MPN Blackmail?? (California) (California) (California)

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MPN Blackmail?? (California) (California) (California)

Postby theAxe on Thu Mar 01, 2012 10:30 am

Scenario:

Pt with accepted injury treating w/board certified PTP w/in the MPN - with authorization from large well known IC

IC pays nothing for 1st full narrative rept., and down-codes most other reports - example: only pays for 1st page of re-eval and 2 moderately complex follow-up reports - and payments not received for 3+ months after billing.

Also IC choses not to pay for some reports including PTP's review of medical records - stating their defense attorney did not request them so they do not need to pay

PTP office calls for clarification and gets no response.

PTP files lein for non-paid and down-coded services.

This pattern has been often repeated with other MPN cases by this IC - and it is clearly their practice when there is no applicable MPN

NOW the IC responds that PTP MUST withdraw their lein NOW or the PTP will be removed from the MPN ASAP

This Pt has not been treating long, and is not yet at mmi.

Question:
Does the PTP have any rights at all within the MPN scenario - or do they only serve at the will of the IC to benefit the IC?

Does having the privilage of being on the MPN require the physician to accept any payment crumbs the IC consends to sprinkle in their direction whenever they feel like it with no recourse but to be removed from the ability to provide medical treatment to their patients if they object?

If the PTP does withdraw the lein now to enable the continued treatment of the existing patient by staying within the MPN - can the PTP refile the lein after treatment is completed before CIC settles, so the board may have some jurisdiction on the dispute?

And they wonder why there are so many medical leins?!!

Any suggestions and advice would be greatly appreciated.
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Re: MPN Blackmail?? (California) (California) (California) (Cali

Postby Barney5 on Mon Apr 02, 2012 10:32 am

I wish someone would respond to this post, as well as another one written by "theAxe" here viewtopic.php?f=46&t=1518.

I am sure many would like to know the answer to his questions. Injured workers are having difficulties with finding treating providers, and keeping primary treating providers due to the above "scenario".
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Re: MPN Blackmail?? (California) (California) (California)

Postby appliedpsych on Mon Apr 02, 2012 7:33 pm

I think one reason there are no answers is simply that no one knows.

I am in several MPN's but have never gotten any guidance from them, letters of instruction, provider manuals, contracts, etc. How did I get in them? Mostly through having applied with some non-industrial insurance carriers to provide treatment services back around 1994 to 1996. Then, over the years, these companies were bought out, merged, morphed and re-configured and emerged as members of an MPN. Every once in a while I get re-certification packages, fill them out, then months later get a letter that 'congratulations, your re-ceritfication has been approved and you will continue being in the ____ MPN'. Sometimes I find out I am in another MPN when a claims examiner or nurse case manager calls me to schedule a consultation report. When I tell them I had no idea I was on this MPN, they say 'it does not surprise us, lots of doctors say that. We don't even know how it works ourselves'. ..... Scary huh ?? !

That is probably why no one can answer - no one really knows the answers to those questions.

If I am wrong, and someone does, I too would like to learn
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Re: MPN Blackmail?? (California) (California) (California) (Cali

Postby jonbrissman on Thu Oct 18, 2012 11:55 am

I can't answer all your questions but I have a little insight on others.

The initial narrative report is not compensable per OMFS guidelines.

I have seen hundreds of examples where only the first page of a narrative report was paid. What has happened is that the report and billing arrived together at the claims adjuster's desk, and the CA placed the report in his or her file and sent the bill to a review service. The reviewer does not know how many pages were included, so it makes the minimum payment and sends an EOB saying documentation does not support the charge. The provider then has to appeal the audit and send another copy of the report, or sometimes it just files a lien.

Note that the adjuster and bill review service in the above scenario both violated Sect. 4603.2(d), which requires all documentation to be submitted with the billing for review. If either one had complied with the statute, the provider would have been paid correctly and no lien would have been necessary.

In prosecuting liens, my office does not honor a PPO discount if defendant did not honor the terms of the contract (payment within a specified time and at a specified rate, usually a percentage of OMFS). Preferred providers are supposed to receive preferential terms.

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Re: MPN Blackmail?? (California) (California) (California)

Postby Drjewel on Sat Mar 02, 2013 3:14 pm

Alternate question...

For a Psych evaluation, is a narrative report necessary, or is a simple Doctor's first adequate as the initial report?

Brazen yes, practical yes. I'm just wondering...

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