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WC Revenue Management Corporation is a Medical service company
owned by WCRM Ltd which is a partnership. WCRM has been in the medical service
business since 1997 and was formed in Dallas, Texas. Principal share holder is
William J. Coates and the company is a privately owned by the Coates Family and
two Attorneys located in Austin Texas.
WCRM was founded in 1997 to audit payments made to the physician
per the physician’s contract at a finder’s fee percentage. During this work we
found that in a lot of cases the physicians were not on the contract that they
thought they were on. It became very evident in 1999 that a bigger need was to
get the physicians on the most favorable contract that in most cases already
exists or was available, but not known, and then work under payments. All
insurance companies work over payments or hire companies like Concentra to work
these issues. When you ask the insurance companies, or other outside audit
companies hired to verify overpayments, to tell you if they found many under
payments during the audit they will not hesitate to tell you they were not
hired, or assigned the function, to look for underpayments.
Next it became apparent that it takes a quarterly review to see
that the physician remains on the most favorable contract. Several offices
would react to new options not understanding that it would sometimes remove
them from the best paying contract. This problem along with mistakes made by
the Payor would remove the physician from the most favorable contract. Nothing
in TEXAS laws states that the companies have to pay physicians the highest rate
available and in all cases you can rest assured the companies didn’t pay the
highest rate available.
We found out that there was very little attention paid to the
contract and a lot of attention paid to individual CPT codes that were paid
incorrectly. The physician office would correct individual payment issues by
addressing the CPT code paid incorrectly, but the issue was not fixed so that
the same error was not made again. We try to come to a resolution so that the
same payment error is not made over and over. Then we review quarterly to
verify that the physician is still participating through the most favorable
contract. In most cases during a quarterly review we find one or more contracts
where participation has been changed with no record of a request for change of
participation. At that time, if a request for the change was not found, WCRM
will request corrections to participation status and past payment back to the
date the change in participation occurred.
WCRM expanded the business in 1999 to offer contract negotiation
for physicians and physician groups. WCRM has established a working
relationship with all the major Payors in the area. We have not failed to
improve any contract that we were requested to negotiate for a physician in the
history of WCRM be it language or rates. WCRM was hired by Pediatric
SubSpecialty Network PA to manage contracting issues in 1999. Now the function
has been expanded to managing the delegated credentialing, on going monitoring
of Federal Trade Commission regulations, financial management/collections,
operational management, and to function as the corporate office for the IPA.
WCRM then saw a need to provide real time, or as real time as
permitted by the Payor, information on rates, contracts, and credentialing data
to the physicians. These actions prompted the start of the system you are
reviewing as a PSN member or a WCRM customer. The plans for WCRM are to carry
this function into other venues or cities and specialize in the pediatric
medicine.
- William J. Coates
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