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The Clinician’s Guide to Answering the Service-Connected Classification Question. A condition is only service connected if it has been rated as an adjudicated service connected disability through the Veterans Benefits Administration (VBA). OBJECTIVES.
A condition is only service connected if it has been rated as an adjudicated service connected disability through the Veterans Benefits Administration (VBA).
This presentation will provide staff with information that will aid in correctly designating a visit as service connected (SC) or non service connected (NSC).
Service Connected Condition
Combat Vet (Combat Related)
Agent Orange Exposure
Ionizing Radiation Exposure
Head and/or Neck CancerThe encounter form or computer screen will display:
Is treatment for a service connected condition?
It is the responsibility of the provider to mark the encounter based on their clinical judgment and eligibility information as: * service connected or *non service connected
Reference: M-1, Part I Chapter 15, section 15.02 b (5). VA can bill: "Veterans for service-connected disabilities when it is medically determined that re-injury or aggravation of the service-connected disability is due to a compensable occupational injury or disease or the negligence or other legal wrong of a third person.”
If the treatment provided was for a condition which you consider to be adjunct/secondary (associated with) or aggravated by the service-connected condition(s), you MUST answer NO to the service connected classification question!
Q. Do veterans receive free care at the VA Medical Center?
A. Not all veterans.
Q. If I don’t mark the encounter as service-connected, will the veteran be eligible for the service?
A. Yes. Public Law 104-262, The Veterans Health Care Eligibility Reform Act of 1996, created a medical benefits package which is available to all enrolled veterans.
Q.If a patient is 100% service connected for a specific condition, are all their encounters service connected?
A. No. The percentage (%) of service connection pertains only to the rated condition. If the encounter was for a non service connected condition, it would not be considered a service connected encounter.
If a patient is 0% or 100%, they are still rated for that specific condition.
Q. Are encounters marked as AO, EC, MST, CV etc…(special authorities) billable?
* If check-out under special authorities, such as Title 38 USC 1710(e), the encounters do not trigger 1st party charges nor the Integrated Billing package.
Q. Must the veteran’s private insurance company be billed for conditions that are adjunct or secondary to the service-connected condition?
A. Yes. Current interpretation of the law:
Adjunct and secondary conditions are not service
connected per interpretation of the law and should be
billed to the insurance carrier
Contact your local Revenue Office for assistance.