Recovery Contract (2003-2006)
Overview
The Inpatient DRG Recovery Audit provides a means for VA to recover overpayments made to community providers for Fee-basis inpatient care. The VA awarded the contract for the second audit in November 2004 to cover claims from October 1, 2002, to September 30, 2006. TC Associates (TCA) is the contractor responsible for reviewing these claims.
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Scope of Contract
The data required to conduct the initial review will be provided to the Contractor from the VA central database. Following an initial review, the Contractor will select cases for intensive auditing to determine:
- If the health care provider used the correct ICD codes on the bill submitted to VA for payment,
- If VA input the correct ICD codes into the computer application used to determine the amount of payment,
- If VA used the correct payment methodology.
Exclusions
Excluded from this contract are payments related to outpatient professional services, domiciliary, State home, contract nursing homes, any payments made by VA under contract or sharing agreement, and any payments made by VA for care furnished outside the United States and its territories.
Contacts
Inquiries on this contract should be referred to the program manager, Catherine Wasson, at 303-331-7516. Written inquiries may be referred to Ms. Wasson at: Department of Veterans Affairs, Health Administration Center, P.O. Box 469060, Denver, CO 80246-9060.
