More on the NYS 'negotiated' rates and what it might mean for the future of the early intervention program

There was some very important information in the Early Intervention Billing FAQ that was distributed via email today:Q: ­If a provider accepts a lower rate for a payment from an insurance company, the municipality will bear a larger portion of the expense, correct?A: If a provider accepts a negotiated rate of payment and that payment from the insurer is made in an amount less than the State-approved early intervention rate for the service provided, the ISFA will process payments for the balance due the provider from the escrow account using municipal funds at State established rates for the EIP. Billing providers will receive the full EIP rate for delivered services. If the provider does not accept the negotiated rate, and the insurer subsequently denies the claim for reasons such as out of network provider, then the entire payment will be made from the escrow account. We have established a policy to refuse the 'negotiated' rate of payment for home based early intervention services UNLESS it is equivalent to the established rates for the EIP.  Most early intervention providers are not aware that standard commercial reimbursement rates have been established based on a Medicare standard that assumes that the visit is occurring in a clinic setting.  Therefore, we are expecting that most of the 'negotiated rates' will be based on pre-existing clinic-based reimbursement schedules.To date we have not been approached by ANY commercial insurance entity to NEGOTIATE a rat...
Source: ABC Therapeutics Occupational Therapy Weblog - Category: Occupational Therapists Tags: health insurance OT practice Source Type: blogs