Guest guest Posted August 5, 1998 Report Share Posted August 5, 1998 Dear Fellow PTManager subscribers, There has been a great deal of recent discussion and questions regarding the current differences between many Florida rehab providers and Blue Cross/Blue Shield of Florida over the issue of focused medical reviews and delayed payments. As editor of Eli’s Rehab Report, I have been a member of this list since its inception, and I have followed these and other discussions with great interest. In its most recent issue, Eli's Rehab Report details the dilemmas faced by several PT providers in Florida. In many cases, providers say they have never had a single run-in with Medicare, but now find themselves under a 100 focused medical review, leaving them with little or no cash flow, and facing the likelihood of shutting their doors. Furthermore, they insist their claims are being branded as " not medically necessary, " without additional clarification and guidance from BCBSF. Now, these providers insist that " BCBSF is out of control, and nobody's watching over them, " leaving them no choice but to pursue a class-action lawsuit. BCBSF representatives, however, insist they are not trying to shut anyone down. The problem, they contend, is that claims " need to paint a picture so that we can tell what's going on. " Unfortunately, they say that most providers are too vague in their documentation, leaving reviewers no other option but to deny the claims. Consequently, too many denied claims and the provider goes under review. This is an issue that I will continue to cover in the future, with several articles planned for the next issue as well, including BCBSF's suggestions for improving documentation. This is just one of the many topics covered recently in Eli's Rehab Report, including: • Is the market weakening for rehab providers who want to sell their practices? • Why do rehab providers need to become quality salespeople, and what skills do they possess that make them naturals at selling? • Does NovaCare’s recent announcement that it will consider “strategic alternatives,” which may include selling off one or more of its operating divisions, indicate that it’s getting too big? If so, why isn’t HealthSouth facing a similar predicament? • Will the delay in consolidated billing actually create new problems for providers if HCFA starts to pay SNFs under a prospective payment system without consolidated billing. If anyone has any questions, please feel free to call or e-mail me. Sincerely, Cary Boshamer Editor, Eli's Rehab Report caryb@... ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 1998 Report Share Posted August 5, 1998 Cary, I read your notice on PT manager. I am a owner of an ORF in south florida and have found the exact problem occurring in my practice. Until just two months ago, I had virtually no problem with reimbursement or ADR's. Since June 98, I am under a 10% ADR rate. Meaning per billing period 10% of my patients medical records fall under the " Additional Documentatin Required " list. This means no cash flow at present on those cases, and I expect (although I have ot yet heard about my cases) them to be denied because " not medically necessary " I base this on what my billing company's other clients are experiencing and what you have described. I feel that the Blues have only a few options to click on their computers and Not Meidcally Necessary is the easiest one to push. This is BS! We both know that now skilled people are reading these charts, how sensible is that? Also, Medicare and their payment to the Blues is on a different timeline. As the year comes to a close, the blues probably sense their payments from medicare will diminish, so they will " cut " disbursement to the providers to save cash. Who know if that is what is really happening, but I am not happy. I would be very interested in hearing from you RE: documentation or any other idaeas for stoppint his nonsense fro the blues. hope to hear from you Witt wittpt@... ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! Quote Link to comment Share on other sites More sharing options...
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