KC Region All PEC Meeting

Work Comp

100

What are the action items of the PEC if a WC Eval is cancelled or rescheduled

• Notify the referral source and payer directly per their communication preferences
• Document all efforts in the correspondence log

200

What is the out of pocket cost for a self-pay FCE

• $800 KS & MO

300

Can an Attorney be a payer for an Active WC Claim?

• No
• Further training – should always be attorney name in case  contacts not the law firm that is representing the patient

400

What health form do the PEC’s need to fill out before WCE/FCE visits?

• Questionnaire for Cardiovascular Risk: High Blood Pressure
• Use this form when scheduling all FCE’s and WCE’s

500

What are at least 4 reminders we give to a FCE or WCE patient before their first appointment:

• Inform the client to eat before the test
• Avoid anything with caffeine day of the test
• Avoid nicotine products day of the test
• Patient should take medications as prescribed by doctor
• Inform patient they will be in the clinic for approximately 4-5hours (FCE)
• Inform patient they will be in the clinic for approximately 2-4hours (WCE)
• Wear closed toed shoes
• Bring gear if available
• If firefighter, gear is mandatory

Auto Lien

100

When do the PEC's need to call the lawyer to ask if they will accept our lien? 

When and ONLY if CIV tasks it to them AFTER at least 2 visits have been attended. 

200

When scheduling out and auto patient, can you copy and paste from the eval appointment? 

No, for this specific payer, we cannot use the eval to schedule out because it messes up the CIV process. 

300

What notes or information are we allowed to fax to the lawyer. 

None, if the lawyers want to see notes they need to put in a records requests even if it it is just progress, eval, or discharge notes. 

400

How would you explain costs to a patient that is only going through Medpay/PIP for their care?

Patient needs to find out their PIP/Med Pay limit when we have that information we can estimate how many visits could be covered (we bill FULL charges) and if we don't have that information they will be liable for those full charges if their PIP/MedPay runs out. 

500

How would you explain but not force an auto patient's choice to go through their commercial insurance? 

You can always discuss all options and outcomes and then they need to choose. Chart note conversation and decisions. Be careful of wording not "you should" "this is better". 

Uber Health

100

What is the mileage limitation for using Uber

• Patient must living within 25 miles of the treating Athletico facility.

200

When a patient is requesting to use Uber Health, other than the phone screen form, what form do you need to fill out?

• The patient transportation form

300

Who has to sign the transportation application form in order for it to be approved?

• The Clinic Manager

400

How often do we need to re-assess the patient to confirm if transportation is still medically necessary?

• Every 2 weeks and it needs to be documented in their records if it is still medically necessary. Also needs to be documented by the clinicians. 

500

What visit can a patient NOT use Uber Health 

Evaluation, since patient has to sign the transportation application. 

Misc

100

How do you track self-pay patients visits for new GFE? 

Use precert auth, add active authorzation and update GFE when needed. 

200

What do you need to do to void a transaction and how much time do you have to do it? 

Log into your PERSONAL transax account. And you can only void day of transactions. 

300

Do we collect the Dry Needling charges for a Lien only patient? 

No, this will be included in the negotiations at the end of care for lien patients. 

400

Scenario: You get to cancellation calls for appointments that are the following day. What are some scheduling tactics you can use to improve your visit slide/0-48 hour numbers? 

- Move around appointments (with patients you know are flexible) to move up evals. 

-Use 48 hour report, specifically details section to identify patients for those spots

- Prioritize work comp/ post surgical patients 

- If you utilize for follow up appointments, if no evals take those spots, use them for that wait list 

500

What is the proper way to handle scheduling on another clinic's schedule

- Fill out the phone COMPLETELY with all information that any PEC would need. 

- DO NOT schedule the appointment yourself, let the patient know you are going to call the other clinic, and have that clinic follow up to confirm eval appointment

- Email the phone screen over to the PEC 

Work Comp 2

100

What is the most ideal scheduling for our work comp patients?

• 3x a week

200

What would you put in a chart note for a work comp patient, rather than a note in a correspondence log?

• Document anything that could financially impact a patient account
• Lack of authorization or denials
• When in doubt, err on the side of over-communication

300

What is the 4 Contact Rule when trying to obtain authorization?

• 4 contacts within 4 consecutive days
• Call and/or email ADJ or authorizing NCM
• Do not rely on one method of communication
• Reach out to adjuster’s supervisor if attempts to reach the case manager/adjuster is unsuccessful. If available: press “0” to speak to a supervisor
• Email or send fax to the adjuster requesting authorization
• Involve NCM to assist in getting a hold of adjuster
• Ask patient to make contact with adjuster, CM or request assistance from their attorney
• PEC to work closely with PES if experiencing difficulty obtaining authorization. All attempts must be documented in correspondence log

400

What health form do the clinician’s need to fill out before WCE/FCE visits?

• BP/HR Screening Form
• If vitals are out of range, then therapist will complete and send the WCE/FCE HR BP Physician Consent form to obtain medical clearance

500

What do we need to do if the patient refuses to sign the authorization for verbal release of protected health information form?

• If the patient refuses to sign this form the PE should document the date we received the refusal to sign in the Correspondence Log and Chart Note
• PEC should create a Next Gen alert so the “Athletico Physical Therapy Representative” is aware they should not contact the employer for this patient- It should state “Patient refused to fill out the PHI form – Do not Communicate with Employer”
• If the employer is handling the claims in house and the patient refuses to sign, we cannot verbally provide updates on the patient care. However, we must continue to send the written IE/PN to the employer in