VA tackles claims backlog with new priority approach

Wednesday - 7/11/2012, 6:12pm EDT

By Esther Carey
Special to Federal News Radio

In the world of benefit claims, not all cases are created equal. The Veterans Benefits Administration is implementing a new system in which claims are separated into three categories based on the difficulty of review needed to increase productivity and help address the backlog of cases.

The agency will deploy the updated model at 16 regional offices initially, said VA's Allison Hickey, undersecretary for benefits, during a press conference today. The plan is designed to increase the number of cases the agency settles by an additional 150,000-to-200,000 each year. VA said about 600,000 of the 900,000 current claims are in the backlog.

VA will evaluate a claim entering under the new method at an intake processing center which will place it in one of three "lanes":

  • Express — Claims which only involve a couple of medical conditions, or those which already have all needed supporting information, known as "fully developed claims."

  • Special Operations — Cases which involve complex medical conditions such as Post Traumatic Stress Disorder or those which have other special circumstances such as financial hardship, homelessness, or prisoner of war status.

  • Core — Claims which involve multiple medical conditions or which require more documentation.
Hickey said estimates indicate the core lane will contain 60 percent of claims, with 20 percent of claims going into each other lane.

VA said the system will improve the claims process by ensuring it addresses critical cases promptly, while also prioritizing the completion of simple claims. Also, case workers will increase in efficiency and accuracy as they become familiar with claims of similar complexity by working in one of the three categories.

Four offices in Indianapolis, Ind., Wichita, Kan., Milwaukee, Wis. and Fort Harrison, Mont. already are working under the new model. The agency plans to have the other 12 onboard by September, Hickey said.

The goal is to have all 56 regional Veterans Affairs offices using this process by December 2013. Hickey said implementation is taking place in a gradual fashion to ensure that there are no hitches that could cause system-wide problems.

Revised Training

The change announced today is only one of a variety of efforts by VBA to improve service and reduce the backlog of claims, defined as claims in the queue for more than 125 days. Hickey said the majority of these backlogged cases are supplemental claims requesting additional assistance for veterans or family members of veterans from all American wars. VA aims to zero backlogged claims by the year 2015.

Another initiative involves overhauling the training for claim workers. The 1,300 employees trained under the revised "Challenge" training exhibited an increase in productivity from half a case completed per day to one-and-a-half completed, along with a 30 percent increase in accuracy, according to a press release.

The new program focuses on ensuring trainees are exposed to a variety of practice cases before beginning work. The previous method relied on home offices to give employees residence-type training after receiving some instruction at central locations. But most offices did not have the resources needed to accomplish this, according to a report released Tuesday.

Challenge training now is standard operating procedure for new hires. Advanced courses for current employees to improve the quality of their work also are under development, Hickey said. VBA also instituted Quality Review Teams at all 56 offices to address problems promptly.

Esther Carey is an intern at Federal News Radio.

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