Payer Relations and Services Support RFI
The Payer Relations and Services (PR&S) department, within the Office of Community Care (OCC), Revenue Operations, provides detailed analytical support to review reimbursement rates paid or proposed by Third-Party Payers (TPPs) and Pharmacy Benefit Managers (PBMs) to determine whether payments meet federal payment requirements. PR&S is also responsible for the implementation of VA’s rates and charges billed to third party payers and other entities. PR&S further provides analysis of the effect of alternative payment methodologies and the financial impact of emerging payment methodologies in the insurance industry on VA revenues. Annual Charge Master updates are analyzed to illustrate the impact of variances in charge amounts, unit dosage changes, and VA utilization from previous years. |