Blog, Live Events, Veterans February 9, 2020

Treating Veterans – More Referrals & Faster payment

Hi, everyone. This is Sam Collins, your coding and billing expert for chiropractic in the HJ Ross Company. We do seminars and much more, but we also partner with ChiroSecure and making sure that you’ve got the latest information to keep your practice successful and keep moving forward. As a quick note, based on last months, we did a little bit on Medicare. Just want to make everyone aware that Medicare or Congress made some changes to some rules that may have changed your Medicare fee slightly, not by much but I would suggest to recheck your Medicare fees.

Today’s program though, let’s talk about the VA. What’s going on with veterans care, the so-called Veterans Choice or PC3? In fact, I’m sure some of you have noticed the names keep changing. At first, it was a course called Veterans Choice Care, then it changed to Patient-Centered Community Care or PC3. Now it appears it’s going back to Veterans Choice. Nonetheless, there’s been updates and changes throughout the country. So I want to make sure you’re up-to-date to make sure you understand what you need to do to make sure you can get these claims paid and get the patients in your office. So let’s begin with the slides and talk first about what we have going on now.

So you notice this map of the United States, and now we have broken up into four, actually six distinct regions, the United States. So you’ll notice areas four is TriWest, so that’s going to be your West Coast areas. Then areas one, two and three as you’ll notice now are taken over by the company called Optum Health. So some of you may be familiar with Optum Health because they have been managing claims for United Healthcare. This now part of the country for VA has now handled through this company. This has been slowly rolled out. About all areas now are taken over or have been managed now by Optum Health. So you definitely want to make sure that your enrollment that was from TriWest is in there, get in with them to make sure you can continue to transition to your patients.

Please note that Hawaii and the Mariana Islands are TriWest, but Alaska sits on its own. You have to do some separate things for Alaska. Nonetheless, the program itself is the same. For some who are aware, of course, the areas you’re noticing as areas one, two and three were handled initially by the company Health Net. As you probably still are aware because some of the claims still are going unpaid, they made a mess of it. The whole country was taken over by TriWest, but now they’ve broken up into different groups. So one thing I want you to do though is we have to make patients aware that our veterans that they have this benefit.

So here’s one thing you can do. You’ll notice here it says, “Thank you for joining. Our mission is to proudly care for veterans.” So the TriWest company is making this available on their website. So I would highly recommend all, it doesn’t matter where you are, even if you’re doing Optum Health to go to the website to this section where it says, and then take these badges. These badges they’re noting you can post on your website or other areas. I suggest you might blow one up, maybe make it a poster and put it outside your office so that veterans coming by understand there is a benefit for them to deal with their pain management and other issues with chiropractic care. One thing for sure is many veterans simply aren’t aware that they have this benefit. We need to do a better job of making that information out there. So begin doing this by promoting if nothing else, just this. So again you can download these. You can put them on your website, business card or just print up in a big poster size.

So now here’s the areas, Optum on the left, TriWest on the right. There’s some phone numbers for Optum depending if your regions one, two or three with phone numbers. Of course, notice the website That’s the direct website that will take you through to it to understand the transition, the protocols and so forth. For TriWest on the right side to request enrollment, you’ll notice here it says, “Community Care Network,” or CCN TriWest, their website and the phone number. They’re a little bit more complicated to join now than there were in the past. Assuming you were already in the network, there’s nothing to do to change that. I would verify for those of you who are already in Optum, just check with your Optum to make sure that you also are included in the VA section. I would suspect that you may be, but you want to make sure that that’s all connected.

Realize that Optum covers many services and, of course, this is for any. Notice chiropractic, of course, but includes acupuncture, massage, OT, physical therapy, speech pathology but here’s an interesting one, tai chi. So they’re actually having some tai chi. I guess practitioners they couldn’t do it, but obviously for chiropractic, can we do the massage? Can we do the occupational and physical therapy? Yes. In fact, in some states, of course, you can even do acupuncture.

To get directly to Optum, notice their website here, That’s where you’ll actually go to make the enrollment. Go there, join. There’s no cost to joining for this particular group, but you don’t have to enroll. They’ll verify your experience and expertise. They’re certainly going to look to make sure that they have enough providers in the region. One thing I have found, if you have an area or a patient that wants to see you and you’re not in network, have that patient contact directly to Optum or the VA and pressure them to say, “I really want to see this particular doctor, that’s who I’ve been with,” that often will transition you over. So that’s Optum.

For TriWest, they use EmpowerChiro. This is something relatively new. Now what’s interesting for Empower, TriWest says that we encourage. Now I find encourage to mean they prefer it, but is it required? What I can tell you the easiest way in is to go to EmpowerChiro. Their phone number is there. That’s a pretty simple enrollment. The only problem with Empower is this. There’s a cost. I’ve heard that there’s an enrollment fee that can be just 179 that’s hoped for the whole year, but I’ve heard others say they paid 15 a month, but you can assume about $15 a month to stay in their network. I would think it’s certainly worth the cost based on one VA patient visit, certainly would cover that or at least potentially.

Also, note if you join Empower, you can choose between which plans you want to belong to. My suggestion, being a coding and billing expert and teaching seminars across the US, is be careful of joining things that are not exclusive. Certainly, TriWest is exclusive. If you’re not in TriWest, can’t see the patient. But EmpowerChiro may enroll you into a lot of plans that you may not want to have affiliation with because those are patients that already can see you and will be paying you a higher amount the Empower might just take a reduction, so something to be careful of. Remember you can opt in and out of certain parts of the plan.

The big issue of course for the VA is making sure the veteran is eligible. Not every veteran will have VA Choice or PC3. Most do. If they’ve had any injury or disability related to their service, it’s going to be covered. So how is it covered? Well, the first thing they notice that it has to be a service that is needed, that is not available at the VA facility. Now remember there are chiropractors and some VA facilities, not all, however. Even the ones that have it, they’re not always available. So if there’s a full VA service available that’s within the veteran lives, they’ll go, or the veteran may grandfather because there is a distance.

Now what I like about this distance, checkout bullet four, care. Even if there is a chiro that cannot be delivered within a 30-minute drive for primary care, which doesn’t include us but a 60-minute for specialty that used to be mileage, why think it’s important to put time because what if you’re in a very densely urban area? Even though it may only be 20 miles, that’s still could be an hour drive and therefore they would be available.

The other thing I think would happen even when there is a chiropractor at the VA facility, if the wait time is more than 28 days. Now often there are chiropractors, of course, but the appointments are so taken aback that it can be weeks if not more. So the patient generally just has to put a lot of pressure that I want to see a chiropractor. I don’t want to wait. I’ve tried all the other things. We’ve done medication. We’ve done PT. We’ve done the medical route. We would like to try chiropractic. Of course, if the VA service just simply does not meet the certain quality standards, of course, the patient can go, “Oh.” the big issue is that it’s really patient driven.

So here’s the appointment authorization process. This is published through TriWest, but it works the same in both. This is why I included it, because I think it breaks it down very easy. Notice it’s veteran driven. If you notice the two left boxes indicate the veteran calls TriWest to confirm eligibility, that will be the same with Optum, or the VA sends a direct referral either to TriWest or to Optum. Realize in both these cases the patient has initiated it or at least the patient through their VA provider. So it’s important to know, can a patient contact directly to Optum or contact directly through TriWest bypassing their primary? Potentially, particularly if they’ve been to their primary for quite some time taking medication. The job of Optum and TriWest in here is to give the patient care that can be helpful. They’ve got to at least allow them to try chiropractic.

Once they’ve determined that they’re eligible, then they’re going to contact the provider, which would be you. They’re going to make an appointment and then send over the authorization. In some instances they may in fact even just give the patient authorization and they can do a self appointment. I generally prefer when the patient makes the appointment because if TriWest or Optum makes it, without the patient on the phone I’m not sure the patient can make that appointment, that could be problematic. My focus here would be please get the patient involved. What I have found that works well is the patient being involved to really indicate they want to try an alternative. They want to try something that they haven’t done before, which is chiropractic care, and they don’t want to use medication.

I’ll give one other place the veteran can go. There is a website just for veterans. They have to have registered for it, but many have and it’s called, so Once they get to that site, it’s like a real time chat where they can discuss directly with the person that they’re wanting chiropractic care and who they like to see. Again I will always emphasize, please make sure if the patient wants to see you. They want to bring you up by name and even if you’re not listed as a provider, this would be one of the ways if they say their network is full to probably get you in the network. So again, I want to focus on the veterans seeks care from the VA. Based on eligibility, they’ll vet engage and send the referral out. So notice everything is getting from VA is veteran driven.

One thing about the VA to understand is that all the out-of-pocket costs are zero to the veterans for chiropractic care essentially. So the patients come in, no deductibles, no out-of-pocket, so it makes it certainly easy. Though I will say this, they have paid them out-of-pocket. They did military service. That being said, and I’ll repeat this twice, all physical medicine codes, everything from 97010 all the way through 97799 must be appended with modifier GP. That is one of the areas I commonly find offices or find out that “Hey, I’m not getting paid for my therapies.” It’s simply because they did not include the modifier GP.

In addition, the allowance is generally based on Medicare rates. However, in some areas, it could be a little bit more. So my suggestion is bill your normal fees when the VA pays, except as payment in full. We have some regions depending on how rural or how underserved that may pay a little above Medicare rates. So certainly give the opportunity to be paid a little bit more, just bill your normal fee, but remember what they pay is payment in full. Now that being said, what did they pay for?

So here’s what’s called a Physical Medicine Rehabilitation Standard Episode of Care, but specifically for chiropractic. You’ll note right at the top it says, “Duration for a year and 12 visits.” Now the patient can get many more visits than that, but that’s always the starting point. Notice it says an initial outpatient evaluation, standard imaging, but I want to focus on this part of it. Notice number three says office visits are limited to 12, but notice what the expectations are in four. The expectations of service are significant durable pain intensity decrease. So it means clearly you must be using some type of visual analog scale, and I would recommend the VA pain scale because they have one that doesn’t focus just on pain but on function. So in other words, show me that the patient is probably changing, getting lower.

Notice that significant would mean more than a point, however, but if you attach it to function probably a bit better. In fact, B is where I would really say we should hang our hats. Functional improvement demonstrated by: clinically meaningful improvement on validated disease-specific outcome instruments, return to work, or documented improvement of activities of daily living. So in other words, using outcome assessments forms, whether it’s Oswestry’s or similar, however, I would recommend probably the general pain index or the patient’s specific functional scale. Those two are a little bit simpler. I think the patients understand them better and it’s more reliable.

Of course, the fifth thing is make sure there’s a decrease in pain-related medications. Certainly, we cannot tell them that they can’t take it, but certainly asking the question of how many pain meds did you take this week and if it’s getting lesser, it shows that they’re improving. The big issue here, just show me that the patient’s getting better subjectively, but maybe more important objectively in the sense of activities of daily living.

Ultimately, what is the Standard Episode of Care include? You’ll see here the typical codes, traction, attended Stim, ultrasound. I want to take notice to the first one, the 0552T. That is actually for laser. Now I won’t say this will always be authorized, but the latest Standard Episode of Care as published late last year included it. It’s for a thermodynamic thermo-kinetic laser, which I think fits most of the standards. You’ll see here again, exercise, neuromuscular education. So clearly it’s not just manipulation.

Of course, it will include x-ray and acupuncture. Again, I’m going to make one for emphasis here and I put it in red. All physical medicine codes included here must be appended with GP, but remember 97112 neuromuscular education, 97124 massage, and 97140 manual therapy will also need a 59 modifier. So if you notice at the bottom, I have 97140, 59 and GP, but then I also have 97140, GP, 59. That’s just to remind you the order of those modifiers doesn’t matter but so long as they both are present.

Now here’s a typical type of authorization you’ll receive, and I apologize for the quality because we had to blow it up. Notice it says right here, “Authorized for 12 visits,” and it says, “Includes chiropractic, manipulative treatment, manual therapy, therapeutic exercise, and neuromuscular education.” Now you may think, “Well, is that the only ones they give?” I don’t know why they produce it this way with that statement because then right on the next page it tells you, “Okay, 12 visits.” Along with the X-ray codes, notice I have here 97012, 97032 and all those codes we just mentioned. Again, I’ll go back to the top and I’ll circle around it with my mouse, notice the 0552T and again that is that new laser code.

So I’m excited. I think chiropractors are really making a headway here and showing how well we can care for these patients. I think this also creates a great transition for us to make sure that Medicare sees the benefits, and I think we’ll start getting full payment from Medicare in the future. For now it’s the VA though. The VA is helpful. They will help you. Please contact them. Be an advocate for the patient. Make sure the patient is also advocating on their own. That first transition, the patient request, when you want to do additional visits, there’s no problem with you requesting additional so long as the focus on that we’re making the patient functionally better.

I hope this has helped. I hope that you can make some transitions. Contact Optum Health. Take a look they have a lot of information on their sites. This is Sam Collins of the HJ Ross Company, your coding and billing expert. Come see me at a seminar. Come see me with the network. Take a look we’re on Facebook, Instagram, and what we post there are new information. We keep up-to-date in news to make sure you know what’s going on. It’s not about selling you something. Also, I’m going to note for next month when I come back, we’re going to go over the new Medicare local coverage determinations because several states have had changes for the New Year, which is going to make it a little bit easier for chiropractors to bill. Next week’s host will be Janice Hughes, and I thank you for your time. This is Sam Collins, see you next time.

Please subscribe to our YouTube Channel ( Follow us on Instagram (, LinkedIn ( Periscope ( If you have any questions about today’s show or want to know why ChiroSecure is still the fastest growing malpractice carrier for over 27 years, then call us at (866) 802-4476. or find out just how much you can save with ChiroSecure by visiting: