The Private Medical Records Program

>>Graphic: VA Seal and Logo >>Narrator: The Private Medical Records Program Transforming VA Claims Processing and Improving
the Veteran Experience Improving the Veteran experience and ensuring
timely access to critical benefits and services is at the heart of the Department of Veterans
Affairs mission. And when it comes to improving access to disability
benefits, increasing the speed and efficiency of the claims development life cycle is an
essential piece of VBAs transformation efforts. Today, more than ever, VA is improving claims
development processes and using new tools and approaches to support faster claims decisions
at every level. An essential part of this effort is the Veterans
Benefits Administrations Private Medical Records, or PMR, Retrieval Program.

Launched in 2010 as part of VBAs Claims Transformation, the PMR Program improves the process for retrieving private
medical records to increase the overall speed, accuracy and quality of disability benefit
claim processing. The PMR Program has five main objectives: Shorten the amount of time it takes to gather
Veteran private treatment records from providers to 12 days or less Receive or close out 90 percent of medical
record requests Improve the Intake Process by Digitizing Medical
Record Receipts for Upload Into the Veterans Benefits Management System (VBMS) Save VA employees time to focus on other claims-related activities And better serve veterans and their families Initially launched as a pilot in 2010, the
PMR program was deployed nationwide in 2014. It now supports all 54 VA Regional Offices,
the Pension Management Centers, and the Appeals Management Center. It also works in collaboration with the National
Work Queue workload management strategy and the Centralized Mail program.

This seamless integration into VAs electronic
claim initiatives allows for the timely receipt of private treatment requests, via VA Form
21-4142, and the transmission of records to VA, which improves the overall speed, quality
and efficiency of claims processing. Hows the program doing? In one word...Great! >>Frank Kush, PMR Program Manager: The Private
Medical Records Program helps us make claims decisions faster, more accurately, and improves
the overall veteran experience. The PMR Program walks the walk. Underneath traditional claims processing,
it took 60 to 90 days with a reduced success rate to get records.

Underneath the PMR Program, it takes 12 days
and we get your records with a 90% success rate. >>Morgan Banjoman, Processing Lead, PMR Program:
Our goal for receiving and closing the medical records request are 12 days or less. And we're meeting that goal. Sometimes even
exceeding.

>>Narrator: Between 2010 and 2016, the program
processed hundreds of thousands of requests and achieved a cumulative 90% success rate in
obtaining records or responses from providers. Bottom line, the PMR Program has centralized
the medical record retrieval process. And what does that mean for Veterans? Faster, more accurate claims decisions Improved customer service Improved access to benefits and resources And, Overall, a Better Veteran Experience with VA. >>Stanley Wade, Veteran, U.S.

Army: I filed
a claim within the last year that took probably about two months to complete where I'd filed
claims previously that took as much as two years to complete. I filed the claim with VA and shortly after
that I received a letter stating that they would be requesting my private medical records. And I believe because of that I was able to
get a result from them in a very short amount of time, which I was, as a matter of fact,
quite pleased with. >>Narrator: The PMR Processing Center makes
the overall claims process faster by speeding up the Gathering Of Evidence step in retrieving
private medical records more efficiently.

How does the PMR process work? VBA is taking advantage of the latest technology,
tools and program management processes to improve the quality, efficiency and security
of how information is retrieved, processed and stored. The program integrates seamlessly with VAs
Centralized Mail process so that all VA Form 21-4142 requests are quickly and securely
transferred to the PMR processing center. Incoming medical record requests are then
thoroughly reviewed to determine if they qualify for development. Each request undergoes a rigorous quality
assurance check for validation.

Once complete, an initial contact letter is
sent to the Veteran and claimants Power of Attorney, if applicable, notifying them
that a request has been made to their provider. Contacting the Veteran keeps them informed
and connected to their claim by improving transparency within the process and promoting
communication with VA. Over two thousand Veteran letters are printed
and mailed each week. Claims Service Representatives, or CSRs, will
then directly call the private health care provider listed on the form within three business
days of receiving the request, and follow up with multiple calls as needed.

>>CSR: Good morning. My name is Tonia and
I'm calling from the Veterans Benefits Administration and I'm calling to obtain the fax number to
send over a medical records request for a patient. >>Narrator: This proactive approach provides
direct outreach to providers and builds stronger relationships with them to gather evidence
faster than previous methods. Call scripts have been optimized to overcome
common objections from providers to secure records quickly and effectively.

Providers are then faxed, or mailed if they
do not accept faxed documents, a formal request to submit the Veterans medical records. They are given multiple options for how to
send the records, including: Secure Toll-Free Fax, Secure electronic upload via the PMR Vault
using a unique passcode, and Mailed Paper Copies This allows Providers the flexibility to use
the method most suitable to their environment, decreasing turnaround time and increasing
response rates. Paper records sent via the United States Postal
Service are quickly scanned and uploaded into the PMR Portal to align with electronic processing
initiatives and support organized internal process workflow. Hard copies are then stored in a secure warehouse
and kept for 365 days before being destroyed in compliance with VA standards.

As an outcome of the PMR Program, relationships
have been established with Release of Information, or ROI, services. These national companies serve as records
request processing centers for healthcare providers. The ROIs allow PMR staff to access their online
portals to pull down electronic records on a daily basis, which helps streamline the
PMR process and align with VAs shift to electronic claim processing. Quality control checks are performed on all
received PMRs to ensure information accuracy.

Records that fulfill all requirements on the
Quality Control checklist are then packaged and electronically sent to Centralized Mail
for subsequent upload to VBMS for further processing. This integration with Centralized Mail and
VBMS completes the PMR Programs ability to perform the entire receipt of evidence
process, eliminating it from VA rating specialists workloads. From start to finish, this process takes an
average of 12 days. >>Frank Kush: I've been with the PMR Program
from the early stages and I've seen it grow from a very small pilot program at three offices
to a nationally-implemented program that receives thousands of records a day.

By having a specific group of individuals
focus on nothing but getting private treatment records, we can use our more experienced VA
employees to focus on making complex claims decisions for veterans in a more timely and
compassionate manner. >>Morgan Banjoman: The VA backlog has really
cleared up and I think it had a lot to do with the PMR Program. I'm really proud of
it. >>Narrator: The PMR Program has played a critical
role in helping to reduce VAs claim processing time and the claims backlog.

Through its continued efforts, the PMR Program
will serve as an important resource for ensuring Veterans timely access to benefits for
years to come. >>Stanley Wade: If I could say anything to
the people who work at VA, it would be "Thank you for your service." Because they're always thanking
us for our service, but they have raised the level of their performance to such a degree
that they stand second to none. And I would recommend them to anyone. >>Graphic: VA Seal and Logo Text: The Private Medical Records Program.