Reimbursement

The Reimbursement Office is charged with the responsibility of identifying and billing third party payors (Medicare, Medicaid, commercial insurance, etc.), evaluating consumers’ and legally liable persons’ ability to pay and assisting consumers with applications for various federal benefits. Article 8, Chapter 2, Title 37.1-105 through 37.1-119 of the Code of Virginia mandates this duty.

Liability

Every person admitted to NVMHI is liable for the full daily rate charge incurred for his/her cost of care and treatment. While NVMHI is a state facility, it is not free. However, through the Reimbursement investigative process, a determination may be made that a consumer or legally liable person is unable to afford payment. At this point, a recommendation may be made to reduce the charges or not pursue payment

Third Party Billing

If a consumer is covered by any third party medical insurance, Medicare or Medicaid, a claim will be submitted for payment, based on approved coverage and benefits. The consumer is responsible for any deductible and/or co-insurance, and for the period of time that may be denied by the third party.

Ability to Pay

It is the responsibility of the consumer and legally liable person to provide financial information to Reimbursement, if he/she feels that he/she cannot afford payment in full. Reimbursement will provide a financial form to the consumer or legally liable person. Upon evaluation of income, assets and liabilities, a determination will be made concerning the expected payment. In some cases a sliding fee scale is used for this purpose.

Legally Liable Persons

Spouses for spouses, adult children for parents and parents for minor children.

Federal Benefits

Based on federal policy, these benefits are to be used for current living expenses. When a person is admitted to NVMHI, the cost of care and treatment is considered as the current living expense, which is given highest priority in the disbursement of benefits. A monthly amount is allocated to the consumer for personal needs. If it is determined that a consumer cannot administer his/her benefits, Reimbursement will submit an application to have the benefit paid directly to the Department. Reimbursement will assist in identifying those consumers that may be eligible for federal benefits (Social Security, Civil Service Annuity, VA, Medicaid, etc.). Further, applications may be completed and submitted by the Reimbursement staff.

Rates

$554.00 per day effective July 1, 2005
$531.00 per day effective April 1, 2005
$528.00 per day effective January 1, 2005
$545.00 per day effective March 1, 2004
$538.00 per day effective January 1, 2004

Contact Information

Reimbursement Field Office Director
Mike Campfield
(703) 207-7136

Fiscal Technician
Suzi Keplinger
(703) 207-7136