Cost Projections... - page 2

Now working as a feild based case manager for worker's comp and auto insurance companies. They always want a cost projection. Does anyone else have to do this? I hate all things financial! I am a... Read More

  1. by   hoolahan
    I found a great site...AMA has a free CPT look-up w prices, BUT the prices are what Medicare will pay the provider not what the provider will actually charge, so definetly figure up, I don't know by how much, but I figure at least to add 50%.

    You have to register, and are limited to ten searches a day, but it's a help...AMA Free CPT Code Look-Up

    No Vegas, they can't get rid of me that easily!!!
  2. by   DallasRN
    'morning to you...still looking info on cost projections? These sites might help:

    I think you have to become a paid subscriber, but the health-mart site is supposed to be really great. Maybe you and a few others could pool resources and subscribe????

    I haven't read all the posts and I'm certain you have received excellent info, so this may be a repeat. However, what I have done on numerous occasions is simply contact the physician (surgeon for example) via visit or letter (they like fill-in-the-blank letters best) with simple questions: Dear Dr. XYZ: I have been instructed to obtain _____. This will assist in assuring timely payments when you submit your billing, yada, yada.....
    Please provide the following info:
    Anticipated number of PT visits, follow-up office visits, etc. Also, find out who the anesthesiologist will be (or the service) and contact them directly. "For this surgical procedure, length of anesthesia, cost per unit, etc.
    For this type of stuff, I generally have good luck with the physicians office or practice manager or his personal secretary.
    Does your State have fee guidelines? Most do. Get a copy. They generally outline everything and the allowances.
    Contact the bill audit unit or provider for your carrier. S/W the manager. They can be a wealth of information and may supply you with very specific info (and as noted elsewhere, delivery of a few dozen cookies/donuts/basket of candy) has never hurt. Seriously...I used to go to Sam's Warehouse and by these mega-size bags of cheap candy, and would pick up baskets, tins, etc., whenever I saw them on sale and would periodically take them to various offices with a thank-you card. Amazing the difference it makes. I found out one office person liked bottled water - started as a joke, but to this very day, whenever I'm in that area, with or without a patient, I take her a $.99 bottle of water. I've NEVER had a problem getting a patient in ASAP, getting reports, or just info in general.
    Cost projections really are not that hard. Just sit down with your claim and think, think, think about everything that could potentially be involved in the process to MMI. Make a list. Then proceed with getting the answers. And always keep the info on file to build your data bank so that you don't have to constantly redo. They get much easier as you go. Good luck.
  3. by   hoolahan
    Thanks everyone, great suggestions. I am starting a binder. I am gathering hosp bills for info too.

    I will check out healthmart too. Thanks!
  4. by   lynnintn
    It took me awhile to figure out how the site works, but it is jam-packed with almost every procedure known; and you can break it down by hospital fees and surgoens fees; however, it is just a guide to help the adjusters set their reserves; I have a guy who just got out of the hospital, and I estimated the total bill would be about 70K; I was too low by about 20K when I checked the bill. The adjusters don't expect you to be right on the $; just ballpark figures.

    Benchmark Fees