Work Comp Question

[Guest guest]

, When SAIF corporation accepts the claim, they can direct the patient into the MCO. If they accept it in a week, then they can do it. It has nothing to do with 18/60 rule, and everything to do with accepting the claim.

Don White, RN, DC

In a message dated 10/10/2011 6:47:06 P.M. Pacific Daylight Time, drandrewcha@... writes:

This is probably a question for vern, however any input will be greatly appreciated. I have a patient who has been MCO'd less than 1 week into treatment. This occured shortly after i had denied Saif's request to return the patient to light duty. It has been a few years since i have had a patient MCO'd so quickly. Does Saif have a right to do this before the 18 visits/ 60 days? Cha D.C

[Guest guest]



Dr. White is correct however as per the "continuity of care" provision you still have 7 days from the date of the enrollment letter to continue to see that patient before the are required to see a panel provider.

Vern Saboe

Re: work comp question

, When SAIF corporation accepts the claim, they can direct the patient into the MCO. If they accept it in a week, then they can do it. It has nothing to do with 18/60 rule, and everything to do with accepting the claim.

Don White, RN, DC

In a message dated 10/10/2011 6:47:06 P.M. Pacific Daylight Time, drandrewcha@... writes:

This is probably a question for vern, however any input will be greatly appreciated. I have a patient who has been MCO'd less than 1 week into treatment. This occured shortly after i had denied Saif's request to return the patient to light duty. It has been a few years since i have had a patient MCO'd so quickly. Does Saif have a right to do this before the 18 visits/ 60 days? Cha D.C

[Guest guest]

Yes, of course you can. But first ask the case manager why she wishes to accompany the patient they may be very positive and simply wish to understand better the valuable service you provide. In short it could be a opportunity rather than the reverse. Call them if you get the hint that they are there for some other "negative" reason whatever the heck that would be.....require them to wait in the reception area....Vern Saboe

Work comp question

For W/C cases, have any of you had the nurse case manager come to the patient's appointments? I have a nurse case manager that wants to come and I'm not sure if I feel comfortable having her in the room with the patient. I don't know that the patient will be honest with me about how she's feeling with someone judging her in the room. Can I ask the case manager to wait in the lobby if I have these concerns? McCabe, DC, CCSP

[Guest guest]

Hi All! I wanted to find out:

If a WC patient went to an MD and was referred for PT, do those visits come out of the 18 visits before an MD needs to get involved again?

Thanks,

Cluen, DC

[Guest guest]

If the MD maintains the position of primary provider, then your visits act as

therapist visits (regardless of treatment) and should not apply to the 18

visits. If you take over the role of primary provider, then the 18 visits

start.

dan miller

On Jan 19, 2012, at 12:03 PM, Cluen wrote:

>

> Hi All! I wanted to find out:

> If a WC patient went to an MD and was referred for PT, do those visits come

out of the 18 visits before an MD needs to get involved again?

>

> Thanks,

>

> Cluen, DC

>

>

[Guest guest]

NO, is the answer. Colleagues, visits to a physical therapist referred to by a medical physician do not count against our 18 visits nor the 60 day time period. Alternatively, visits to a naturopathic physician prior to seeing a chiropractic physician do count against our 18 visits and the clock starts ticking on the sixty day clock. The same can be true if a physician’s assistant sees your patient first if they and not the medical physician has signed off on the Form 827. This is something you need to check on EVERY TIME most of the time the MD always signs off on the Form 827 and as such the 18/60 doesn’t start…..clear as mud? Vern Saboe From: [mailto: ] On Behalf Of CluenSent: Thursday, January 19, 2012 12:03 PM Subject: Work Comp Question Hi All! I wanted to find out:If a WC patient went to an MD and was referred for PT, do those visits come out of the 18 visits before an MD needs to get involved again? Thanks, Cluen, DC

[Guest guest]

Doesn’t make any sense whatsoever. Man, can we just get some Parity please. 18/60 is in and of itself a slap in the face (I know it’s an improvement from the old 12/30, but still). The fact that our 18/60 is engaged when anyone other than the MD is in charge is junk. There is no valid reason for denying chiropractors the same rights as MD’s in regards to these cases. Heck, I believe NP’s and PA’s actually are alotted more freedom. I mean, I can even see limiting the ND’s on these cases due to the nature of their practices. Chiros however, work with musculoskeletal injuries on a daily basis, are completely immersed in rehab and perform most if not ALL of the treatment the patient needs without referring with Incredible satisfaction and success rates..

We’re the ones that should be running the majority of these cases, particularly the musculoskeletal ones. Yet, they want to limit and restrict us. It makes no sense.

ph Medlin D.C.

From: vsaboe

Sent: Thursday, January 19, 2012 5:15 PM

' Cluen' ;

Subject: RE: Work Comp Question/

NO, is the answer. Colleagues, visits to a physical therapist referred to by a medical physician do not count against our 18 visits nor the 60 day time period. Alternatively, visits to a naturopathic physician prior to seeing a chiropractic physician do count against our 18 visits and the clock starts ticking on the sixty day clock. The same can be true if a physician’s assistant sees your patient first if they and not the medical physician has signed off on the Form 827. This is something you need to check on EVERY TIME most of the time the MD always signs off on the Form 827 and as such the 18/60 doesn’t start…..clear as mud?

Vern Saboe

From: [mailto: ] On Behalf Of CluenSent: Thursday, January 19, 2012 12:03 PM Subject: Work Comp Question

Hi All! I wanted to find out:

If a WC patient went to an MD and w as referred for PT, do those visits come out of the 18 visits before an MD needs to get involved again?

Thanks,

Cluen, DC

[Guest guest]

First Dr. Medlin, Thank you for being a member of your only trade organization the Oregon Chiropractic Association.  The OCA has continued to work this issue and is doing so currently, we have key legislative concepts relative to chiropractic services being superior to standard medical treatment in efficacy, cost effectiveness and safety.  Last session the OCA’s legislative work resulted in our getting our study which is a pilot study to look at the feasibility of performing a large statewide study using the Washington State COHE system which uses no closed panel MCOs.  We also have concepts for the 2013 long regular session the OCA has in fact been working hard on W/C issues since 2005 and I assure you we are not letting up on the pressure nor gas pedal….. Vern Saboe, DC., FACOLobbyist, Oregon Chiropractic AssociationACA Delegate for OregonQuestions?  Call me any time at 541-231-4528 Cell From: ph Medlin [mailto:spinetree@...] Sent: Friday, January 20, 2012 10:12 AM' Cluen'; ; vsaboeSubject: Re: Work Comp Question Doesn’t make any sense whatsoever. Man, can we just get some Parity please. 18/60 is in and of itself a slap in the face (I know it’s an improvement from the old 12/30, but still). The fact that our 18/60 is engaged when anyone other than the MD is in charge is junk. There is no valid reason for denying chiropractors the same rights as MD’s in regards to these cases. Heck, I believe NP’s and PA’s actually are alotted more freedom. I mean, I can even see limiting the ND’s on these cases due to the nature of their practices. Chiros however, work with musculoskeletal injuries on a daily basis, are completely immersed in rehab and perform most if not ALL of the treatment the patient needs without referring with Incredible satisfaction and success rates.. We’re the ones that should be running the majority of these cases, particularly the musculoskeletal ones. Yet, they want to limit and restrict us. It makes no sense. ph Medlin D.C. From: vsaboe Sent: Thursday, January 19, 2012 5:15 PM' Cluen' ; Subject: RE: Work Comp Question/ NO, is the answer. Colleagues, visits to a physical therapist referred to by a medical physician do not count against our 18 visits nor the 60 day time period. Alternatively, visits to a naturopathic physician prior to seeing a chiropractic physician do count against our 18 visits and the clock starts ticking on the sixty day clock. The same can be true if a physician’s assistant sees your patient first if they and not the medical physician has signed off on the Form 827. This is something you need to check on EVERY TIME most of the time the MD always signs off on the Form 827 and as such the 18/60 doesn’t start…..clear as mud? Vern SaboeFrom: [mailto: ] On Behalf Of CluenSent: Thursday, January 19, 2012 12:03 PM Subject: Work Comp Question Hi All! I wanted to find out:If a WC patient went to an MD and w as referred for PT, do those visits come out of the 18 visits before an MD needs to get involved again?Thanks, Cluen, DC