issues.
- Accelerate payments and remittances with our efficient, error-free submissions
- Experience higher success rates and minimize denials
- Stay compliant with VA regulations so your agency is always ahead
- Maximize cash flow with direct payments from the VA
Using AxisCare VA Billing, your agency will reduce the time spent managing claims and improve cash flow, getting paid in as little as 8 to 10 days on average.
Streamline your VA Management With AxisCare
Don’t leave your claims acceptance up to chance. Automate the entire VA billing process with AxisCare and get support from real humans who want to see you get paid on time. To learn more, book a free demo with our team.
