FCE for less
Tue, 02/10/2009 - 2:20pm
I am in the midst of growing my business in Industrial Rehab....so far things have been going well and have begun getting referrals from sources that once used only my competitor. Today, I again received an FCE referral from this physician group, only this work comp carrier pays for 2.5 hour FCEs. Obviously it will be difficult to obtain all or even most of the information on this client that I will need to really help my physician and the client. I am thinking about just eating the cost and performing a thorough FCE in the hopes that a good product will bring more business and in the future with some success I will have a little more leverage to negotiate a better reimbursement rate with the work comp carrier. Any thoughts?
Mon, 03/16/2009 - 11:24am
#2
FCE for less
I agree completely with Jason. It would be wonderful for insurance companies to just pay us based upon us being licensed professionals. I can only speak from personal experience in having started out with one case manager's card and growing to where I am now did not come from holding out for full payment. I assume you have already explained to the insurance company why reimbursement for 2.5 hrs. is innapropriate for your services. I am also assuming that they told you that the Medicare Fee Scheduel for this service will cover about 2.5 hrs. ($294). Maybe they generously pay a little more. This is a common practice with many insurance companies to contain costs.
The key to developing your company may be to get your name out there as a step above, and have an agreement with that company to pay a set rate that is agreeable with you. You can determine how many FCE's you do at a lower rate! Keep track with each company. When they "get the picture" about what you mean by doing a quality FCE, they should want to use you. Case managers will request you and be your best referral source-for free!
We send out and receive back a signed agreement to pay a specific amout for each FCE I do-unless we have a contract with that company. If it is not signed (agreed upon) we have the option of not doing the FCE. With the workman's comp laws in Illiniois, if you are doing a good job and shining above your competitors, you should be able to build your business-especially if you are strategically located. I get several referrals a year from Illinois-complex medical cases with big settlements-because no one in the area (another state) provides the kind of service I provide. Word does get around-people in the industry do share information. These are my thoughts-hope they help.
Sat, 03/14/2009 - 6:58pm
#3
Re: FCE for less
niquewillis wrote:
I am in the midst of growing my business in Industrial Rehab....so far things have been going well and have begun getting referrals from sources that once used only my competitor. Today, I again received an FCE referral from this physician group, only this work comp carrier pays for 2.5 hour FCEs. Obviously it will be difficult to obtain all or even most of the information on this client that I will need to really help my physician and the client. I am thinking about just eating the cost and performing a thorough FCE in the hopes that a good product will bring more business and in the future with some success I will have a little more leverage to negotiate a better reimbursement rate with the work comp carrier. Any thoughts?
Just my opinion...
I sounds more like this company/physician isn't really looking for quality but a cheaper provider. You are a licensed professional, you deserve to get properly paid for your work.
It would seem better to sit down and explain why they couldn't get a quality report for the 2.5 hours and discuss a new reimbursement plan for a quality report.
I know it's easier said than done, but stand up for yourself and what you have to offer in terms of a quality product.
Regards,
Jason Harris, PT, DPT
Wed, 02/11/2009 - 11:13am
#4
FCE for less
Hello,
This is what our clinical advisor had to say:
I think that as long as the quality is there, the referrals will come. Carriers will vary in what they will reimburse-sometimes it is the good with the not so good in my business. The key will be to get in with the case managers in your area and work to get their business-then when what you provide is viewed as a superior product, you can arrange a set price for your services. I have an agreement with Corvel that is a little less than what our asking price is-but they pay that amount without hassle and with no discounting issues. I get about 10 a month from them. Be wary of sacrificing your product for cost-you may end up with a report no more valuable than your competitor! Once you get more established in your area as a top notch evaluator-you can seek referrals from non-insurance referral sources like; vocational rehab offices, attorneys and long term disability carriers. Some of them pay 100% up front!
Good luck!
Jenn
Depending on your relationship with the referral and payment source, you may want to begin a discussion of recent federal court rulings. The very strong trend, especially in "return-to-work, same-job, same-employer" cases is away from cookbook evaluations. If a payment source is designating the amount of time it takes for a procedure I would think that he/she has an idea of what that procedure should be. I am thinking that they may use something like the old ARCON machine approach to evaluation. This approach, in my reading of the recent law, is clearly not acceptable any more. I would find it incredible for an evaluator using that type of testing to defend it in any peer-review setting. And if it will not withstand peer review then it will not be accepted in a court of law.
Further, with the finding in both the Indergard case and the James case, RTW SJSE evals clearly have to be base on a valid FCE protocol that looks at the physical demands of the essential functions of the job. A 2.5 hour FCE probably is a formula that does not allow time or discretion to do this.