Re: Fwd: Wake up call for the future

[Guest guest]

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From: MLUNDYPT@...

To: ptmanager@...

I just read a letter to physician providers for United Healthcare of Florida

and thought the information was worth passing on because I believe what

happens to physicians will probably happen to therapists in the future.

The letter states that the company has implemented Patterns Review software

and the two higher paying E & M CPT codes used for claims will be reviewed on

all claims submitted by providers.

If there is a denial, the physician may appeal the decision by " documenting

the clinical basis for disagreement in writing and submit at least two

articles from nationally recognized journals in your specialty that support

your position to your Patterns liaison registered nurse. "

In essence, a computerized review of practice patterns for high paying CPT

codes is being implemented on all claims submitted for payment by all

providers.

If this improves the companies bottom line for shareholders, we better start

saving/publishing our articles in nationally recognized journals.

What do you think? Has anyone else seen this?

in Florida

>>

Sounds like evidenced based medicine --- agree we should be soundly

responsible for our practices --quantitative // although the art of medicine

is difficult to study too --qualitative ----~g