At Tri-Star Health, Paul Fisher, Director of Medical Cost Management, recently reconstructed the company’s internal codes used to process medical claims. This action not only changed the monetary value of certain codes, but it also altered the numeration assigned to a particular treatment drug. Fisher submitted all the documentation to alter these codes, but failed to submit an update to the physician representatives.
Fisher’s busy schedule hindered him from requesting a newsletter explaining how to use the new codes as well as their payment schedule. Shortly after the new codes were implemented, various physicians had their claims denied and subsequently were left unpaid. The contracted physicians were reasonably upset and sought financial settlement with interest for the company’s failure to update their provider network.
Discussion Questions Relating to Communications
1. What should Fisher have done when he first decided to tackle this project?
2. What protocols should have been in place to avoid the present situation?
3. What positive resolution can be implemented in order to keep these contracted physicians with the plan?