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UCR claim by a non-lcp and non-iarp member

  • 1.  UCR claim by a non-lcp and non-iarp member

    Posted 05-08-2024 15:46

    Hello colleagues,

    I am wondering if this is reportable. A accountant in a federal case pulled a article somehow from a IARP article that advocates for 50 th percentile ucr. . This accountant is not a member of IARP or a LCP. This individual is claiming that 50th percentile is Usual and Customary and plans to testify on court with what is a article he extracted from one of our journals. Is this a actionable offense? Should I contact the ethics committee about misrepresentation as he is stating this is IARP standard? First time I came across this I would love input. 



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    Jenn Toles MS CRC CLCP CCM
    Guided Life Care Planning Services
    info@guidedlifecare.com
    Lithia, Florida
    ------------------------------


  • 2.  RE: UCR claim by a non-lcp and non-iarp member

    Posted 05-08-2024 15:55

    Hi Jen,

     

    Off line I would be happy to discuss this specific issue.  With respect to a general commentary I would say this – I am not sure if we can "sanction" a non-member.  Without additional  background at best the CPA may not have the appropriate credentials to understand the IARP standards.  I have seen CPA's provide commentary on the use of cost data bases- The professionals that I have seen have absolutely no revenue cycle background and do not understand how charges are processed among various healthcare stakeholders.  Thus, more often than not their opinions cannot be supported.

     

     

     

     

    Rebecca M S Busch,

    RN, MBA, CCM, CFE, CPC, CHPA-IV, CRMA, CICA, FIALCP, FHFMA

    CEO, Medical Business Associates MBE* WBE* WOSB* Certified Firm

    www.mbaaudit.com

     

    Author: "The Cyber Patient, Navigating Health Informatics" 2019; "A Practitioner's Tool Kit for Patient Advocacy" 2017; "Leveraging Data in Healthcare: Best Practices for Controlling, Analyzing, and Using Data" 2016; "Healthcare Fraud Audit & Detection Guide" 2nd Edition 2012 "Electronic Healthcare Records An Audit & Internal Control Guide" "Personal Healthcare Portfolio" 2010

     

    This communication, including attachments, is for the exclusive use of addressee and may contain proprietary, confidential or privileged information. If you are not the intended recipient, any use, copying, disclosure, dissemination or distribution is strictly prohibited. If you are not the intended recipient, please notify the sender immediately by return mail and delete this communication and destroy all copies.

     

     




    Original Message


  • 3.  RE: UCR claim by a non-lcp and non-iarp member

    Posted 05-08-2024 18:02
    Edited by Rebecca Busch 05-08-2024 18:04

    One more comment.  The article with respect to the 50th percentile (which by the way is only about professional bills NOT facility) was part of a special costing edition.

    You should consider the context of the entire "special edition" first read the editors commentaries – which facilitate an introduction to the topic of costing.  Then read all articles within that publication.  The edition nor any one article is not intended to purport the IARP standard.  In full disclosure I am the author of another article in the same publication which presents an alternative perspective. We also had a literature review of the subject – PLEASE READ IT.    Keep the entire edition in your library and appreciate the context of the discussions. Remember, data that is published in data repositories is just  raw data.  The cost data is absent of license type, including both rendering and billing provider. The $ data by cpt code is also separated from the diagnosis pointer on the claim line.  Any process that involves just looking up a CPT code and picking a percentile number is not a true analysis.  The cost data should be brought back to your LCP like any other research item and incorporated into your analysis.  Their appears to be an overreach of well I believe the 50th the 80th is UCR. As if we repeated it often enough it may just be true.  This is a false and irresponsible narrative.  Most people do not even appreciate that the data depositories are weighted toward group health insurance recipients. Yes they often provide both paid and presenting charges.  They do not include the billions  to trillions of dollars that are spent in property and casualty health claims.

     

    Further, if you think about the process – the claim leaves the hospital or provider, goes to a clearing house, it is then collected by various parties that produce the data that many in our group will utilized.  They strip the cost data from the original presentation of the bill.  I can tell one thing that it will miss.....

                  A provider implements an electronic health system. Many of them have contracts – some of them will actually just bill the amount that they know the payer will pay. The contracted amount not the gross charges.  Guess what – that contracted paid data is not parsed out when it is collected by these data warehouses.  I have worked in the arena of revenue cycle – the process that supports the generation of a bill by a provider. Have you ever looked at a price in those data bases and felt like cheez this does look low ?      So with added emphasis – you have plenty of opportunities to educate yourself and of course attorneys that retain you that all research including costs need to be evaluated in their proper context.

    Happy to discuss with anyone that feels "stuck" with an uneducated party.

     

    Best




    Original Message


  • 4.  RE: UCR claim by a non-lcp and non-iarp member

    Posted 05-08-2024 18:30

    can someone add the link to the special edition costing edition? I am having a hard time from my cell phone.... thanks 



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    Rebecca Busch
    CEO
    rebecca@mbaaudit.com
    Westmont, IL United States
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    Original Message


  • 5.  RE: UCR claim by a non-lcp and non-iarp member

    Posted 05-08-2024 18:38

    It is Volume 20, Number 2, 2022.

    June_JLCP_2022.pdf (ymaws.com)



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    Laura Woodard, MA, CRC, CLCP, CCM, FIALCP
    Rehabilitation Counselor
    ReEntry Rehabilitation Services Inc.
    Lakewood, CO United States
    lwoodard@reentry.comWoodard
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    Original Message


  • 6.  RE: UCR claim by a non-lcp and non-iarp member

    Posted 05-08-2024 18:42

    Thank you laura




    Original Message


  • 7.  RE: UCR claim by a non-lcp and non-iarp member

    Posted 05-08-2024 19:03
    Edited by Jennifer B Toles 05-09-2024 07:23

    Thank you , I appreciate those who assisted with  constructive and thoughtful responses. 



    ------------------------------
    Jenn Toles MS CRC CLCP CCM
    Guided Life Care Planning Services
    info@guidedlifecare.com
    Lithia, Florida
    ------------------------------

    Original Message


  • 8.  RE: UCR claim by a non-lcp and non-iarp member

    Posted 05-10-2024 10:06
    I am in agreement with Steve here.  

    I think you could at the very least counter his statement that this is an IARP standard - it is an article that is peer reviewed and published in one of our journals, but this does not extend to a conclusion it is a 'standard' by IARP or any other organization, group or body.  

    A good example is Rick Robinson's book listing various models for doing EC....seems you could look at why you do or do not agree with the 50th %tile.  

    IMHO -that is the issue, not the other expert drawing from an article, IARP's or others.

    Best Regards,
    Lynne Tracy, M.A., LMFT, CRC, ABVE/D
    Vocational Counseling 
    P.O. Box 8333, Calabasas, CA 91372
    Direct: (818) 880-6460  
    FAX:  (818) 880-6494   
     
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    Original Message


  • 9.  RE: UCR claim by a non-lcp and non-iarp member

    Posted 05-10-2024 10:16

    There is no such thing as an authoritative journal article or book. One article does not eliminate all other articles or points of view. There are many great journal articles and books. But one doesn't trump everything else.

    Carl Gann

     




    Original Message


  • 10.  RE: UCR claim by a non-lcp and non-iarp member

    Posted 05-08-2024 16:04

    Jenn,

    Interesting situation. A few things: 

    1.  If he is not an IARP member, there would be nothing an ethics or overseeing committee would be able to do. They are an accountant and can claim whatever they please. 
    2. However as they say, anybody can say anything on direct examination. Can they defend their "expertise" and position on cross? 

    This sounds more like a matter for intense cross examination. As an accountant, what would qualify them to engage in the specialty practice of Life Care Planning? Are they familiar with the SOP? What qualifies them to opine on any percentiles as generally accepted methodology, much less the cost of care in general? 

    As the most recent Summit set out, costing methodology is a diverse process and many professionals rely on a triangulation of sources to determine what is reasonably available now and into the future for an individual, not simply just a percentile value in a database. 

    The SOP does not take any stance beyond this, nor does IARP. Publications in a journal like the JLCP are peer reviewed, but this does not make any particular approach or publication on costing "generally accepted " just at surface value. 

    Hope that helps!

    Good luck! 

    -Nick 



    ------------------------------
    Nick Choppa
    Rehabilitation Counselor/Case Manager/Life Care Pl
    nick@osc-voc.com
    Seattle, WA United States
    ------------------------------

    Original Message


  • 11.  RE: UCR claim by a non-lcp and non-iarp member

    Posted 05-08-2024 16:58

    Thank you both. It seems like a pretty open and shut case and I thought the judge would already exclude his opinion but it seems like it may go to trial. It perturbs me as he is relying on a single article in the journal of life care planning and is pointing it out as fact and claiming this is IARP's standards of 50th percentile.



    ------------------------------
    Jenn Toles MS CRC CLCP CCM
    Guided Life Care Planning Services
    info@guidedlifecare.com
    Lithia, Florida
    ------------------------------

    Original Message


  • 12.  RE: UCR claim by a non-lcp and non-iarp member

    Posted 05-08-2024 17:55

    Not to be a contrarian, (or at least no more than I usually am), I have to say, I personally welcome the chance to have strong adversaries.  It seems to me that in this case, the opposing expert found a reasonable article for use as a challenge of your work.  All the better!  Rehab articles are not limited to use just by Rehabbers.  You, of course, are allowed to refer to economics or accounting articles whenever you want.  In some ways, this kind of work isn't governed by a lot of rules.  One thing your story may mean is that you are getting cases that warrant higher level opponents (rhetorically speaking).  Having been challenged, it seems to me that it now falls to you to figure out what responses you will want to make to the arguments in that article.  You may have some reading ahead of you.

     

    -Steve Bast, MHS, CVE, CDMS, FVE, CCM, IPEC, ABVE/F, EA

    Westwind Consulting, Inc.

     




    Original Message


  • 13.  RE: UCR claim by a non-lcp and non-iarp member

    Posted 05-08-2024 18:27
    Jennifer, 

    If you are concerned with the conduct of the accountant and the veracity of the scope of their opinions, CPA's have their own code of conduct which may be a better source to answer your questions. For instance, the AICPA Code of Professional Conduct 0.300.030(.04) states,

    "Those who rely on members expect them to discharge their responsibilities with integrity, objectivity, due professional care, and a genuine interest in serving the public. They are expected to provide quality services, enter into fee arrangements, and offer a range of services-all in a manner that demonstrates a level of professionalism consistent with these Principles of the Code of Professional Conduct." [Emphasis added]

    0.300.060(.04) states, 

    "Competence represents the attainment and maintenance of a level of understanding and knowledge that enables a member to render services with facility and acumen. It also establishes the limitations of a member's capabilities by dictating that consultation or referral may be required when a professional engagement exceeds the personal competence of a member or a member's firm. Each member is responsible for assessing his or her own competence of evaluating whether education, experience, and judgment are adequate for the responsibility to be assumed."

    The above information may be better suited for cross examination as Rebecca and Nick suggest.

      Thank you,


    John R. Cary, MA, CRC, CDMS