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It's our 10th anniversary! A special thanks to you for contributing to our success! |
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| Volume 5/Summer 2006 Qviews is a quarterly newsletter containing important product updates, company news and information relevant to medical bill payors in the workers' compensation industry. |
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Message from
the President |
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We're celebrating our 10th anniversary! This is a significant milestone for our company and all of us at Qmedtrix would like to take a moment to say thank you. It’s because of you that we are successful. During the past 10 years, you’ve given us the bills and data that allow us to analyze trends and develop solutions. We’re grateful for your dedication and willingness to stand with us as we face the challenges inherent in a complex and expensive health care system. Qmedtrix began in 1996 as OccuHealth Services, Inc., a parent company over several subsidiaries that provided workers’ compensation-related services. This business model allowed us to examine and analyze all aspects of the industry. In 2001, we consolidated our business to focus on what we do best – specialty bill review – and changed our name to Qmedtrix. In the years since, we have expanded our business and territory by developing a comprehensive group of services based on our core expertise. So to all of our clients and partners – on behalf of the entire Qmedtrix team and me personally – please accept our profound thanks and appreciation for your trust in us. We look forward to many years of continued success! Mike Raffaele Bill edits effective in fee schedule states When a fee schedule sets the price level for medical services, repricing to a “fair and reasonable” reimbursement level is no longer a viable cost-containment option. However, providers still find ways to maximize reimbursement to recoup some of the revenue lost to the fee schedule, such as breaking out global procedure charges into many separate charges. Billing edits, a feature of BillChek, finds and recommends appropriate reimbursement for these coding errors that inflate charges, impacting bills in fee schedule states where repricing isn’t available. Colorado provides a good example of a state where edits are effectively working to reduce payer costs. WCBI supports Qmedtrix reviews in Indiana, but increased recons still possible The Workers’ Compensation Board of Indiana (WCBI) recently handed down three decisions on medical fee disputes involving Qmedtrix recommendations. In all the decisions, the Qmedtrix recommended reimbursement levels were deemed appropriate under Indiana statutes and no additional payment was awarded to the facility plaintiff. But a recent rule change in Indiana may lead clients to start seeing an increase in reconsiderations from providers protecting their right to file a fee dispute. New rule for Indiana providers... Illinois sees increased unbundling of charges Qmedtrix is finding increasing levels of unbundling, as providers anticipate any and all charges being paid to fee schedule. They’ve also seen a small increase in the level of pass-through charges being coded as non-pass though charges for reimbursement at 76 percent. Under the fee schedule, pass-though charges – for items such as prosthetics, implants, drugs and others – are only reimbursed at 65 percent. In one case, charges for a recently performed single-level lumbar procedure at an Illinois ambulatory surgery center came to $51,604.74. Paid to fee schedule, payment would have been $39,219.60. For more information, questions or comments, visit our web site or contact Joanie Tardie at jtardie@qmedtrix.com |
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