Re: Negotiated out-of-network payment services

[Guest guest]

If you have a signed agreement stick to your guns and do not accept less. I

know an attorney that this is all he does - hold companies to their agreed to

rates when they are trying to beat you down. You're under no obligation to

reduce the amount.

> To: PTManager

> From: bobnotrob@...

> Date: Mon, 2 Jul 2012 16:17:12 +0000

> Subject: Negotiated out-of-network payment services

>

> I was recently contacted by National Health Quest offering a settlement on a

WC claim that I find unacceptably low in terms of reimbursement. What happens if

I reject the settlement offer? How much negotiating room does one have with

these types of organizations?

>

> B Schroedter, PT

> Miami, FL

>

>

>

> ------------------------------------

>

> In ALL messages to PTManager you must identify yourself, your discipline and

your location or else your message will not be approved to send to the full

group.

>

> Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our

professions. PTManager is not available to support POPTS-model practices. The

description of PTManager group includes the following:

> " PTManager believes in and supports Therapist-owned Therapy Practices ONLY "

> Messages relating to " how to set up a POPTS " will not be approved

>

> PTManager encourages participation in your professional association. Join

APTA, AOTA or ASHA and participate now!

>

> Follow Kovacek, PT on Facebook or Twitter.

> PTManager blog: http://ptmanager.posterous.com/

>

[Guest guest]

If you have a signed agreement stick to your guns and do not accept less. I

know an attorney that this is all he does - hold companies to their agreed to

rates when they are trying to beat you down. You're under no obligation to

reduce the amount.

> To: PTManager

> From: bobnotrob@...

> Date: Mon, 2 Jul 2012 16:17:12 +0000

> Subject: Negotiated out-of-network payment services

>

> I was recently contacted by National Health Quest offering a settlement on a

WC claim that I find unacceptably low in terms of reimbursement. What happens if

I reject the settlement offer? How much negotiating room does one have with

these types of organizations?

>

> B Schroedter, PT

> Miami, FL

>

>

>

> ------------------------------------

>

> In ALL messages to PTManager you must identify yourself, your discipline and

your location or else your message will not be approved to send to the full

group.

>

> Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our

professions. PTManager is not available to support POPTS-model practices. The

description of PTManager group includes the following:

> " PTManager believes in and supports Therapist-owned Therapy Practices ONLY "

> Messages relating to " how to set up a POPTS " will not be approved

>

> PTManager encourages participation in your professional association. Join

APTA, AOTA or ASHA and participate now!

>

> Follow Kovacek, PT on Facebook or Twitter.

> PTManager blog: http://ptmanager.posterous.com/

>

[Guest guest]

If you have a signed agreement stick to your guns and do not accept less. I

know an attorney that this is all he does - hold companies to their agreed to

rates when they are trying to beat you down. You're under no obligation to

reduce the amount.

> To: PTManager

> From: bobnotrob@...

> Date: Mon, 2 Jul 2012 16:17:12 +0000

> Subject: Negotiated out-of-network payment services

>

> I was recently contacted by National Health Quest offering a settlement on a

WC claim that I find unacceptably low in terms of reimbursement. What happens if

I reject the settlement offer? How much negotiating room does one have with

these types of organizations?

>

> B Schroedter, PT

> Miami, FL

>

>

>

> ------------------------------------

>

> In ALL messages to PTManager you must identify yourself, your discipline and

your location or else your message will not be approved to send to the full

group.

>

> Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our

professions. PTManager is not available to support POPTS-model practices. The

description of PTManager group includes the following:

> " PTManager believes in and supports Therapist-owned Therapy Practices ONLY "

> Messages relating to " how to set up a POPTS " will not be approved

>

> PTManager encourages participation in your professional association. Join

APTA, AOTA or ASHA and participate now!

>

> Follow Kovacek, PT on Facebook or Twitter.

> PTManager blog: http://ptmanager.posterous.com/

>

[Guest guest]

I know physician and PT practices who have provider numbers intentionally out of

network because the reimbursements are higher. They verify the benefits in

advance and then hold them to what they were told.

> To: ptmanager

> From: polevaulter@...

> Date: Mon, 2 Jul 2012 19:40:01 -0500

> Subject: RE: Negotiated out-of-network payment services

>

>

> If you have a signed agreement stick to your guns and do not accept less. I

know an attorney that this is all he does - hold companies to their agreed to

rates when they are trying to beat you down. You're under no obligation to

reduce the amount.

> > To: PTManager

> > From: bobnotrob@...

> > Date: Mon, 2 Jul 2012 16:17:12 +0000

> > Subject: Negotiated out-of-network payment services

> >

> > I was recently contacted by National Health Quest offering a settlement on a

WC claim that I find unacceptably low in terms of reimbursement. What happens if

I reject the settlement offer? How much negotiating room does one have with

these types of organizations?

> >

> > B Schroedter, PT

> > Miami, FL

> >

> >

> >

> > ------------------------------------

> >

> > In ALL messages to PTManager you must identify yourself, your discipline and

your location or else your message will not be approved to send to the full

group.

> >

> > Physician Self Referal/Referral for Profit {POPTS} is a serious threat to

our professions. PTManager is not available to support POPTS-model practices.

The description of PTManager group includes the following:

> > " PTManager believes in and supports Therapist-owned Therapy Practices ONLY "

> > Messages relating to " how to set up a POPTS " will not be approved

> >

> > PTManager encourages participation in your professional association. Join

APTA, AOTA or ASHA and participate now!

> >

> > Follow Kovacek, PT on Facebook or Twitter.

> > PTManager blog: http://ptmanager.posterous.com/

> >

[Guest guest]

I know physician and PT practices who have provider numbers intentionally out of

network because the reimbursements are higher. They verify the benefits in

advance and then hold them to what they were told.

> To: ptmanager

> From: polevaulter@...

> Date: Mon, 2 Jul 2012 19:40:01 -0500

> Subject: RE: Negotiated out-of-network payment services

>

>

> If you have a signed agreement stick to your guns and do not accept less. I

know an attorney that this is all he does - hold companies to their agreed to

rates when they are trying to beat you down. You're under no obligation to

reduce the amount.

> > To: PTManager

> > From: bobnotrob@...

> > Date: Mon, 2 Jul 2012 16:17:12 +0000

> > Subject: Negotiated out-of-network payment services

> >

> > I was recently contacted by National Health Quest offering a settlement on a

WC claim that I find unacceptably low in terms of reimbursement. What happens if

I reject the settlement offer? How much negotiating room does one have with

these types of organizations?

> >

> > B Schroedter, PT

> > Miami, FL

> >

> >

> >

> > ------------------------------------

> >

> > In ALL messages to PTManager you must identify yourself, your discipline and

your location or else your message will not be approved to send to the full

group.

> >

> > Physician Self Referal/Referral for Profit {POPTS} is a serious threat to

our professions. PTManager is not available to support POPTS-model practices.

The description of PTManager group includes the following:

> > " PTManager believes in and supports Therapist-owned Therapy Practices ONLY "

> > Messages relating to " how to set up a POPTS " will not be approved

> >

> > PTManager encourages participation in your professional association. Join

APTA, AOTA or ASHA and participate now!

> >

> > Follow Kovacek, PT on Facebook or Twitter.

> > PTManager blog: http://ptmanager.posterous.com/

> >

[Guest guest]

I know physician and PT practices who have provider numbers intentionally out of

network because the reimbursements are higher. They verify the benefits in

advance and then hold them to what they were told.

> To: ptmanager

> From: polevaulter@...

> Date: Mon, 2 Jul 2012 19:40:01 -0500

> Subject: RE: Negotiated out-of-network payment services

>

>

> If you have a signed agreement stick to your guns and do not accept less. I

know an attorney that this is all he does - hold companies to their agreed to

rates when they are trying to beat you down. You're under no obligation to

reduce the amount.

> > To: PTManager

> > From: bobnotrob@...

> > Date: Mon, 2 Jul 2012 16:17:12 +0000

> > Subject: Negotiated out-of-network payment services

> >

> > I was recently contacted by National Health Quest offering a settlement on a

WC claim that I find unacceptably low in terms of reimbursement. What happens if

I reject the settlement offer? How much negotiating room does one have with

these types of organizations?

> >

> > B Schroedter, PT

> > Miami, FL

> >

> >

> >

> > ------------------------------------

> >

> > In ALL messages to PTManager you must identify yourself, your discipline and

your location or else your message will not be approved to send to the full

group.

> >

> > Physician Self Referal/Referral for Profit {POPTS} is a serious threat to

our professions. PTManager is not available to support POPTS-model practices.

The description of PTManager group includes the following:

> > " PTManager believes in and supports Therapist-owned Therapy Practices ONLY "

> > Messages relating to " how to set up a POPTS " will not be approved

> >

> > PTManager encourages participation in your professional association. Join

APTA, AOTA or ASHA and participate now!

> >

> > Follow Kovacek, PT on Facebook or Twitter.

> > PTManager blog: http://ptmanager.posterous.com/

> >

[Guest guest]

I don't know about Florida but in Mississippi we have a Workman's compensation

commission that sets the maximum reimbursable per CPT code. Then my clinic has

contracts with different networks for a negotiated lower amount that we honor.

Of course we enter those contracts, taking less money, on the premise that we

will obtain more volume.

However, your situation sounds different, and we do run into this scenario

often. We treat patients and the bill is sent to the work comp insurer. Then

they send it to a 're-pricer'. A network that will come to you and ask you to

take a settlement offer. You have no contract with them, they simply want you

to take less money.

Sometimes they actually say that you should accept this so that the claim " will

be paid faster....otherwise it may take sixty days or more " ; to which we reply

that Mississippi Work Comp says that all claims are to be paid in thirty days of

receipt of documentation and there is 1) an interest penalty of 1.5% per month

from the due date as well as 2) that properly submitted bills not paid fully

within sixty days of receipt will be subject to an additional penalty equal to

ten percent (10%), of the unpaid remaining balance, including interest as herein

provided.

Now, the one thing that REALLY gets these re-pricers is the following:

No party, in attempting to negotiate a repricing or other post treatment price

reduction agreement, shall state or omply that consent to such an agreement is

mandatory, or that the failure to enter into any such agreement may result in

audit, delay of payment, or other adverse consequence. If the Commission

determines that any party, or other person in privity therewith, has made such

false or misleading statements in an effort to coerce another party's consent to

a repricing or other price reduction agreement outside the Fee Schedule, the

Commission may refer the matter to the appropriate authorities to consider

whether such conduct warrants criminal prosecution under section 71-3-69 of the

Law. This statute declares that any false or misleading statement or

representation made for the purpose of wrongfully witholding any benefit or

payment otherwise due under the terms of the Workers' Compensation Law shall be

considered a felony. In addition, the Commisssion may levy a civil penalty in

an amount not to exceed ten thousand dollars ($10,000.00) if it finds that

payment of a just claim has been delayed without reasonable grounds, as provided

in section 71-3-59(2) of the Law.

You cite something like this and they leave you alone.

You enter into a negotiated contract for really only one reason....volume. So,

if the repricer wants to negotiate AFTER you have seen the patient, they

provided you no service at all. Why should you take a reduction?

Don't know if Florida has a Work Comp Commission but you might want to look into

that. Then, if they do, ask them if you can purchase the manual. We purchase

the Mississippi Work Comp manual from INGENIX.

http://www.optumcoding.com/Product/35113/

I did a quick google for you and found this out for Florida.

http://www.myfloridacfo.com/WC/publications.html

Hope this all helps.

Matt Capo, PT

Accelerated Physical Therapy and Occupational Health, Inc.

Bay St. Louis and Diamondhead, Mississippi

Negotiated out-of-network payment services

I was recently contacted by National Health Quest offering a settlement on a WC

claim that I find unacceptably low in terms of reimbursement. What happens if I

reject the settlement offer? How much negotiating room does one have with these

types of organizations?

B Schroedter, PT

Miami, FL

[Guest guest]

I don't know about Florida but in Mississippi we have a Workman's compensation

commission that sets the maximum reimbursable per CPT code. Then my clinic has

contracts with different networks for a negotiated lower amount that we honor.

Of course we enter those contracts, taking less money, on the premise that we

will obtain more volume.

However, your situation sounds different, and we do run into this scenario

often. We treat patients and the bill is sent to the work comp insurer. Then

they send it to a 're-pricer'. A network that will come to you and ask you to

take a settlement offer. You have no contract with them, they simply want you

to take less money.

Sometimes they actually say that you should accept this so that the claim " will

be paid faster....otherwise it may take sixty days or more " ; to which we reply

that Mississippi Work Comp says that all claims are to be paid in thirty days of

receipt of documentation and there is 1) an interest penalty of 1.5% per month

from the due date as well as 2) that properly submitted bills not paid fully

within sixty days of receipt will be subject to an additional penalty equal to

ten percent (10%), of the unpaid remaining balance, including interest as herein

provided.

Now, the one thing that REALLY gets these re-pricers is the following:

No party, in attempting to negotiate a repricing or other post treatment price

reduction agreement, shall state or omply that consent to such an agreement is

mandatory, or that the failure to enter into any such agreement may result in

audit, delay of payment, or other adverse consequence. If the Commission

determines that any party, or other person in privity therewith, has made such

false or misleading statements in an effort to coerce another party's consent to

a repricing or other price reduction agreement outside the Fee Schedule, the

Commission may refer the matter to the appropriate authorities to consider

whether such conduct warrants criminal prosecution under section 71-3-69 of the

Law. This statute declares that any false or misleading statement or

representation made for the purpose of wrongfully witholding any benefit or

payment otherwise due under the terms of the Workers' Compensation Law shall be

considered a felony. In addition, the Commisssion may levy a civil penalty in

an amount not to exceed ten thousand dollars ($10,000.00) if it finds that

payment of a just claim has been delayed without reasonable grounds, as provided

in section 71-3-59(2) of the Law.

You cite something like this and they leave you alone.

You enter into a negotiated contract for really only one reason....volume. So,

if the repricer wants to negotiate AFTER you have seen the patient, they

provided you no service at all. Why should you take a reduction?

Don't know if Florida has a Work Comp Commission but you might want to look into

that. Then, if they do, ask them if you can purchase the manual. We purchase

the Mississippi Work Comp manual from INGENIX.

http://www.optumcoding.com/Product/35113/

I did a quick google for you and found this out for Florida.

http://www.myfloridacfo.com/WC/publications.html

Hope this all helps.

Matt Capo, PT

Accelerated Physical Therapy and Occupational Health, Inc.

Bay St. Louis and Diamondhead, Mississippi

Negotiated out-of-network payment services

I was recently contacted by National Health Quest offering a settlement on a WC

claim that I find unacceptably low in terms of reimbursement. What happens if I

reject the settlement offer? How much negotiating room does one have with these

types of organizations?

B Schroedter, PT

Miami, FL

[Guest guest]

I don't know about Florida but in Mississippi we have a Workman's compensation

commission that sets the maximum reimbursable per CPT code. Then my clinic has

contracts with different networks for a negotiated lower amount that we honor.

Of course we enter those contracts, taking less money, on the premise that we

will obtain more volume.

However, your situation sounds different, and we do run into this scenario

often. We treat patients and the bill is sent to the work comp insurer. Then

they send it to a 're-pricer'. A network that will come to you and ask you to

take a settlement offer. You have no contract with them, they simply want you

to take less money.

Sometimes they actually say that you should accept this so that the claim " will

be paid faster....otherwise it may take sixty days or more " ; to which we reply

that Mississippi Work Comp says that all claims are to be paid in thirty days of

receipt of documentation and there is 1) an interest penalty of 1.5% per month

from the due date as well as 2) that properly submitted bills not paid fully

within sixty days of receipt will be subject to an additional penalty equal to

ten percent (10%), of the unpaid remaining balance, including interest as herein

provided.

Now, the one thing that REALLY gets these re-pricers is the following:

No party, in attempting to negotiate a repricing or other post treatment price

reduction agreement, shall state or omply that consent to such an agreement is

mandatory, or that the failure to enter into any such agreement may result in

audit, delay of payment, or other adverse consequence. If the Commission

determines that any party, or other person in privity therewith, has made such

false or misleading statements in an effort to coerce another party's consent to

a repricing or other price reduction agreement outside the Fee Schedule, the

Commission may refer the matter to the appropriate authorities to consider

whether such conduct warrants criminal prosecution under section 71-3-69 of the

Law. This statute declares that any false or misleading statement or

representation made for the purpose of wrongfully witholding any benefit or

payment otherwise due under the terms of the Workers' Compensation Law shall be

considered a felony. In addition, the Commisssion may levy a civil penalty in

an amount not to exceed ten thousand dollars ($10,000.00) if it finds that

payment of a just claim has been delayed without reasonable grounds, as provided

in section 71-3-59(2) of the Law.

You cite something like this and they leave you alone.

You enter into a negotiated contract for really only one reason....volume. So,

if the repricer wants to negotiate AFTER you have seen the patient, they

provided you no service at all. Why should you take a reduction?

Don't know if Florida has a Work Comp Commission but you might want to look into

that. Then, if they do, ask them if you can purchase the manual. We purchase

the Mississippi Work Comp manual from INGENIX.

http://www.optumcoding.com/Product/35113/

I did a quick google for you and found this out for Florida.

http://www.myfloridacfo.com/WC/publications.html

Hope this all helps.

Matt Capo, PT

Accelerated Physical Therapy and Occupational Health, Inc.

Bay St. Louis and Diamondhead, Mississippi

Negotiated out-of-network payment services

I was recently contacted by National Health Quest offering a settlement on a WC

claim that I find unacceptably low in terms of reimbursement. What happens if I

reject the settlement offer? How much negotiating room does one have with these

types of organizations?

B Schroedter, PT

Miami, FL

[Guest guest]

Thanks all for your input. I did not have a contracted rate so there was nothing

to hold them accountable to. I sent a counter-offer and they came close to

matching it so I acquiesced and accepted the amount. Thanks Matt for the info

and link. I went on a researching journey as a result and apparently there isn't

any good, clear ruling in Florida Statutes that I was able to find like what you

quoted in MS.

The Repricing agent I was talking to didn't cross a line of coercion and

admitted it was basically the WC insurer wanting to get this off their books in

an expeditious manner. I will likely run into this again when I bill for the

rest of the visits so I may take a different approach and see and compare the

results.

B Schroedter, PT

Miami, FL

>

> I don't know about Florida but in Mississippi we have a Workman's compensation

commission that sets the maximum reimbursable per CPT code. Then my clinic has

contracts with different networks for a negotiated lower amount that we honor.

Of course we enter those contracts, taking less money, on the premise that we

will obtain more volume.

>

> However, your situation sounds different, and we do run into this scenario

often. We treat patients and the bill is sent to the work comp insurer. Then

they send it to a 're-pricer'. A network that will come to you and ask you to

take a settlement offer. You have no contract with them, they simply want you

to take less money.

> Sometimes they actually say that you should accept this so that the claim

" will be paid faster....otherwise it may take sixty days or more " ; to which we

reply that Mississippi Work Comp says that all claims are to be paid in thirty

days of receipt of documentation and there is 1) an interest penalty of 1.5% per

month from the due date as well as 2) that properly submitted bills not paid

fully within sixty days of receipt will be subject to an additional penalty

equal to ten percent (10%), of the unpaid remaining balance, including interest

as herein provided.

>

> Now, the one thing that REALLY gets these re-pricers is the following:

> No party, in attempting to negotiate a repricing or other post treatment price

reduction agreement, shall state or omply that consent to such an agreement is

mandatory, or that the failure to enter into any such agreement may result in

audit, delay of payment, or other adverse consequence. If the Commission

determines that any party, or other person in privity therewith, has made such

false or misleading statements in an effort to coerce another party's consent to

a repricing or other price reduction agreement outside the Fee Schedule, the

Commission may refer the matter to the appropriate authorities to consider

whether such conduct warrants criminal prosecution under section 71-3-69 of the

Law. This statute declares that any false or misleading statement or

representation made for the purpose of wrongfully witholding any benefit or

payment otherwise due under the terms of the Workers' Compensation Law shall be

considered a felony. In addition, the Commisssion may levy a civil penalty in

an amount not to exceed ten thousand dollars ($10,000.00) if it finds that

payment of a just claim has been delayed without reasonable grounds, as provided

in section 71-3-59(2) of the Law.

>

> You cite something like this and they leave you alone.

>

> You enter into a negotiated contract for really only one reason....volume.

So, if the repricer wants to negotiate AFTER you have seen the patient, they

provided you no service at all. Why should you take a reduction?

>

> Don't know if Florida has a Work Comp Commission but you might want to look

into that. Then, if they do, ask them if you can purchase the manual. We

purchase the Mississippi Work Comp manual from INGENIX.

> http://www.optumcoding.com/Product/35113/

>

> I did a quick google for you and found this out for Florida.

> http://www.myfloridacfo.com/WC/publications.html

>

>

> Hope this all helps.

>

> Matt Capo, PT

> Accelerated Physical Therapy and Occupational Health, Inc.

> Bay St. Louis and Diamondhead, Mississippi

>

>

>

>

>

>

>

> Negotiated out-of-network payment services

>

>

>

>

>

> I was recently contacted by National Health Quest offering a settlement on a

WC claim that I find unacceptably low in terms of reimbursement. What happens if

I reject the settlement offer? How much negotiating room does one have with

these types of organizations?

>

> B Schroedter, PT

> Miami, FL

>

>

>

>

>

>

>

>

>

>