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VA Tackles Backlog of Claims Inventory


VA Tackles Backlog of Claims Inventory

In an August 13th press release, the Department of Veterans Affairs (VA) announced that the Veterans Benefits Administration (VBA) has improved procedures by incorporating artificial intelligence (AI) to reduce the time it takes to process in-coming mail from ten days down to one day.

According to their statement, AI-infused software reads the mail document’s contents and automatically routes it to VA employees that are working the next step of the claims process. That means processing times are reduced because the information submitted by the Veteran to support their claim is reviewed faster.

VA Secretary Robert Wilkie praised the automation, stating, “Moving past manual mail processes to automation puts the emphasis on Veterans. This new capability allows the VA to process Veterans’ claims quickly and efficiently.”

The VA receives more than 500,000 pieces of mail each month, most of them related to benefits and services. Those sending mail to the VA are often the Veterans themselves or surviving spouses, service agencies, attorneys and claims agents. Physically mailing documents is how claims are started and also how supporting documentation is submitted for potential monetary benefits.

VA Has Already Resumed In-Person Exams

On May 28th, just a short time after much of the country slowed due to COVID-19 lockdowns, the VA announced that it was resuming in-person Compensation and Pension (C&P) exams, but only in select locations across the country.

In order to resume these exams, COVID-19 safety measures like social distancing and appropriate personal protective equipment were implemented, allowing the VA to resume examinations and reduce the backlog of claims cases, which already averaged over 100,000 at any pre-pandemic point of time.

For any veterans outside of the coverage areas, listed here, claims services are available through telehealth appointments and a review of the “accepted clinical evidence process”, which reviews the existing medical records to provide information needed to complete the claim. This process is often helpful, but it does not eliminate the need for in-person examinations.

VA Historically Subcontracts Exams

During a July 6th interview on Federal Drive, a podcast of the Federal News Network, we learned that the Veterans Health Administration only conducted about 25% of the in-person C&P exams before the pandemic. David McLenachen, director of the Appeals Management Office at VBA, stated that contractors hired by the VBA conducted about 75% of these exams. These contractors are physicians and healthcare companies that manage hospitals who have subcontracted themselves with the VA in order to expand the coverage areas across the country. Many of us do not live near VA facilities, and often have to drive for hours to visit one.

Mr. McLenachen also reported that, as of early July, they were carrying a backlog of over 300,000 necessary exams, up from the usual 100,000. This despite the “tele-CMP” exams that have taken place during the pandemic, which offered an alternate mode of examination that would allow for the completion of some open cases.

Great Effort, Uncertainty Remains

It is still difficult to gauge the impact of the effectiveness of telehealth appointments on the claims process. The closest VA clinic to me is in Washington, D.C., and they are operating with extremely limited in-person appointments, preferring a heavy use of telehealth options. I’ve had numerous telehealth appointments in the past, and they are good for most applications and conditions. However, the claims that lead to compensatory benefits, especially initial claims, still require an in-person examination by the VA or one of its contractors.

All VA medical clinics follow the CDC’s guidance regarding COVID-19 measures to influence normal operations. Ensure that you check your clinic’s website before arriving for guidance on entry procedures. You can utilize their COVID-19 Fast Pass Pre-Screen to expedite your entry at many of the VA’s medical clinics.

With the infusion of AI into document screening, an earlier-than-expected start of in-person exams, and an army of subcontractors willing to perform them, the VA continues striving to support veterans by getting them the care and compensation they deserve.

(Image courtesy of Monika Wisniewska via www.123rf.com)


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About the author

Lori Waddell serves as Co-director of an emergency response COAD in Montana, a freelance writer, and an Air Force Key Spouse. She is passionate about empowering communities and individuals through knowledge and resources. She currently lives in Montana with her husband and two children.