Home Care U - Everything You've Ever Wanted to Know About VA BIlling (Greg Bean Pt. 1)

Episode Date: June 5, 2023

VA billing is one of the most technical, opaque topics in home care—yet it's a critical part of business growth for thousands of agencies. We've found one of the industry's leading experts on how VA billing works and making him tell us everything he knows.Enjoying the show? Send me a text and let me know!Learn more about Careswitch at: careswitch.comConnect with the host on LinkedIn: Miriam Allred This episode was produced by parkerkane.co

Hey, welcome to Home Care U, a podcast made by the team at Care Switch. Nobody went to school to learn how to run a home care agency, so we're bringing the education to you. Join our live audience by going to careswitch.com slash homecareu or listen on your own time wherever you get your podcasts. Home Care U is hosted by myself, Miriam Allred, and Connor Koons of CareSwitch. Enjoy the session. Welcome everyone to Home Care U.

Looks like we've got some new faces on today's call, so welcome and thank you for being here and thank you for taking time out of your busy schedules to join us for a quick 60-minute session about VA billing. Before we jump into things, quick introductions. I'm Miriam Allred, head of partnerships at CareSwitch. I'm also joined today by my co-host, Connor Koons, who's our head of growth here at CareSwitch. Connor, thanks for jumping on today. Thanks, Miriam. Glad to be here. Excited for today.

Likewise. For those that are jumping in here, also share if you are using Paradigm and if you're billing VA, it might be good for us to see kind of what the payer mix here is on today's call. So give Paradigm some love before we jump on. Let's go ahead and jump in. Greg, we are super excited to have you. Greg Bean is the VP of Business Development at Paradigm Senior Services. Before we get into the weeds, Greg, why don't you tell everyone a little bit about yourself and about your background and about some of the success and experience that you have in home care? So, well, thanks for having me first off. I am Greg Bean. I'm the Vice President of Business Development at Paradigm Senior Services. I actually started my health care career at the ripe old age of 17 in the United States Navy as a hospital foreman. So when I look back at my history and my background, we start talking about

the VA. Of course, I'm a veteran, my father, a couple of uncles were veterans, my grandfather, his brothers, my brother, my sister, my son-in-law, my son, my brother-in-law, I could go on and on with the people that are my brothers, my son's currently in the military. So we're a military family. So the veterans benefits are incredibly important to me. And it's a passion. Alongside of that, I spent the next 10 years after being in Navy working in health care, critical care, emergency medicine, intensive care, so on and so forth. And then a friend of mine said, hey, let's move over to the home care side and let's open up a home care company. I worked for multiple different organizations

for many years thereafter. I spent about 10 years with Bayada Home Health. I spent six or seven with PSA Healthcare. And then the last three years before moving over to Paradigm Senior Services, I was the Director of Operations for Visiting Angels. So I've been in the home care space, both skilled and non-skilled, and across the industry for many years now. So I'm ready. Let's just jump in and get started on the VA. Thank you, Greg. You've seen it and done it all. And I just want to say thank you to you and your family for your service. And I think you have this perfect storm of a background to be able to speak expertly on some of these topics. So just just to set the stage for everyone here today, we're going to cover VA billing and focused and drill down on VA billing. Next week, we'll have Greg back and we'll go into the other third-party payer sources like long-term care and Medicare and Medicaid, etc. So today,

we're just going to focus on VA. If you've got questions on the other payer sources, hold them until next week and come back and join us same day, same time. So let's get right into it. And the place that I want to start, Greg, is who should be considering VA billing? Think about the industry. Think about people that are starting out and are considering new payer sources or people that are five or 10 years in business and thinking about diversifying. Who's a right fit to consider VA billing as a revenue stream for their business? I think anybody providing private duty and or skilled services fits into the VA platform. So you can be providing

on the skilled, in the skilled industry, as well as in the private duty side. So if you've had your entire business on private pay in the private duty world, and one of the things that we're learning from Home Care Pulse this year, as well as multiple other opportunities, is that market is shrinking. We're seeing 10, 11, and 12 percent decreases in the number of hours being provided on the private side. We see a lot of the industry moving over to private payers and outside of the home care industry. So how do we make up the difference? What other resources are there? And I think a VA is an incredible opportunity, especially since we look at the average rate of billing across the United States is greater than $40 per hour. So it's a great opportunity on And keeping it generic is good because it is applicable and a lot of agencies should be considering this. Are there any specific demographics or prerequisites for an agency that's more equipped to take on VA billing?

I think the real key is everyone has an opportunity in this space because it doesn't matter if you have one private pay client, if you have 500 private pay clients, you can still move into this industry and provide private hours to veterans and in the veteran community. It even enhances and allows you to expand your portfolio in every single one of those environments. Well, I know we're going to talk about the different forms and the different pieces and parts, but the aid and attendance pension associated with the VA is stackable. So those benefits can be paid right alongside of any other payer source, including private pay that you might be getting from your client. So it's a pension piece. So we'll talk about that, I'm sure, in a bit when we talk about the different benefits. But the key to this is, it doesn't matter what piece or part of the industry you're in. This is a great opportunity to expand your portfolio from having one client to building it off to 500. I can talk specifically about a private client in Oregon, for instance,

that has been in business for about 18 months and they have 174 clients. And that was starting out as a new agency. So the VA was the direction they took that agency. And in a private duty, private pay environment, they've gone to an astronomical number of hours and pay. So I would tell anyone who's in the space of wanting to provide private duty care that the VA is a great opportunity to expand their portfolio. And you, if I'm understanding right, you can probably confirm this is at the end of the day, it probably comes down to preference, personal preference of the owner or the administrative team, the executive team of the agency. Some people are cut out for this and want this and take their business in this

direction and others don't. And there's no right or wrong in home care. But I like the way that you're speaking about it in that anyone and everyone should consider it and then determine if it's right for their business. A hundred percent. So, you know, I've had many owners speak to me in the past. And the first thing that comes out of their mouth is I don't want anything to do with a government agency. I don't want to bill them. I don't want to expect payment from them. I don't want to work with them. I love my private duty, private pay clients that are paying me every week for the services they're getting. And I don't have to deal with the bureaucracy of the government or payer sources from the government. But those same people over the last 18 months that I've been

having that conversation with that had those exact mindsets a year and a half ago are starting to change and say, well, maybe it's time for me to expand a little bit, to look a little bit different or to look a little bit deeper into my business. And the pay rates are appropriate to that. You know, one of the challenges that comes about with private pay is our caregivers' wages are going up. And when caregivers' wages go up, our rates have to go up to match those rates. And the VA's pay cycle typically is higher than that of private pay clients. So it allows them to offset some of those margins and expand their business portfolio and pay for some of those downfalls that are falling on the fact that their caregivers are

making more money and their margins are shrinking. So if I can kind of jump in here with the question, Greg, I think we've kind of touched on this, but I want to dig a little more deeply into this. So we've kind of talked about how selecting your payer source mix is a pretty crucial decision from a strategic standpoint, right? And how different businesses are going to be conducive to making different choices about their payer sources they're relying on. Do you mind talking us through what some of the characteristics of an agency whose priorities are going to be conducive to pursuing VA billing would look like and what some of the characteristics might look like of an agency whose processes, priorities, capabilities might not be conducive to making VA a heavy part

of their payer source mix and strategy. So as you look at demographics across the country and you look at financial mixes and you look at where people are and you're meeting them where they are in the community. And you might have a very rural area that doesn't have the financial structure to accommodate private pay at 30 to $40 per hour for services to be rendered. But yet you might have a very high VA population within that same group of people,

which would now want you to push a higher mix or a bigger push towards having a VA client because your demographics of your community might be ones which fit more into a veteran life cycle. On the opposite side of that, if you're in a very affluent, and not that veterans aren't very affluent, don't get me wrong, because pay and money is not what structures the veterans benefit. But if you're in a very affluent area where people have been and are paying a higher structured rate for private duty, private pay, and you have a large number of hours and you have extended hours within those platforms, then that might be where you want to continue or maintain the structure of your company is within that demographic. But again, the reason that one of the things that I have been speaking about for the last year and

really talking across this country about it, multiple conferences and state agencies and so on is when do we diversify and how much do we diversify? And I think the key role here is what fits best into your personal platform. So someone, someone who has a large private duty, private pay practice or, or, or agency that might actually want to say, oh, I only want to have 10% VA to offset, to continue to provide care to veterans, to expand this benefit, but yet it isn't necessarily fitting into what my overall success of my agency is. On the opposite side, we find people in remote areas that are saying, I can't get enough private pay clients. I can't get enough clients to actually push my revenue source up to maintain

my caregivers, to maintain my business and so on. So my remote area might be the most, the highest structured number of where I have veterans. That makes lots of sense. Love that. And I think maybe one follow-up question there. So I really like what you point out about kind of looking at your market and the density of different demographics that might be conducive to particular payer sources. I would consider that to be kind of an external factor, so to speak, in the sense that you're looking out of your agency at your market to decide what makes sense as far as payer sources. Are there internal factors too, where you would look at the capabilities or processes or whatever of your agency? And it might be that particular, you know, things about VA, whether it's the differences in pay rates or the differences in timelines of reimbursement or things like that may or may not make sense for your business. So in today's world, we have two significant payer sources within the VA. You're either

working with TriWest in the West or you're working with Optum in the East. We're seeing those revenue cycles pay within five to 11 days, depending upon your market. So if you're looking for a quick cash turnover or consistent pay in your revenue cycle and things moving forward, the VA is an exceptional payer and they pay. And like I say, if you're in the Eastern portion of the United States, typically if you're processing your payroll on a Monday or a Tuesday, you're being paid on Saturday or Monday of the following week on your revenue cycle. If you're in the West, it's about 10 to 11 days. So it's still an incredibly quick turnaround in your money and transition of funding. Whereas sometimes with your private pay markets, you're billing monthly and or depending upon how that revenue cycle works for you and how well

uh your payment cycles work it can be much it's a very quick turnaround in the finance and it's consistent and it's direct deposit and it's put back into your account and it makes for a real easy revenue cycle to manage your revenue and your and your your office monies the The other thing is that VA clients, I'm sorry, VA clients typically are long-term. So the life cycle of a VA client is usually 24 months and longer. So when you're looking at consistency for keeping caregivers and managing your office and having hours and long-term hours, you know, we aren't worried about clients turning over weekly or even monthly. They're much longer life cycle to that client, which allows for better retention and recruitment because you have consistent hours on a long-term basis and you keep clients and caregivers in the same place.

Great questions, Connor, and great responses, Greg. I think this is a perfect place to start this conversation is answering some of these high level questions and giving people kind of a lay of the land of VA, because a lot of people listening to this are probably in this consideration phase. You know, they're, they're asking those age old questions of, do I diversify? And when do I diversify? And how, you know, they're asking these questions. So this was a good kind of foray into some of that information. So I think someone just asked it here on Facebook Live. I think this is the perfect time to get into the weeds on how do you become an approved provider? You know, what is the eligibility requirements? How do you get that authorization? What does that look like? So I want to start there, Greg, and let you just kind of detail that out. I know there's a

lot to it, but I'm just going to kind of turn you loose and you take us down that path. I'm going to start retroactively a little bit because four years ago, if you were credentialing or getting into the VA's network, you had to contract with each regional hospital or VA medical center in your region.

So they accepted as many as they want or as few as they wanted. If they wanted six providers or if they wanted 60 providers, whatever each hospital wanted to be in their network is what they allowed. So it was some markets were incredibly limited with very few agencies allowed to participate and some expanded depending upon the hospital's wish. And there was no continuity to it whatsoever. There was no VA requirement whatsoever to it. It was genuinely whatever each hospital case management department decided. Well, four years ago, they moved into the community care network. And you'll hear people call it the CCN community care network. Anyway, the reality was, is the VA moved over to a managed care

platform. So in two thirds of the United States, or it was broken into regions, actually, there's region one, two, three, and four in the United States. So one being in the Northeast, two being in the Southeast, the Midwest, becoming zone three, and then zone zone four becoming the West Coast and then zone five being like Hawaii and the islands and Alaska away. So the three eastern regions or zones became managed by Optum, which is a subsidiary or a department within UnitedHealthcare. Zone four and five in the West moved under TriWest purview for their billing. So what happened at that point in time is all credentialing and all network providers were credentialed through and accepted through those entities. So you have to apply for and be accepted in and credentialed in and added to the network for every hospital through a centralized location. So that's how the

credentialing and getting into network got created. The challenge to that is that's how your payer sources are, and that's what your credentialing bodies are, and that's how you're added into the network to become a VA provider. But the authorizations and the referrals and the client referrals allowed to get referrals by each regional medical center, but you have to be credentialed by the overall body of TriWest or Optum, depending upon which region you're in. Typically, most of the hospitals will allow however many you wish to have in. But what we're finding now is that some markets have become more saturated than other markets, and so getting into network has become slower in some areas than it has in others. They're not closing any networks, they haven't shut anything down, they're just not allowing them in as quickly in some areas as they

are in others because they're more focused on helping the areas where they have high needs and expanded needs into some of the markets where it becomes the focal point of their credentialing requirements. So that's how you get into network within the VA is applying through either TriWest or through Optum in their networks. Can I ask a clarifying question? Someone just jumped here in the chat and asked this, and I want to kind of reemphasize this. They said, I contacted Optum for VA, but they said they're not taking any more agencies. What are my options? So to clarify, they're not pausing or stopping accepting new agencies, but it's at their leisure to accept new agencies. Is that a fair assessment?

They're prioritizing some areas over others. So what I would say is everything is being prioritized on needs. So if you were to look at they have 3000 plus needs in their network. So they have this mass number of places where they're desperately looking for help. And they want more agencies to assist more of the hospitals in some networks and other networks. And, you know, I'm just, you know, a fictitious, you know, Abrams Hospital, Abrams Hospital might have 500 providers already, or they might have 150 providers already, whatever that number might be. That's when they say those people get put into a queue. And if and when they have a need in the future, they would expand the network and allow them in. So they really haven't closed. It just becomes prioritizing and trying to get credentialed and people up and rolling into where they have needs specific into their environments. Got it. Is that information publicly accessible? Their priorities are where those locations are, or is that not public information?

I don't know that that is public information at this point in time. I think it's just a matter of, I would encourage people to apply and apply for network and submit their applications and put their applications through. And then they'll be placed into that queue and some will be moved forward quicker depending upon the needs and the expeditious needs of the agencies. Okay. Brian saying, I had to go with the VA and Optum with a list of 18 agencies in my area and show them which ones were closed, which ones weren't taking new clients, which ones never returned my calls or emails. Out of the 18, I was able to help my clients find two that said they may be

able to help them. Not sure if it helped me get in, but I was finally able to. So interesting. So again, that's someone who was advocating back through on their behalf and going in with specific numbers and ideas and thoughts as to what challenges have gone on. Again, they started credentialing agencies into this networks four years ago. So did people just jump on the bandwagon immediately and credential? Are they providing care to the VA? Are they not providing care to the VA? Have they closed in that four year time frame? Has it been listed that they're closed? There's a lot of varying factors. Another reason why I would tell people I would encourage them to apply and go through the application process and then that

will allow them to understand where they are as they're reached back out to by triwester to opt them to tell them where they are in the queue or what's going on with their their applications as far as the application itself um it's it's going to be um asking them things like what is their npi number their business business name, they're going to ask for insurance information. TriWest actually asks them for their employee handbook information to make sure that they're hiring diversified and so their hiring practice. And so they each have their own application process. And then once they've acquired all of that application information,

they then push them through what they call credentialing, which is basically running their background checks, running them through MPDB, which is your national provider database, the OIG records to make sure they haven't committed fraud or had fraudulent claims against the OIG or Medicaid and Medicare. If they're in a licensed state, if their license is active and in good standing, if they're in a non-licensed state, they can apply anyway because even though they're not

in a licensed state, they can still fill out their application and be pushed through. We've even seen some of the states that have had a moratorium on licenses. And when agencies have applied, they've put through that moratorium on the license and a letter, a copy of that moratorium, and what they're doing and what they're practicing. And those still have been pushed through in need areas for their application. So all those things are going to come through on the application. And then once they're pushed through the background checking, and once that's completed, if they're in that need area, they'll push them right through to contracts, at which point in time, the agency would receive a contract, they would sign over there on their contract. And then at that point

in time, either TriWest and or Optum uploads them into the system and they and they're eligible to start providing service to veterans okay i've got a few questions thinking through the application process so are there areas where you see a lot of agencies get hung up you know you mentioned for example the employee hand book there's some there's some elements it sounds like that are more qualitative rather than quantitative are there common areas where agencies get hung up, I guess? Absolutely. I think the largest area where we see people get hung up is with their DBAs, and they have like an NPDB, or they have their provider name, and they're doing business as name,

their legal name are different than maybe their licensure name. So if those things don't match up in their NPI number, when they've applied for an NPI, many people apply for an NPI, their national provider identifier, they apply for those as a single entity, and then, or as a name as an agency, but then they do, they're doing business as a separate name. If those things don't all align and they don't match and they're not correct, then they get kicked back. I would say 99% of the people that I see getting their licensure kicked back are on their doing business as, their licensed as, and their NPI number, those three items not matching

up and having the same identities. And then of course, kicking in their actual license. If they don't all match, they're going to push your application back. Seems straightforward, but I'm glad you're reiterating that because you've seen as many of these as probably anyone. And if that's a common mishap, then people need to be aware of that. It's a very common mishap because people apply for some of those things long before. And then the other thing is then they'll then they're actually, you know, Mark and Elizabeth's Caring Angels is their legal name, but they're under Greg's Home Care. And then, of course, those names don't match up. Well, then they go out to get clients and they want to start providing

services and the VA starts looking for their name, there's no Greg's Home Care. It's Mark and Elizabeth's Caring Angels. So they have to make sure that those things are matching up and they're identified correctly as they go through and their DBAs are correctly put into play. Or even at the end of it, they literally won't be seen in the database as a provider for the VA. It would be under maybe their legal name and not under their doing business as name. Interesting. So before we move on any other hangups, I know you're saying this is like the main one, but are there any other mishaps or hangups that people need to be aware of? No, I think that's probably the only, I mean, obviously, you know, physical address making sure, I mean, again, just making sure that your physical

address matches your license address and your mailing piece. And so that all those things, you know, when you fill out that application, everything on the application is a matching piece to that. Because if they're not matching pieces, if they don't, at the end of the day, when they start pushing all these pieces and parts into one place, and then they go run your background check, and then it doesn't match up to the name and things along that line, it'll kick it back. Those are the real key. Those are the only key factors that I see for rejections other than, you know, where they have a saturated market and they put them into a non-priority type setting.

There are no other real holdups within the industry that I know of. Seems straightforward. But again, I'm glad that you're touching on these things because if they're common mistakes or mishaps, we need to identify them. So my next question is, you mentioned the application process, then you jump into credentialing, et cetera. I know this varies state by state and by priority, et cetera, but what is maybe an average timeline on this start to finish process? I would love to give you an answer to that and can't. And no ballpark at all. It varies that drastically. I have seen people credentialed in as few as three weeks and I have seen people credentialed

in 18 months. So to tell you that there's an average or a number in there in the middle that I think I would be misspeaking and speaking out of turn or out of place, because I don't think it's fair to any of the agencies to actually make an assumption. I think just one question, if I can prod a little bit here, and if the answer is the same to this one, that's fine. But I guess my follow-up to that would be, is there a trend in, does it seem to be taking more or less time than it used to be? I think typically it takes more time now than it used to. Okay. So let me prod a little bit there.

For all the reasons mentioned before, and I guess I'm just curious, I know we've got, we've got about 30 people listening live, a lot of which are using paradigm or billing third party or billing VA. Maybe people could jump in the chat and say, you know, what state they're located, even what city they're located in and how long it took them just for kind of a pulse check, but no, yeah, no, no issues with your response there, Greg. I think it's better to set the expectation, you know, in this broad spectrum submitting the claims and the documentation and the billing you know what what you open up this can of worms and you're locked in and you're approved credentialed etc what what do people expect comes their way here's the real challenge and here's where i'm going to dive a little bit away from the billing and more into the benefit and the platforms associated with the benefit so So everybody gets credentialed,

and then they expect the door of the floodgate to open and the VA to just start sending them referrals. But here's what we know about the program within the community care network. And we touched on this a little bit earlier, but the VA says there's 153,000 people in the entire country receiving this benefit. So that are registered in the system, that the VA is authorized and providing services, there's just over 150,000. But to get this benefit for the homemaker, home health aid, and respite services, this is one of the benefits. This is the community care benefit that we're talking about specific. We know that you have to be a service-related disability

veteran. Whatever that service-related disability is, whatever that percentage is, those things all factor in in the end to how many hours and so on. But the reality is you have to have a service-related disability. There's 5.58 million veterans in the United States today with a service-related disability. So when you factor that out, it's less than 3% of the people who would be eligible for this benefit are actually receiving it. So you're not going to receive these veterans from just a floodgate opening and the hospital just sending you 50 veterans tomorrow. That's not the way it's working. What we're finding is, is that people have to go out into the community,

back to boots on the ground, back into understanding how to actually market to organizations and facilities and hospitals and community engagement and so on into driving those veterans back to them as the provider. And there's one thing that we know about the VA, and that is veterans have choice. So if you're meeting with a veteran who has a veterans-related disability but hasn't been receiving these services and wishes to do so,

he needs to get an appointment with a VA clinic with a physician and get an order for assistance with ADLs. If he chooses Gregg's Home Care, case management has to give that client to Gregg's Home Care. The VA says the veteran has choice. As long as you are credentialed in and have a contract with the VA, that veteran must be given you the choice of what agency they prefer. Whether the local hospital puts you on their list or doesn't put you on their list, that veteran has a choice to choose you. So creating veteran clients and understanding how to go out into the community and actually educate and train and help them to understand that the benefit that they're eligible for is there for them has been the massive driving force for what we're seeing in growth, internal growth and organic growth across this country by leaps and bounds. You're saying something really important, and I want to just like recap part of it to make sure that I'm understanding part of this correctly. It sounds like you're

saying that there's maybe an easy mistake to make here with overemphasizing the expectation of referrals that are sent to you as a result of being able to be involved in VA billing versus the benefits of marketing directly to the consumers and educating the consumers directly, understanding that it doesn't always have to come through a referral partner to see benefits here. Is that accurate to say? Correct. Eventually, that referral is going to have to come from the VA Medical Center. Case management, social workers, and so on at the Regional Medical Center are eventually going to send every referral out to you or to the agencies associated in Evolve. But the referral up to them comes from the primary care clinic. What we know is that 80% of the veterans receiving service never set foot in the hospital itself. So case managers are getting the referral from the local clinics and from the VA clinics and from outside source pushing into them of these clients that are eligible for the benefit. So educating the community, educating the veterans and educating the organizations around

you. You know, I would use specifics, an example of a person in one of the Northeastern United States, that's the president of the local VFW that owns a home care company. He has like 84 veteran clients. Every one of those clients have been through his education into the community. And he does veterans walks and parades and growth. And it's all done through the VFW. And he's educated his veteran community. He's only in a town of about 25,000. But he's educated the veteran community in his town.

Exactly. Wow. He's educated his community into the fact that there's a benefit available to them under this program associated with people who have a service-related disability. That is such an important way to be marketing and growing a home care agency, we may have to have him on the podcast sometime. I appreciate this reality check, Greg. You're saying, well, because you're approved doesn't mean the floodgates are open and you're going to grow this new revenue stream exponentially. That's not the reality. You're saying it's up to the agency and their willingness to educate and market and appeal to the general consumer and to essentially find those leads themselves or use their resources and network. But they are the ones drumming up those leads.

And then they go through the process full cycle and get that client. I was on the phone at one o'clock this afternoon with an owner in a Midwest state who's been VA credential for almost 15 months, doesn't have a single client, and came to me and said, I think it's about time I try to market, go get a client. How do I do that? He said, you're 15 months too late. Well, no, the point was is that he wasn't in a mindset where this was something that was critical to the growth of his office, but he's seeing a decline in his other business. So he said, oh, I probably should make up some of that decline in third-party payers or other opportunities.

And I'm already credentialed with the VA, so I probably should jump on this bandwagon and go get clients. So now how do I do it? And so we went through a lot of education into how to market back out into his community resources, whether it be, you know, through the VFW, the Moose, the Elks Lodge. I mean, I could go on and on with all the local organizations that have veterans in them that don't have a clue they have an eligible benefit. You know, I always use family members because it's easy for me and I can't offend anybody. But, you know, a good example would be my son-in-law, who was a Marine who had a couple of surgeries on his ankle. He's a police

officer in Florida. He runs, he jumps, he crawls, he's far healthier than I am. But the military discharged him with 100% disability. But if he had a need for a home health aid tomorrow, he would qualify for 100% benefit. So there's so many people out there in the world who don't know that they have an eligible benefit that can be receiving it. And I've heard the stories from veterans that say, I don't want to take money away from someone who's more deserving, or I don't need it as bad as somebody else does. So I don't want to take money away. The thing they need to realize is that every single veteran that falls under this platform already has an allocated amount of money created by the Veterans Administration back for veterans with disabilities that gets paid out to regional medical centers.

And the benefit for veterans, when you look at what gets paid out to regional medical centers. And the benefit for veterans, when you look at what gets paid out to hospitals, it's a little over $400,000 per veteran per year. It's an astronomical amount of money, and only a sliver of that is paid back into home care. So these individuals should be and can be receiving benefits associated with their disabilities. I think now is a really good time to talk about the different benefits. Patricia's asking, can you touch on how is community care benefit different than aid and attendance? So let's take a few minutes to detail out the different types of VA benefits that exist. Right. So there's really four significant benefits within this platform or within the VA.

One is aid and attendance pension. The aid and attendance pension is an actual pension paid to a veteran who served at least one day in active wartime. So they had to have served in-country in Vietnam, in-country in Korea, in-country in the Second World War. Well, guess what? That has drastically opened in-country since Desert Storm and Afghanistan and all these other periods. So it's not truly defined after Vietnam. So after Vietnam, there's not a defined date prior to and including Vietnam, there's specific dates of in-country wartime that they have to have and then been active duty for at least three months. The big kicker to the aid and attendance pension is they have to have a medical needs.

They have to have a doctor's order that says they need help with ADLs and or be legally blind. And they have to have a net worth under $150,500 and some change, not including their house, their car and up to two acres. If they have over two acres of land, it's considered an asset. Okay. So it's a pretty significant amount of money that's gone up over years. So people can have a little bit more money in cash asset monies. And they're not, it used to be that they had to have like no money. At one point in time, it was like $9,000. Now it's 150. But what's the benefit to them? This is the one benefit that's paid to a surviving spouse. It's $1,432 a month for a surviving spouse. It's a single veteran gets $2,229 as a max benefit. A married veteran with a spouse's needs is $1,750. It's the one that a spouse can actually receive

benefits for. And then a married veteran is $2,642 a month. Those are monies that are paid directly to the veteran as a pension, direct deposit into their bank account monthly, and then you can bill them as a private duty, private pay client off of those amounts of money or any amount of money you wish to bill. You just have to bill your usual customary rate. The next program is your veterans directed care. Now veterans directed Care has really popped up in popularity. It popped up in popularity because a month or so ago, President Biden said he was going to look to expand this program to be in all hospitals by the end of the year. And this is actually a platform where the veteran gets paid directly for the care that they're going to be

provided, and they can hire anybody they want as a caregiver. So it's veteran-directed care. They receive the money. They hire the caregiver they want. Alongside of that program is the caregiver support program, where the caregiver actually becomes the employee, the wife, the child, or whatever it might be, becomes the employee of the VA, they get the stipend paid directly to them to provide care for the veteran. Now, when you think about these first two, the two programs of veteran directed care and the caregiver support program, the first thing that comes to mind if you're an agency is, oh, well, that's going to take money out of my pocket because they're receiving the pay directly and I'm not getting any benefit from this but within these programs there's an incredible amount of respite time both paid to the client as well

as the client caregiver so the caregiver support program has a massive amount of hours allocated to them for respite time for that caregiver. So now the 80 year old wife who has hip surgery or whatever it might be who now needs respite for herself because she can't be the primary caregiver but she was the caregiver can actually be receiving those respite services. So there's a large amount of respite services paid back to the agency. So aligning yourselves with these programs as an agency is incredibly helpful. In fact, in a lot of instances, we're seeing more respite hours than we were seeing primary hours for the client under the normal programs. So there's still a benefit back to our client base. And of course,

it's a benefit because more veterans are getting care. But from an agency or an agency standpoint, there's an opportunity, a huge opportunity to provide not only support if the caregiver is not available, but also respite time alongside of it. So aligning yourself with these two programs that are relatively new and that are starting to expand into our environment is still a great opportunity. And then the last or the fourth benefit is the one that we talk about all the time, which is your community care network, which is your homemaker home health aid services. Those typically are anywhere from, we're seeing the number has come up drastically. The national average is up closer to 16 hours. It's somewhere between 13 and 16 hours a week. We used to see a lot of really short hour cases. We don't see that as much. We only see it in a few hospital networks that still

give shorter hour cases, but typically we're seeing 12, 16, 20, and even more hours than 20 hours per week. With this, there's no income requirement associated with it. You have to be enrolled in the health system of the VA, and within that health system of the VA, you have to have a service-related disability. Those are the four different pieces or programs. The last one, the Community Care Network or CCN or Homemaker Home Health Aid Benefit is where you see the large increase in the rates of pay associated around the zip code of the client and where they live. So those rates are specifically set up by where the client lives pay associated around the zip code of the client and where they live. So those rates are specifically set up by where the client lives, not by the VA hospital and or by where the office is, but where the client lives. And they can range from anywhere in

Wisconsin at $82 an hour to $29 and some change in parts of Arkansas. So they vary from all the way up to $82 an hour down to $29. But national average is greater than $40. That was a lot of information. People are chatting in, where do I get the recording? I'm literally taking notes. This is so much information. And I see you looking to the side. I'm sure you're referencing documentations because that is a lot of information. So my question is, well, I've got a few different questions. You kind of maybe touched on this, but as far as like the reimbursement rates and the way that payments work, does it look the same for each of these four benefits or it varies pretty drastically because the benefits are different? So here's where it varies drastically. The payment for the aid and attendance

pension is a pension flat rate amount of money that's paid to the veteran as a pension each month. They get a direct deposit into their account. Then you can bill them as a private pay client, whatever your usual and customary rate is. So if your rate's $30 an hour, you would charge them $30 an hour and they can pay you either out of their own funds or up to and including all of the monies associated with their benefit. The thing is, is that the money has to be paid back for a benefit. It has to be paid back to an agency. It can't be paid to your sister, your brother, their uncle. It has to be paid back to an agency. And the VA does audit those monies back to make sure that there's either timesheets and or documentation to show that the veteran paid the money. But that's paid on whatever you set with them as a private pay rate. The other three

programs, which are the veteran-directed care, is paid directly to the veteran. But if you're providing respite and or services back through the program to help that veteran, that's paid through the same pay rates as the community care network. That's where your rates are exactly the same. They're billed under the same billing codes and the authorizations come across from the VA where the amount of respite hours and or service hours for those clients are directly back from the VA. So those programs work exactly the same as far as

billing and reimbursement, just the authorizations look different. So the authorization will come across and it'll say for the caregiver support program hours, you know, 16 hours per respite per week to assist blah, blah, blah, whoever that client might be. That's how you're going to receive the authorization. Whereas you're going to get an authorization from the VA for your homemaker home health aid that'll say zero to 20 hours, you get 12 hours per week to assist Mr. Smith with these benefits. So it's just the way the authorizations are written out. They're coming from two programs, but all of them are coming from the VA hospital except for the aid and attendance pension. Okay. That clarification

was really useful. My next question is, there are these four benefits. Is there saturation in any one or two benefits regarding home care or can home care providers pick and choose which benefits to tap into? They can do any and all of these programs. In fact, I would suggest, if I was telling someone from a business perspective, which or which ones to look at, I would tell them every one of them. Because as an example, if someone doesn't have a lot of funding and they qualify and they're a wartime veteran and can get the aid and attendance pension, they can be receiving services under the community care network, respite, all the above, and still get the pension paid on top of that as an extra benefit.

So say we, if we went to the top pay at $2,600 and something per month at $30 an hour, it would give you about 20 hours per week of service. And if you were getting 16 hours per week under the Homemaker Home Health Aid program, now all of a sudden you've got a client that's getting 36 hours a week. So you can stack the program and offer the benefits. So I would suggest utilization of all of the above. There are third-party sources out there that assist with aid and attendance pension that help to get the benefit, but you can assist them directly. The veteran can do this on their own and get the benefit if they wish to do so, and then just hire the agency as a private agency. Either way works best, and sometimes it's better with whichever way you feel is the best opportunity for the veteran. Okay. Very useful information. I want to kind of put a pause in here. We've covered a lot of ground.

I want to ask you, is there any, we've just got, you know, about eight minutes left here. Is there any direction or anything that we haven't covered yet that you would like to make sure we cover in this time? All I would say is, you know, as you look to diversify your portfolio, and as you look to expand, the veterans opportunity is just untapped. I mean, just I just going to throw the numbers out there one more time. 153,000 people receiving the Homemaker Home Health Aid and Respite Benefit and over five and a half million eligible veterans. So when we talk about a genuinely untapped opportunity, with rates running from anywhere from $82 an hour in Wisconsin down to $30 an hour in the lowest marketplace, you know, you go across states, you know, you go, you know, Texas at $72 and Oklahoma at 67. 62 in Nebraska, $41 in West Virginia. I could keep going on and on with why this is an amazing opportunity for a home health agency or a home care agency. Providing care to veterans on the private duty side is just incredibly untapped and it's an astronomical opportunity.

Awesome. I couldn't have said it better myself. And that's what we want people to get out of today's call is the education and learning, but also to your point, this opportunity, we need to make this opportunity more known to more home care providers, which is why we're talking to you, the expert here today. One thing that I want to ask, Brian here is doing a great job of dropping some links here in the chat. Are there other go-to resources or links or places that we can direct people to learn more about things that we've covered today and beyond? I mean, I was saying the links that he's bringing up, those are direct to the VA's website. All of

those are great opportunities. I mean, obviously, if you reach out to us at Paradigm, we can assist you with a lot of these same questions, including state rates and opportunities and what's going on in your state. There is a table built into the VA system also to look up the rates by zip code. But when you go to look them up, they're not broken out by service type. They're actually broken out by all services within a geographic area. So you're going to get every skilled code, non-skilled code, therapy code, dentists, primary care physicians. But if you go to our website, the rate table's actually there and accessible to everybody that they can just type in a zip code and it'll bring up the rates for them and the zip code they're looking for.

Highly recommend those tables that Paradigm has built out to anyone. Greg, before I even knew you, before I even knew anything about Paradigm, I came across those over a year and a half ago. I send those to people all of the time and I didn't even know you or we didn't even know Paradigm, etc. But your team has spent time building send out those links as well because they are very useful. People are already saying thank you and fantastic information. So let's maybe cap here. We've covered a lot of ground and we've gone really deep. I also just want to end and say, if you have more questions, we've covered a lot of ground, but we've also just scratched the surface. Greg and his team at Paradigm are experts when it comes to third-party billing. Like I said, next week, we're going to go into other third-party payer sources and we're going to go deep on those as well. But know that Greg and his team at Paradigm are more than willing to answer any and all of your questions. And they're also there to help. Greg, maybe in just a minute or two, you can share a little bit about Paradigm Services and what

exactly you all do to help providers. So actually, Paradigm Senior Services can do everything from assisting you in going through the credentialing process, understanding, helping you with your application, getting you enrolled in the system as assisting them with that process. And then from a revenue cycle management, we actually do all of your billing to the VA. We manage your authorization processes, as well as training and education and ongoing education and direct posting back to you. We genuinely start front to back the entire revenue cycle for the VA for you, as well as all third party

payers. But it starts with helping you to get into network and then closes out with posting your payments back in to your AMS in real time. So if this information is intimidating to any of you, know that Paradigm, you can basically lean on them to do all of this for you. Great information today, Greg. Thank you so much. You run a busy schedule and travel the country sharing this information, but we appreciate you giving us 60 minutes of your time today and also next week to share this with our audience. So thanks so much for being here. Thank you for the opportunity. Appreciate it. Thanks everyone for being here. Like I've said multiple times, same day, same time next week, we'll have Greg and we'll go

into other third-party payer sources and we welcome you back to join us. And again, this is being recorded. We'll publish it as a podcast and send out the recording link along with some of these resources that we've mentioned today. So thank you for being here and we'll see you all back next week. Thanks, everyone. That's a wrap. This episode was made by the team at CareSwitch, the first free home care agency management software. If you're tired of running your agency on an outdated software that looks and works like Windows 98, and you want to save a little money for your bottom line, check us out at CareSwitch.com. Thanks for listening. See you next time.