Guest guest Posted December 24, 2008 Report Share Posted December 24, 2008 Ric: My experience with them is not good-terrible in fact. This is a classic case where the business and clinical model of working with comp carriers (or self-insured) makes great sense-however, rate matters. Contract specifics matter. Administrative overhead matters. The burden of submission, certification, chasing outliers, documentation requests add up-routine for these patients way out of normal " flow " for your clinic. At the end of the day, your suspicion is correct-they play a " zero sum game " in which you will lose and they will win. The only way you can win is to provide substandard care where your PT's consciously underutilize and they know PT's won't do this. I admit to liking their business model and am quite sure they are making a fortune-all at the expense of PT's backs. __________________________________________ Larry Larry Benz PT, DPT PT Development LLC 13000 Equity Place Suite 105 Louisville, KY 40223 larry@... mobile (Spinvox converts voice to email) office (if you get voice mail-don't worry, it will Spinvox and go to email) (Fax. It will convert to email) Follow PhysicalTherapy updates on Twitter<http://twitter.com/PhysicalTherapy> blog: EvidenceInMotion<http://blog.myphysicaltherapyspace.com/> EIM Executive Management Program<http://blog.myphysicaltherapyspace.com/2008/11/eim-executive-course-in-p\ ractice-management.html> and Orthopedic Residency<http://www.slideshare.net/1008/evidence-in-motions-residency-pro\ gram-presentation-762713/> CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy legal speak that none of us reads or understands if often contained here. From: PTManager [mailto:PTManager ] On Behalf Of RBaird5957@... Sent: Tuesday, December 23, 2008 4:35 PM To: PTManager Subject: Network Synergy Group Are any of you familiar with this group? They are a work-comp middle man ,so to speak, who offer a DRG based reimbursement per diagnosis. They do have an impressive list of companies, however my suspicion is that they are pocketing the difference in the work comp fee schedule vs. what they are paying you per DRG which would be a winning situation for them the majority of the time unless you can get that work comp rotator cuff tear back to work after surgery in 10 visits in which case their $1750 reimbursement would be a winner for you and a loser for them, but I am betting not many of us accomplish that feat! Even at 20 visits you would get $87.50/visit. This is just 1 example that doesn't appear to be too bad, however, the $570 for a lumbar strain at 10 visits would be a winner for them and a loser for us at $57/visit which is the way the majority of the DRG's are set up (most are from $570 to $615 per DRG). Anybody have any feedback or experience on or with this company? I usually avoid these things and file them in the trash, but had not seen one of this type and wondered what your experiences with them were. Thanks, and Merry Christmas! Ric A. Baird, MS, PT, ATC Interactive Physical Therapy & Fitness Center 4745 NW Hunters Ridge Circle Suite D Topeka, KS 66618 (785)246-2300 (P) (785)246-2301 (F) Interactive Physical Therapy 2018 SE 28th Street Topeka, KS 66605 (P) 20(F) www.interactiveptandfitness.com Request input CMS policy please I recently was informed that I am on the STATS Policy Workgroup nominated by several colleagues. STATS is the Short Term Alternatives for Therapy Services (STATS) contract by the Centers for Medicare and Medicaid Services (CMS) to perform follow-on claims analysis and to work with outpatient therapy stakeholders to develop recommendations for improving outpatient therapy payment policy in the short-term. There are 2 workgroups-Policy and Clinical. There are several PT's, OT's, and SLP in the workgroups. The mission of the STATS Policy Workgroup is as follows: - Evaluate existing payment policy (not limited to existing outpatient therapy policy). - Identify specific policy applications that could reduce barriers to the efficient/effective delivery of medically necessary services. - Identify specific policy applications to increase confidence that medically necessary services are being delivered. The project is roughly 2 years and is very committed to not only productive dialogue but transparency as well. I have received permission to publish this and to seek suggestions and recommendations directly by you and I assure you that these suggestions once consolidated will be forwarded as appropriate. Per the director of the STATS workgroup, a chief constraint of our activities will be to discuss20policy options that are realistically achievable in the short-term. For example, some changes in Medicare Manual language and some coding changes, if appropriate, can be achieved in relative short periods, while complex changes to CMS payment systems or forms may take extended periods of time. We are not seeking to develop a new instrument or to validate an existing tool as other CMS contracts serve those longer-term analyses. However, among several options, we are considering if it is feasible that existing processes being used by clinicians could be used in a new short-term policy to help describe clinical need and/or progress on the claim form through the introduction of new codes that could serve to describe clinical information (e.g. severity, progress, or outcome). The proposed introduction of such information may have policy implications within the scope of CMS activities (e.g. Medicare Manual language and regulations) to those beyond the direct scope of CMS control (e.g. Social Security Act or CPT-4 and ICD-9 coding development). This workgroup will help inform CSC of policy variables to consider, as well as policy barriers that need to be addressed in order for proposed options to be considered viable. Time constraints may be the largest barriers to some potentially good suggestions. As the project proceeds, it will begin to focus in on the most realistic options and begin to address the details of what would need to be addressed for those option(s) to be realized. Here is your assignment! Prior to Jan 4, ple ase comment directly on this blog or to me at larry@...<mailto:larry%40physicaltherapist.com><mailto:larry@p\ hysicaltherapist.com<mailto:larry%40physicaltherapist.com>> the following: What are the top 5 most achievable short term policy options that help better identify patient need for therapy and/or measure progress/outcome? Your feedback and input is greatly appreciated. Happy Holidays! larry@...<mailto:larry%40physicaltherapist.com><mailto:larry@p\ hysicaltherapist.com<mailto:larry%40physicaltherapist.com>> __________________________________________ Larry Larry Benz PT, DPT PT Development LLC 13000 Equity Place Suite 105 Louisville, KY 40223 larry@...<mailto:larry%40physicaltherapist.com><mailto:larry@p\ hysicaltherapist.com<mailto:larry%40physicaltherapist.com>> mobile (Spinvox converts voice to email) office (if you get voice mail-don't worry, it will Spinvox and go to email) (Fax. It will convert to email) Follow PhysicalTherapy updates on Twitter<http://twitter.com/PhysicalTherapy> blog: EvidenceInMotion<http://blog.myphysicaltherapyspace.com/> EIM Executive Management Program<http://blog.myphysicaltherapyspace.com/2008/11/eim-executive-course-in-p\ ractice-management.html> and Orthopedic Residency<http://www.slideshare.net/1008/evidence-in-motions-residency-pro\ gram-presentation-762713/> CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy legal speak that none of us reads or understands if often contained here. Quote Link to comment Share on other sites More sharing options...
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