Reimbursement questions
David Gerecke
Description
Collection
Title:
Reimbursement questions
Creator:
David Gerecke
Date:
8/11/2004
Text:
Greetings Colleagues,
I have been meeting with contract managers of insurance companies that I contract with in an effort to increase my reimbursement. Their fee schedules are based on Medicare allowable. I have generated significant interest on their part in claiming that while Medicare is the national standard on which to base their fee schedules, it has some shortcomings which include the following:
1.. Medicare's rates are frozen for the next three years, thereby not allowing for increases in the Consumer Price Index (CPI) or other economic indicators.
2.. Medicare's reimbursement through the DMERCs vary in reimbursement amount. I live and work in Seattle, which has the second lowest reimbursement in the DMERC system. Seattle, as many of you know, has a comparatively high cost of doing business and cost of living. Our region does not make allowances for variations in local costs of living/business.
3.. Medicare has fallen significantly behind the CPI over the years.
4.. Medicare has fallen behind other medical specialties in reimbursement of P&O supplies. I want to compare P&O against commonly used codes for PT, OT, and common medical specialties such as internal medicine and others.
I am looking for numbers to substantiate these claims. The DMERC fee schedule is easy enough to find and print out. Short of hiring an economist, can anyone help by providing numbers for the above claims?
I am finding that the contract managers are generally very well educated and connected people. They have extensive credentials (MD/MBA), and respond well to me when I do my homework and back up my claims. I have been told that when I provide the evidence to support my claims, they will review and possibly adjust their fee schedules.
David Gerecke, CPO, FAAOP
Seattle Prosthetic and Orthotic Associates
I have been meeting with contract managers of insurance companies that I contract with in an effort to increase my reimbursement. Their fee schedules are based on Medicare allowable. I have generated significant interest on their part in claiming that while Medicare is the national standard on which to base their fee schedules, it has some shortcomings which include the following:
1.. Medicare's rates are frozen for the next three years, thereby not allowing for increases in the Consumer Price Index (CPI) or other economic indicators.
2.. Medicare's reimbursement through the DMERCs vary in reimbursement amount. I live and work in Seattle, which has the second lowest reimbursement in the DMERC system. Seattle, as many of you know, has a comparatively high cost of doing business and cost of living. Our region does not make allowances for variations in local costs of living/business.
3.. Medicare has fallen significantly behind the CPI over the years.
4.. Medicare has fallen behind other medical specialties in reimbursement of P&O supplies. I want to compare P&O against commonly used codes for PT, OT, and common medical specialties such as internal medicine and others.
I am looking for numbers to substantiate these claims. The DMERC fee schedule is easy enough to find and print out. Short of hiring an economist, can anyone help by providing numbers for the above claims?
I am finding that the contract managers are generally very well educated and connected people. They have extensive credentials (MD/MBA), and respond well to me when I do my homework and back up my claims. I have been told that when I provide the evidence to support my claims, they will review and possibly adjust their fee schedules.
David Gerecke, CPO, FAAOP
Seattle Prosthetic and Orthotic Associates
Citation
David Gerecke, “Reimbursement questions,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 26, 2024, https://library.drfop.org/items/show/223538.
