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Acupuncture Today
December, 2002, Vol. 03, Issue 12
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Beware the Trojan Horse

By Garrett Casey

By now, many of you have been exposed to workers' compensation patients, either as the PTP (primary treating physician) or as the secondary treating physician treating under a prescription from the PTP.

As you know, the type of referral from the primary treating physician allows you to enter the California workers' compensation system without significant impact to your requirements. Essentially, all you have to do is initially report to the carrier and then bill.

With the successes you achieve in management of these injured workers, referrals are a welcome benefit and the foundation of any good broad-based practice. There are other avenues of patient referral, of course, one of which is the subject of this article.

Over the past 15-20 years, there have been groups and companies that marketed themselves as providers of workers' compensation patients to your office for little or no up-front costs, and guaranteed a "per office call" fee or reimbursement for the services you provided. At the completion of care, after completing certain forms requirements, you'd submit a bill for your services and receive a prearranged fee for service. Sounds easy, doesn't it? Just treat, bill and receive payment. But beware!

Not outlined in many of these contracts is the source of the referrals: contested cases in which the carrier has objected to all providers rendering care, resulting in the filing of a "green lien"; applicant cases in which you provide care that is duplicative of other physicians providing the same care; cases of overlapping care, where the injured person was involved in an automobile accident/workers' compensation case; or cases in which you don't know who the primary treating physician is.

Additionally, many companies or groups do not show you the billing sent to the carrier. If you are listed as a private contractor, the billing must list you as the provider and bear your signature. Leaving someone else to do your billing for you and letting them sign documents on your behalf is foolhardy and potentially dangerous.

Finally, these groups/companies will retain management of all your compensation patients for a contracted period and also obtain a percentage of all referrals made to you by the workers already treated.

What seems to be an easy way to get patients on the table has far-reaching consequences. Beware the Trojan horse standing in your waiting room. It may be a nice horse, but its internal workings contain hidden dangers to the unsuspecting practitioner. Just wheel that horse back onto the pavement. No one will know it was you.

Click here for more information about Garrett Casey.


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