MCO Applications: Nine Common Mistakes You Should Avoid

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By Michael Metzger, DPM, MBA

More often than not, we feel like we’re doing the managed care company a favor by applying. There’s also a tendency to believe the process is so cut and dry that we can apply at the last minute. Let’s clear up these misconceptions. If you don’t apply and apply properly, someone else will. Secondly, as our mothers use to tell us, haste makes waste. Indeed, simple mistakes can slow the process down to a snail’s pace and/or cause the company to reject your application. First, I strongly recommend filling out the application yourself. Often, the application will ask for information that your staff may not know. This saves the time of your staff asking you or trying to guess at the answers. Now, as a follow-up piece to the article, “Negotiating The Maze Of Insurance Contracts” (see page 33 of the February issue), let’s take a look at some of the more common mistakes that podiatrists make during the application process. 1. Contracting with the wrong plans or not contracting with the right ones. Deciding which plans to apply for takes some homework on your part. There are many nationally known plans that may not be in your area. Yet there are often smaller, lesser known plans that serve the biggest employers in the area. Be sure to evaluate all the plans that your hospital, referring PCPs and those specialists you refer to are participating in. Also be wary of plans that are served by a single hospital 50 miles away. Many of our colleagues simply sign up for every plan that they can so they can be sure that they never have to say no to a patient. While this is an individual decision, it’s one that may not make good business sense. 2. Requesting an application by phone. Phone messages get lost and often the request for an application has to move from desk to desk. Always make the request in writing. If you want to be able to document the process, ask for a return receipt when you send in your request. Try to learn the name of your provider representative (get the name from a nearby colleague, not the hospital). Give him or her a call and let the rep know you have requested an application. Make this the first step in making an ally of your representative. Avoid Glaring Omissions 3. Leaving blank spaces or omitting key information. The most common omission is the doctor’s signature. Have someone else proofread the application before it leaves the office. Plans want copies of your license, DEA certificate and CV among other things. Be sure you send the current, up-to-date copies. If you need the “additional space,” be sure that any attached sheets of paper are firmly attached to the applications. Staple it two or three times, not just once. Mailrooms tend to lose sheets of paper. 4. Not realizing malpractice history is important. This can be especially troublesome if you have your office manager or spouse fill out this part of the form. They simply may not know everything about your malpractice history or feel that “it is impossible that any patient could have ever been so low as to sue you.” It is suggested that you make a self-inquiry to the National Practitioner Data Bank to see what is on record. You can do this for $20 at www.npdb-hipdb.com. This enables you to ensure that your application matches up with the information from the data bank. Don’t forget to mention pending suits on your application. In fact, this may be another reason why it may be best to complete the application yourself. Let’s face it. To expand this thought, how many of our staff knows all the hospitals we have ever worked at or every malpractice carrier that has carried us? Other Pertinent Points 5. Not reading all the questions on the “yes/no” page. Representatives have told me that one of the biggest problems they see with applications is on the yes/no page. The podiatrists get going with the no answers (no suspensions, no drug problems) and start to simply answer no without fully reading the questions. Just remember that sometimes yes is the right answer. 6. Believing that “they won’t really visit my office.” These insurance plans do send representatives to do on-site inspections and you need to be ready. There is no need to panic if they call the day before or arrive unannounced. Simply assume they are coming. The plan’s representative will want to check out the organization of your office.

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