UHC Par Providers Watch for These Billing Tactics

[Guest guest]

We provide third party billing services for outpatient PT/OT/SLP and have

one client that opted to stay with UHC after the per diem rate dropped last

year. All other clients terminated their contract with UHC.

Besides the obvious fact that UHC does not reimburse providers at a

reasonable/customary rate or pay claims promptly, they have used other " stall

tactics " and unethical payment practices that include and are not limited to

the

following:

1. In Louisiana, UHC's per diem rate for outpatient PT/OT treatment is $45

($65 for evaluation). A true story. On one DOS, the PT bills 1 unit of

manual therapy, 1 unit of ther-ex and 1 unit of ultrasound. UHC paid $44 for

the

manual therapy, $1 for the ther-ex and $0 for the ultrasound, which equals

$45, the contracted per diem rate. On the very same EOB, for the same

patient, with the same diagnosis and same services performed on a subsequent

DOS,

UHC paid $44 for the ther-ex, $0 for the manual therapy and $0 for the

ultrasound, which equals $44, not the contracted $45 per diem rate. The

dilemma: Do

you spend your staff's time and the cost of resubmitting a corrected

electronic or paper claim to collect the $1 owed to you or do you do nothing?

UHC

hopes you do nothing. If they can skim $1 off of every other claim imagine

how much money that would add up at the end of each year.

2. It's 45 to 60 days since you have received payment on a batch of clean

claims filed to UHC. You contact UHC or check claims status online for these

dates of service and UHC reports " No claim on file, " so you resubmit these

claims once more. In 30 days you receive an EOB from UHC that states the

claims

you resubmitted are " duplicate charges. "

3. When UHC does pay a claim within 45 days, they will frequently pay

claims out-of-order and/or pay the latest claim submitted first and wait

another

45 to 60 days to pay claims that were submitted two or three months prior.

They are also famous for skipping a DOS that was filed in the same batch as all

other DOS claims in hopes that you do not resubmit the claim or as a stall

tactic.

4. My all time favorite UHC stall tactic is when the deny a claim because

there is NO ACN registration number on file, when in fact the practice has

obtained an ACN registration number. This buys UHC another 2 weeks to

" reprocess " claims.

We no longer resubmit clean claims that have already been submitted to UHC,

yet have not been paid. Instead, we send UHC a Request for Prompt Payment

that includes LA Title 22 R.S. 22:250.31 through 250.37 (prompt payment

statute) along with a list of the claims that have not been paid promptly and

proof

of timely filing of those claims. We copy the patient. If this is our second

request, we copy the LA Insurance Commissioner's Office and the

policyholder's employer if it is a group plan.

ACN/UHC continues to grow in market share in Louisiana as their policy rates

are competitive and attractive to employers who are looking for ways to cut

cost and still provide healthcare coverage for their employees. For those

providers who have wizened up to ACN/UHC unethical practices and payment stall

tactics and have terminated contracted services, check all your contracts

very carefully before renewing as ACN/UHC is buying up smaller insurance

companies and most recently, going after government contracts (Tricare). Greed

breeds greed!

D. Cavitt

Claims Processing & Recovery, LLC

**************Wondering what's for Dinner Tonight? Get new twists on family

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[Guest guest]

Hi ,

Great info we should all be compiling. Would it be all right to forward

your information to the APTA reimbursement department? I think it is time

to find out what the Association has been doing about this. I know they are

aware of it but compiling as many horror stories as possible helps.

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

howellpt@...

_____

From: PTManager [mailto:PTManager ] On Behalf

Of mlavcavitt@...

Sent: Wednesday, May 14, 2008 8:11 AM

To: PTManager

Subject: UHC Par Providers Watch for These Billing Tactics

We provide third party billing services for outpatient PT/OT/SLP and have

one client that opted to stay with UHC after the per diem rate dropped last

year. All other clients terminated their contract with UHC.

Besides the obvious fact that UHC does not reimburse providers at a

reasonable/customary rate or pay claims promptly, they have used other

" stall

tactics " and unethical payment practices that include and are not limited to

the

following:

1. In Louisiana, UHC's per diem rate for outpatient PT/OT treatment is $45

($65 for evaluation). A true story. On one DOS, the PT bills 1 unit of

manual therapy, 1 unit of ther-ex and 1 unit of ultrasound. UHC paid $44 for

the

manual therapy, $1 for the ther-ex and $0 for the ultrasound, which equals

$45, the contracted per diem rate. On the very same EOB, for the same

patient, with the same diagnosis and same services performed on a subsequent

DOS,

UHC paid $44 for the ther-ex, $0 for the manual therapy and $0 for the

ultrasound, which equals $44, not the contracted $45 per diem rate. The

dilemma: Do

you spend your staff's time and the cost of resubmitting a corrected

electronic or paper claim to collect the $1 owed to you or do you do

nothing? UHC

hopes you do nothing. If they can skim $1 off of every other claim imagine

how much money that would add up at the end of each year.

2. It's 45 to 60 days since you have received payment on a batch of clean

claims filed to UHC. You contact UHC or check claims status online for these

dates of service and UHC reports " No claim on file, " so you resubmit these

claims once more. In 30 days you receive an EOB from UHC that states the

claims

you resubmitted are " duplicate charges. "

3. When UHC does pay a claim within 45 days, they will frequently pay

claims out-of-order and/or pay the latest claim submitted first and wait

another

45 to 60 days to pay claims that were submitted two or three months prior.

They are also famous for skipping a DOS that was filed in the same batch as

all

other DOS claims in hopes that you do not resubmit the claim or as a stall

tactic.

4. My all time favorite UHC stall tactic is when the deny a claim because

there is NO ACN registration number on file, when in fact the practice has

obtained an ACN registration number. This buys UHC another 2 weeks to

" reprocess " claims.

We no longer resubmit clean claims that have already been submitted to UHC,

yet have not been paid. Instead, we send UHC a Request for Prompt Payment

that includes LA Title 22 R.S. 22:250.31 through 250.37 (prompt payment

statute) along with a list of the claims that have not been paid promptly

and proof

of timely filing of those claims. We copy the patient. If this is our second

request, we copy the LA Insurance Commissioner's Office and the

policyholder's employer if it is a group plan.

ACN/UHC continues to grow in market share in Louisiana as their policy rates

are competitive and attractive to employers who are looking for ways to cut

cost and still provide healthcare coverage for their employees. For those

providers who have wizened up to ACN/UHC unethical practices and payment

stall

tactics and have terminated contracted services, check all your contracts

very carefully before renewing as ACN/UHC is buying up smaller insurance

companies and most recently, going after government contracts (Tricare).

Greed

breeds greed!

D. Cavitt

Claims Processing & Recovery, LLC

**************Wondering what's for Dinner Tonight? Get new twists on family

favorites at AOL Food.

(http://food. <http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001>

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[Guest guest]

, where in Louisiana are you?? Here on the Mississippi Gulf Coast very

few private practice settings are still with UHC.? Primarily, it is only

hospital outpatient depts that stayed with them.?? I have turned away a number

of patients with UHC but when I explain to them about UHC they understand.?

Hopefully, enough go back to their personnel depts.?

Matt Capo, PT

Accelerated Physical Therapy and Occupational Health, Inc.

Bay St. Louis and Diamondhead, Mississippi

UHC Par Providers Watch for These Billing Tactics

We provide third party billing services for outpatient PT/OT/SLP and have

one client that opted to stay with UHC after the per diem rate dropped last

year. All other clients terminated their contract with UHC.

Besides the obvious fact that UHC does not reimburse providers at a

reasonable/customary rate or pay claims promptly, they have used other " stall

tactics " and unethical payment practices that include and are not limited to the

following:

1. In Louisiana, UHC's per diem rate for outpatient PT/OT treatment is $45

($65 for evaluation). A true story. On one DOS, the PT bills 1 unit of

manual therapy, 1 unit of ther-ex and 1 unit of ultrasound. UHC paid $44 for the

manual therapy, $1 for the ther-ex and $0 for the ultrasound, which equals

$45, the contracted per diem rate. On the very same EOB, for the same

patient, with the same diagnosis and same services performed on a subsequent

DOS,

UHC paid $44 for the ther-ex, $0 for the manual therapy and $0 for the

ultrasound, which equals $44, not the contracted $45 per diem rate. The dilemma:

Do

you spend your staff's time and the cost of resubmitting a corrected

electronic or paper claim to collect the $1 owed to you or do you do nothing?

UHC

hopes you do nothing. If they can skim $1 off of every other claim imagine

how much money that would add up at the end of each year.

2. It's 45 to 60 days since you have received payment on a batch of clean

claims filed to UHC. You contact UHC or check claims status online for these

dates of service and UHC reports " No claim on file, " so you resubmit these

claims once more. In 30 days you receive an EOB from UHC that states the claims

you resubmitted are " duplicate charges. "

3. When UHC does pay a claim within 45 days, they will frequently pay

claims out-of-order and/or pay the latest claim submitted first and wait another

45 to 60 days to pay claims that were submitted two or three months prior.

They are also famous for skipping a DOS that was filed in the same batch as all

other DOS claims in hopes that you do not resubmit the claim or as a stall

tactic.

4. My all time favorite UHC stall tactic is when the deny a claim because

there is NO ACN registration number on file, when in fact the practice has

obtained an ACN registration number. This buys UHC another 2 weeks to

" reprocess " claims.

We no longer resubmit clean claims that have already been submitted to UHC,

yet have not been paid. Instead, we send UHC a Request for Prompt Payment

that includes LA Title 22 R.S. 22:250.31 through 250.37 (prompt payment

statute) along with a list of the claims that have not been paid promptly and

proof

of timely filing of those claims. We copy the patient. If this is our second

request, we copy the LA Insurance Commissioner's Office and the

policyholder's employer if it is a group plan.

ACN/UHC continues to grow in market share in Louisiana as their policy rates

are competitive and attractive to employers who are looking for ways to cut

cost and still provide healthcare coverage for their employees. For those

providers who have wizened up to ACN/UHC unethical practices and payment stall

tactics and have terminated contracted services, check all your contracts

very carefully before renewing as ACN/UHC is buying up smaller insurance

companies and most recently, going after government contracts (Tricare). Greed

breeds greed!

D. Cavitt

Claims Processing & Recovery, LLC

**************Wondering what's for Dinner Tonight? Get new twists on family

favorites at AOL Food.

(http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001)

[Guest guest]

Absolutely! I have included our billing company information below in the

event they need to contact me.

Vickie

D. Cavitt, Executive Director

Claims Processing & Recovery, L.L.C.

310 Magnate Drive, Suite 204

Lafayette, LA 70508-3871

Phone

Fax

In a message dated 5/14/2008 9:23:12 P.M. Central Daylight Time,

thowell@... writes:

Hi ,

Great info we should all be compiling. Would it be all right to forward

your information to the APTA reimbursement department? I think it is time

to find out what the Association has been doing about this. I know they are

aware of it but compiling as many horror stories as possible helps.

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

_howellpt@..._ (mailto:howellpt@...)

_____

From: _PTManager@yahoogrouPTMana_ (mailto:PTManager )

[mailto:_PTManager@yahoogrouPTMana_ (mailto:PTManager ) ] On

Behalf

Of _mlavcavitt@..._ (mailto:mlavcavitt@...)

Sent: Wednesday, May 14, 2008 8:11 AM

To: _PTManager@yahoogrouPTMana_ (mailto:PTManager )

Subject: UHC Par Providers Watch for These Billing Tactics

We provide third party billing services for outpatient PT/OT/SLP and have

one client that opted to stay with UHC after the per diem rate dropped last

year. All other clients terminated their contract with UHC.

Besides the obvious fact that UHC does not reimburse providers at a

reasonable/customarreasonable/customar<WBR>y rate or pay claims promptly,

" stall

tactics " and unethical payment practices that include and are not limited to

the

following:

1. In Louisiana, UHC's per diem rate for outpatient PT/OT treatment is $45

($65 for evaluation). A true story. On one DOS, the PT bills 1 unit of

manual therapy, 1 unit of ther-ex and 1 unit of ultrasound. UHC paid $44 for

the

manual therapy, $1 for the ther-ex and $0 for the ultrasound, which equals

$45, the contracted per diem rate. On the very same EOB, for the same

patient, with the same diagnosis and same services performed on a subsequent

DOS,

UHC paid $44 for the ther-ex, $0 for the manual therapy and $0 for the

ultrasound, which equals $44, not the contracted $45 per diem rate. The

dilemma: Do

you spend your staff's time and the cost of resubmitting a corrected

electronic or paper claim to collect the $1 owed to you or do you do

nothing? UHC

hopes you do nothing. If they can skim $1 off of every other claim imagine

how much money that would add up at the end of each year.

2. It's 45 to 60 days since you have received payment on a batch of clean

claims filed to UHC. You contact UHC or check claims status online for these

dates of service and UHC reports " No claim on file, " so you resubmit these

claims once more. In 30 days you receive an EOB from UHC that states the

claims

you resubmitted are " duplicate charges. "

3. When UHC does pay a claim within 45 days, they will frequently pay

claims out-of-order and/or pay the latest claim submitted first and wait

another

45 to 60 days to pay claims that were submitted two or three months prior.

They are also famous for skipping a DOS that was filed in the same batch as

all

other DOS claims in hopes that you do not resubmit the claim or as a stall

tactic.

4. My all time favorite UHC stall tactic is when the deny a claim because

there is NO ACN registration number on file, when in fact the practice has

obtained an ACN registration number. This buys UHC another 2 weeks to

" reprocess " claims.

We no longer resubmit clean claims that have already been submitted to UHC,

yet have not been paid. Instead, we send UHC a Request for Prompt Payment

that includes LA Title 22 R.S. 22:250.31 through 250.37 (prompt payment

statute) along with a list of the claims that have not been paid promptly

and proof

of timely filing of those claims. We copy the patient. If this is our second

request, we copy the LA Insurance Commissioner'request, we copy

policyholder'policyholder'<WBR>s employer if it is

ACN/UHC continues to grow in market share in Louisiana as their policy rates

are competitive and attractive to employers who are looking for ways to cut

cost and still provide healthcare coverage for their employees. For those

providers who have wizened up to ACN/UHC unethical practices and payment

stall

tactics and have terminated contracted services, check all your contracts

very carefully before renewing as ACN/UHC is buying up smaller insurance

companies and most recently, going after government contracts (Tricare).

Greed

breeds greed!

D. Cavitt

Claims Processing & Recovery, LLC

************************<WBR>**Wondering what's for Dinner Tonight? Get new

favorites at AOL Food.

(_http://food._'>http://food._ (http://food./)

<_http://food.http://food.<WBhttp://food.http://food.<WBRhttp_

(http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) >

aol.com/dinner-aol.com/dinneaol.com/dinner-aol.c

[Non-text portions of this message have been removed]

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[Guest guest]

Matt, our third party billing company is located in Lafayette, LA. The

client I made reference to in my e-mail is located in New Orleans and treats

both

adult and pediatric patients. Their decision to stay in-network with UHC

was based on the high volume of special needs children they treat that have UHC

coverage--many of which returned to this client after a four month clinic

closure as a result of Hurricane Katrina. They have made numerous attempts

over the past six months to negotiate a higher rate with UHC for their

pediatric patients and have had no success in getting anyone to return their

calls or

respond to their correspondence. To add insult to injury, UHC has not paid

their claims correctly or timely! This client is finally realizing that

remaining in-network with UHC is no longer an option.

For years, we have read story after story about uninsured and under-insured

patients not having access to the medical care they need. But what about

insured patients not having access to the medical care they need? I realize

that there are hospital outpatient PT/OT departments that are exceptional and

for a growing number of adult patients, transitioning from an outpatient

private practice setting to an outpatient hospital setting is not difficult.

Conversely, and from what I have read and have been told by physicians and

therapists who treat children with special needs, some children have difficulty

with even the most minimal changes made in their daily routines.

In my humbled opinion, it should be UHC, not the provider, that has to

explain to a patient or parent of a patient why they will have to find a new

therapist to treat them!

Have a great Thursday. Thanks for your feedback.

D. Cavitt, Executive Director

Claims Processing & Recovery, L.L.C.

210 Magnate Drive, Suite 204

Lafayette, LA 70508-3871

Phone

Fax

In a message dated 5/15/2008 5:58:45 A.M. Central Daylight Time,

acceleratedptbsl@... writes:

, where in Louisiana are you?? Here on the Mississippi Gulf Coast

very few private practice settings are still with UHC.? Primarily, it is only

hospital outpatient depts that stayed with them.?? I have turned away a number

of patients with UHC but when I explain to them about UHC they understand.?

Hopefully, enough go back to their personnel depts.?

Matt Capo, PT

Accelerated Physical Therapy and Occupational Health, Inc.

Bay St. Louis and Diamondhead, Mississippi

UHC Par Providers Watch for These Billing Tactics

We provide third party billing services for outpatient PT/OT/SLP and have

one client that opted to stay with UHC after the per diem rate dropped last

year. All other clients terminated their contract with UHC.

Besides the obvious fact that UHC does not reimburse providers at a

reasonable/customarreasonable/customar<WBR>y rate or pay claims promptly,

they

tactics " and unethical payment practices that include and are not limited to

the

following:

1. In Louisiana, UHC's per diem rate for outpatient PT/OT treatment is $45

($65 for evaluation). A true story. On one DOS, the PT bills 1 unit of

manual therapy, 1 unit of ther-ex and 1 unit of ultrasound. UHC paid $44 for

the

manual therapy, $1 for the ther-ex and $0 for the ultrasound, which equals

$45, the contracted per diem rate. On the very same EOB, for the same

patient, with the same diagnosis and same services performed on a subsequent

DOS,

UHC paid $44 for the ther-ex, $0 for the manual therapy and $0 for the

ultrasound, which equals $44, not the contracted $45 per diem rate. The

dilemma: Do

you spend your staff's time and the cost of resubmitting a corrected

electronic or paper claim to collect the $1 owed to you or do you do

nothing? UHC

hopes you do nothing. If they can skim $1 off of every other claim imagine

how much money that would add up at the end of each year.

2. It's 45 to 60 days since you have received payment on a batch of clean

claims filed to UHC. You contact UHC or check claims status online for these

dates of service and UHC reports " No claim on file, " so you resubmit these

claims once more. In 30 days you receive an EOB from UHC that states the

claims

you resubmitted are " duplicate charges. "

3. When UHC does pay a claim within 45 days, they will frequently pay

claims out-of-order and/or pay the latest claim submitted first and wait

another

45 to 60 days to pay claims that were submitted two or three months prior.

They are also famous for skipping a DOS that was filed in the same batch as

all

other DOS claims in hopes that you do not resubmit the claim or as a stall

tactic.

4. My all time favorite UHC stall tactic is when the deny a claim because

there is NO ACN registration number on file, when in fact the practice has

obtained an ACN registration number. This buys UHC another 2 weeks to

" reprocess " claims.

We no longer resubmit clean claims that have already been submitted to UHC,

yet have not been paid. Instead, we send UHC a Request for Prompt Payment

that includes LA Title 22 R.S. 22:250.31 through 250.37 (prompt payment

statute) along with a list of the claims that have not been paid promptly

and proof

of timely filing of those claims. We copy the patient. If this is our second

request, we copy the LA Insurance Commissioner'request, we copy

policyholder'policyholder'<WBR>s employer if it is

ACN/UHC continues to grow in market share in Louisiana as their policy rates

are competitive and attractive to employers who are looking for ways to cut

cost and still provide healthcare coverage for their employees. For those

providers who have wizened up to ACN/UHC unethical practices and payment

stall

tactics and have terminated contracted services, check all your contracts

very carefully before renewing as ACN/UHC is buying up smaller insurance

companies and most recently, going after government contracts (Tricare).

Greed

breeds greed!

D. Cavitt

Claims Processing & Recovery, LLC

************************<WBR>**Wondering what's for Dinner Tonight? Get new

favorites at AOL Food.

(_http://food.http://food.<WBhttp://food.http://food.<WBRhttp_

(http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) )

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

**************Wondering what's for Dinner Tonight? Get new twists on family

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[Guest guest]

We are not a provider for UHC but still accept UHC patients. Since we have no

contractual obligations to UHC, we are able to assist these patients with the

balance of their account.

Amy Stelly

Clinic Coordinator (Office Manager)

LeBlanc, Chamberlain and Physical Therapy Services

4027 I-49 South Service Road

Opelousas, Louisiana 70570

Telephone: Facsimile:

________________________________

From: PTManager [PTManager ] On Behalf Of

acceleratedptbsl@... [acceleratedptbsl@...]

Sent: Wednesday, May 14, 2008 9:42 PM

To: PTManager

Subject: Re: UHC Par Providers Watch for These Billing Tactics

, where in Louisiana are you?? Here on the Mississippi Gulf Coast very

few private practice settings are still with UHC.? Primarily, it is only

hospital outpatient depts that stayed with them.?? I have turned away a number

of patients with UHC but when I explain to them about UHC they understand.?

Hopefully, enough go back to their personnel depts.?

Matt Capo, PT

Accelerated Physical Therapy and Occupational Health, Inc.

Bay St. Louis and Diamondhead, Mississippi

UHC Par Providers Watch for These Billing Tactics

We provide third party billing services for outpatient PT/OT/SLP and have

one client that opted to stay with UHC after the per diem rate dropped last

year. All other clients terminated their contract with UHC.

Besides the obvious fact that UHC does not reimburse providers at a

reasonable/customary rate or pay claims promptly, they have used other " stall

tactics " and unethical payment practices that include and are not limited to the

following:

1. In Louisiana, UHC's per diem rate for outpatient PT/OT treatment is $45

($65 for evaluation). A true story. On one DOS, the PT bills 1 unit of

manual therapy, 1 unit of ther-ex and 1 unit of ultrasound. UHC paid $44 for the

manual therapy, $1 for the ther-ex and $0 for the ultrasound, which equals

$45, the contracted per diem rate. On the very same EOB, for the same

patient, with the same diagnosis and same services performed on a subsequent

DOS,

UHC paid $44 for the ther-ex, $0 for the manual therapy and $0 for the

ultrasound, which equals $44, not the contracted $45 per diem rate. The dilemma:

Do

you spend your staff's time and the cost of resubmitting a corrected

electronic or paper claim to collect the $1 owed to you or do you do nothing?

UHC

hopes you do nothing. If they can skim $1 off of every other claim imagine

how much money that would add up at the end of each year.

2. It's 45 to 60 days since you have received payment on a batch of clean

claims filed to UHC. You contact UHC or check claims status online for these

dates of service and UHC reports " No claim on file, " so you resubmit these

claims once more. In 30 days you receive an EOB from UHC that states the claims

you resubmitted are " duplicate charges. "

3. When UHC does pay a claim within 45 days, they will frequently pay

claims out-of-order and/or pay the latest claim submitted first and wait another

45 to 60 days to pay claims that were submitted two or three months prior.

They are also famous for skipping a DOS that was filed in the same batch as all

other DOS claims in hopes that you do not resubmit the claim or as a stall

tactic.

4. My all time favorite UHC stall tactic is when the deny a claim because

there is NO ACN registration number on file, when in fact the practice has

obtained an ACN registration number. This buys UHC another 2 weeks to

" reprocess " claims.

We no longer resubmit clean claims that have already been submitted to UHC,

yet have not been paid. Instead, we send UHC a Request for Prompt Payment

that includes LA Title 22 R.S. 22:250.31 through 250.37 (prompt payment

statute) along with a list of the claims that have not been paid promptly and

proof

of timely filing of those claims. We copy the patient. If this is our second

request, we copy the LA Insurance Commissioner's Office and the

policyholder's employer if it is a group plan.

ACN/UHC continues to grow in market share in Louisiana as their policy rates

are competitive and attractive to employers who are looking for ways to cut

cost and still provide healthcare coverage for their employees. For those

providers who have wizened up to ACN/UHC unethical practices and payment stall

tactics and have terminated contracted services, check all your contracts

very carefully before renewing as ACN/UHC is buying up smaller insurance

companies and most recently, going after government contracts (Tricare). Greed

breeds greed!

D. Cavitt

Claims Processing & Recovery, LLC

**************Wondering what's for Dinner Tonight? Get new twists on family

favorites at AOL Food.

(http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001)