Have You Been Singled Out?

If you are considered an independent physical therapist by Blue Cross Blue Shield of Michigan (BCBSM), you have been singled out! 

Someone at BCBSM had a fabulous idea on improving their bottom line.  Audit... We've all heard that word.  The goal of the audit was to recapture overpayments to independent physical therapists.  This "audit" isn't something that has been implemented quarterly or monthly or anything.  This audit just happened to consider a chunk of time from the beginning of 2005 until the end of 2006.  This "audit" also never stated that through the recapturing of overpayments that BCBSM would correct the computer glitches or rules within their system to reduce the probability of overpayments to providers. 

Last Friday, there were about 1,000 of us independent physical therapists that received a nice letter with pages of processing errors that resulted in overpayment.  It wasn't user friendly for us in the sense that the whole report identified the patient by the contract number only and of course left out our identifying account number.  Of course, we have 30 days upon the receipt of the result of the audit to pay back the overpayments or communicate an arrangement to pay.  The time it is going to take to verify the account without the account number and ensure that overpayment really did occur isn't going to be some nice quick and dirty job.  I'm thinking I'm going to give them a call.  I'd like 3 months to analyze their data and then I'll get back to them on a payment arrangement.  :)  The latest news from MPTA on payments is:  "Members are encouraged to determine what rate of payment their business can afford before initiating such discussions."  Hmmm, I'm kind of thinking $10-25/month.  It doesn't take me that long to write a check, but I can imagine the behind the scenes processes that will HAVE to occur.  Statements going out with current balance... payments entered... LOL  Let's let 'em work for their errors! 

From a business perspective it is probably a good idea to audit.  When you do audit though and you find that you errored, wouldn't it also make logical sense to implement something in your processes to reduce the likelihood of error?  If you are going to audit, would you only single out one business entity (independent physical therapists) OR would you also within that same category of provider also audit hospital based services?  Why were independent physical therapists the only physical therapy provider category audited?  Rumor has it that only the BCBSM Messa contracts were audited.  Hmmm...

Another reason to be a member of the APTA.  The MPTA has been working around the clock to determine the appropriateness of the actions taken by BCBSM and has been meeting/discussing with BCBSM.