Guest guest Posted February 13, 2007 Report Share Posted February 13, 2007 Medrisk will only look at changing the global rate after 3 months, if you can justify extending care. I can see the justification, but the 3 month time frame is arbitrary and is very detrimental to the patient AND provider. I also believe they continue to bill the insurnce carrier after you reach your maximum reimbursement from Medrisk. They also pay a daily rate, regardless if you offer PT and OT/CHT. Then the patient with say a wrist fracture and knee surgery would have to be seen on different days to treat both body parts. Good luck. PT DPT Edison NJ Also, they take their time paying bills. MedRisk We are an outpatient private practice in Arkansas and have recently been approached by MedRisk about becoming in network with them. I have looked through the recent dialogues regarding MedRisk/ACN and am trying to decide if this is a contract we are interested in. My question for the group is regarding the DxFee system MedRisk uses. They are currently telling us their aim is for reimbursement to be around $70/visit, but they will pay only up to a certain amount based on diagnosis and clinic indicators. They are saying that if care goes beyond what was expected at evaluation, that they will re-evaluate their fee and increase this when indicated. What has been the experience of the group with this arrangement? Have they actually been reasonable in increasing this DxFee when continued care is indicated? I appreciate your feedback. Thanks Gabe Freyaldenhoven River Valley Therapy and Sports Medicine ________________________________________________________________________ Check out the new AOL. Most comprehensive set of free safety and security tools, free access to millions of high-quality videos from across the web, free AOL Mail and more. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2007 Report Share Posted February 13, 2007 Gabe, My clinic was also approached by MedRisk to become an in-network provider. After reading every line in the contract, we decided against becoming a provider. Especially disconcerting was the fact that if a patient is discharged from my care, returns to his job and reinjures himself, I would have to see the patient for free to rehabilitate him again. I don't think so..... Anne McClure, PT Physical Therapy Solutions Lawton, OK MedRisk We are an outpatient private practice in Arkansas and have recently been approached by MedRisk about becoming in network with them. I have looked through the recent dialogues regarding MedRisk/ACN and am trying to decide if this is a contract we are interested in. My question for the group is regarding the DxFee system MedRisk uses. They are currently telling us their aim is for reimbursement to be around $70/visit, but they will pay only up to a certain amount based on diagnosis and clinic indicators. They are saying that if care goes beyond what was expected at evaluation, that they will re-evaluate their fee and increase this when indicated. What has been the experience of the group with this arrangement? Have they actually been reasonable in increasing this DxFee when continued care is indicated? I appreciate your feedback. Thanks Gabe Freyaldenhoven River Valley Therapy and Sports Medicine Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2007 Report Share Posted February 14, 2007 Gabe, We once accepted Medrisk in our office; however, we had problems with the way they would pay out the claims. They would give you a case rate depending on the script and the physical therapist's initial evaluation, ex: 458.00, however they would pay only a daily maximum for the visit 50.00 a visit with a max of the $458. They wouldn't pay any more then the case rate no matter how many visits the patient needed. Additional, If the patient was referred back even 6 months later for the same diagnosis, we would have to treat them for no additional compensation. We lost a ton of money with this contract. Buyer Beware!!! Estrella Vantuyl,BS Florida Fitness and Rehabilitation 18900 N. Tamiami Trail Suite A-5 N. Ft. Myers, FL 33903 Phone: Fax: Email: estrella@... _____ From: PTManager [mailto:PTManager ] On Behalf Of Gabe Freyaldenhoven Sent: Tuesday, February 13, 2007 3:18 PM To: PTManager Subject: MedRisk We are an outpatient private practice in Arkansas and have recently been approached by MedRisk about becoming in network with them. I have looked through the recent dialogues regarding MedRisk/ACN and am trying to decide if this is a contract we are interested in. My question for the group is regarding the DxFee system MedRisk uses. They are currently telling us their aim is for reimbursement to be around $70/visit, but they will pay only up to a certain amount based on diagnosis and clinic indicators. They are saying that if care goes beyond what was expected at evaluation, that they will re-evaluate their fee and increase this when indicated. What has been the experience of the group with this arrangement? Have they actually been reasonable in increasing this DxFee when continued care is indicated? I appreciate your feedback. Thanks Gabe Freyaldenhoven River Valley Therapy and Sports Medicine Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2007 Report Share Posted February 14, 2007 Gabe, As you can see from the other emails, the message is to BEWARE! STAY AWAY! NIGHTMARE! Same situations happened with us as well. We NEVER were paid on time, customer service was horrible and the reimbursement was ridiculous. Exact same thing happened to us about being required to treat a patient after their max. global fee was reached. No matter how much more therapy was needed and when, we had to treat them. I honestly dont know how they can get away with this. Cathi Redwood Hand Therapy Santa , Ca. MedRisk We are an outpatient private practice in Arkansas and have recently been approached by MedRisk about becoming in network with them. I have looked through the recent dialogues regarding MedRisk/ACN and am trying to decide if this is a contract we are interested in. My question for the group is regarding the DxFee system MedRisk uses. They are currently telling us their aim is for reimbursement to be around $70/visit, but they will pay only up to a certain amount based on diagnosis and clinic indicators. They are saying that if care goes beyond what was expected at evaluation, that they will re-evaluate their fee and increase this when indicated. What has been the experience of the group with this arrangement? Have they actually been reasonable in increasing this DxFee when continued care is indicated? I appreciate your feedback. Thanks Gabe Freyaldenhoven River Valley Therapy and Sports Medicine Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2007 Report Share Posted February 14, 2007 We thought long and hard before starting with MedRisk also. We are getting reimbursed a higher visit rate than I am seeing on this list which is reasonable for us. They did try to include the clause regarding treating the patient for free if they came back within so many months with the same injury. We said we would not sign until they took the clause out and they quickly sent an addendum. They do have procedures for requesting extensions beyond the global fee although we have not had to make that request yet. Prior to signing, I did talk to our state work comp network representative regarding whether some of this was ok for them to put into an agreement, and basically there are no limitations. The agreement can be cancelled with a 90 day notice, so we decided to give it a shot and cancel if we ran into difficulties or we saw no benefit in the referral base. Lott Physical Therapy Fairfield, TX _____ From: PTManager [mailto:PTManager ] On Behalf Of Redwood Hand Therapy Sent: Wednesday, February 14, 2007 11:23 AM To: PTManager Subject: [POSSIBLE-SPAM] Re: MedRisk Gabe, As you can see from the other emails, the message is to BEWARE! STAY AWAY! NIGHTMARE! Same situations happened with us as well. We NEVER were paid on time, customer service was horrible and the reimbursement was ridiculous. Exact same thing happened to us about being required to treat a patient after their max. global fee was reached. No matter how much more therapy was needed and when, we had to treat them. I honestly dont know how they can get away with this. Cathi Redwood Hand Therapy Santa , Ca. MedRisk We are an outpatient private practice in Arkansas and have recently been approached by MedRisk about becoming in network with them. I have looked through the recent dialogues regarding MedRisk/ACN and am trying to decide if this is a contract we are interested in. My question for the group is regarding the DxFee system MedRisk uses. They are currently telling us their aim is for reimbursement to be around $70/visit, but they will pay only up to a certain amount based on diagnosis and clinic indicators. They are saying that if care goes beyond what was expected at evaluation, that they will re-evaluate their fee and increase this when indicated. What has been the experience of the group with this arrangement? Have they actually been reasonable in increasing this DxFee when continued care is indicated? I appreciate your feedback. Thanks Gabe Freyaldenhoven River Valley Therapy and Sports Medicine Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2007 Report Share Posted February 14, 2007 We have been approached by MedRisk several times in recent months. As I understand it MedRisk is primarily a work comp network. Obviously work comp laws differ from state to state, so the analysis should begin with what your state's work comp rules and laws say an employer, WC insurer or MCO can and can't do. Some states, several of which are represented in this string of emails, have employer/insurer/MCO ability to direct referrals to specific contracted providers (Arkansas, New Jersey Oklahoma, Florida, California). In these cases providers may need to look at the MedRisk contract and decide on its merits, of which the comments seem to indicate are few if any. Many states do not have any laws allowing the employer or work comp carrier to direct referrals to specific providers. From our research states where employees have sole choice are Alaska, Delaware, Hawaii, Louisiana, land, Mississippi, Washington and West Virginia. In these states there seems to be no need to even consider a contract with MedRisk, they can't truly direct patients (hard channel) by law regardless of what they say, so why supply them a discount when they can't back up their claim of truly bringing you volume? Other states require the MCO to be " certified or approved " in some way. States like Oregon, Kentucky, Minnesota, and Ohio seem to have some type of law with this feature. In these states providers should determine if MedRisk is " certified or approved " before even considering an agreement. If they're not " certified or approved " they don't have the directional ability that would be worth any discount. The majority of our clinics are in Oregon and Washington. MedRisk is not a certified or approved MCO in Oregon and employees in Washington have choice in where they want to seek care, so MedRisk cannot provide us anything that would warrant accepting their discounted reimbursement. As discussed with other subjects recently (UHC / ACN), not every contract is a good contract and providers need to know which are worth having and which contracts are not worth having. Todd Gifford, PT TherapeuticAssociates www.therapeuticassociates.com www.careconnections.com [POSSIBLE-SPAM] Re: MedRisk Gabe, As you can see from the other emails, the message is to BEWARE! STAY AWAY! NIGHTMARE! Same situations happened with us as well. We NEVER were paid on time, customer service was horrible and the reimbursement was ridiculous. Exact same thing happened to us about being required to treat a patient after their max. global fee was reached. No matter how much more therapy was needed and when, we had to treat them. I honestly dont know how they can get away with this. Cathi Redwood Hand Therapy Santa , Ca. MedRisk We are an outpatient private practice in Arkansas and have recently been approached by MedRisk about becoming in network with them. I have looked through the recent dialogues regarding MedRisk/ACN and am trying to decide if this is a contract we are interested in. My question for the group is regarding the DxFee system MedRisk uses. They are currently telling us their aim is for reimbursement to be around $70/visit, but they will pay only up to a certain amount based on diagnosis and clinic indicators. They are saying that if care goes beyond what was expected at evaluation, that they will re-evaluate their fee and increase this when indicated. What has been the experience of the group with this arrangement? Have they actually been reasonable in increasing this DxFee when continued care is indicated? I appreciate your feedback. Thanks Gabe Freyaldenhoven River Valley Therapy and Sports Medicine Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2007 Report Share Posted February 15, 2007 Contact you State Insurance Commission. A. Towne, PT Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2007 Report Share Posted February 15, 2007 We participated with MedRisk for a few years and had all the same problems. After we dropped them we still had 6 old accounts they had not finished paying on. It's now 2 years later, we still are not paid, and they have not responded to a single claim or letter of complaint we have sent them. When I call them I get the standard " We did not receive them " answer, even though they were sent registered mail with a date, time, and signature of receipt. Amy Marshall, PT BIAPT Gabe Freyaldenhoven wrote: We are an outpatient private practice in Arkansas and have recently been approached by MedRisk about becoming in network with them. I have looked through the recent dialogues regarding MedRisk/ACN and am trying to decide if this is a contract we are interested in. My question for the group is regarding the DxFee system MedRisk uses. They are currently telling us their aim is for reimbursement to be around $70/visit, but they will pay only up to a certain amount based on diagnosis and clinic indicators. They are saying that if care goes beyond what was expected at evaluation, that they will re-evaluate their fee and increase this when indicated. What has been the experience of the group with this arrangement? Have they actually been reasonable in increasing this DxFee when continued care is indicated? I appreciate your feedback. Thanks Gabe Freyaldenhoven River Valley Therapy and Sports Medicine --------------------------------- Any questions? Get answers on any topic at Yahoo! Answers. Try it now. --------------------------------- TV dinner still cooling? Check out " Tonight's Picks " on Yahoo! TV. Quote Link to comment Share on other sites More sharing options...
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