UNDERSTANDING THE BASICS
Objective Surgical is a specialty program, offering services that focus on WC surgical cases. We have processes in place designed to address the most common pain points associated with WC cases: overall cost, pricing predictability for reserves estimating and proper care & attention to get employees back to work.
Objective Surgical offers complete management of a WC surgical case for the entire episode of care – from time of injury through MMI.
- A hand-picked network of WC-savvy doctors selected specifically to properly treat injured workers.
- Aggressively negotiated rates for each component of the surgical process, resulting in significant savings.
- A global quote prior to surgery to help adjusters set reserves.
- Handling of all bills so you write ONE check for the entire episode of care.
- As a general rule, our care coordination team handles all communication with patients, providers, adjusters and nurse case managers. They can schedule all appointments and send reminders. They can arrange everything associated with the episode of care, including DME, PT, etc. They can also handle all “housekeeping” items, including requesting and tracking down paperwork. (Adjusters/NCMs determine what level of assistance is needed.)
- Complete simplification of the surgical process for adjusters and NCMs.
- A worker gets injured and needs medical attention.
- A diagnostic is performed.
- If there is an objective finding, the referral is sent to Objective Surgical to see a specialist.
- With conservative care, a treatment plan is put in place.
- With surgical care, a global quote is issued for the entire episode of care. The adjuster signs off and agrees to pay the global invoice within 10 days of receipt, not to exceed 30 days.
- Upon quote approval, the adjuster/NCM determines the level of assistance they need from our care coordination team and a plan is put in place. (The Care Coordinators can handle all aspects involved with the coordination of care through MMI, keeping the adjuster/NCM in the loop the entire time.)
- Upon completion of the surgery, Objective Surgical verifies all CPT codes and sends a global bill 2 weeks post-op.
- A PPI rating is provided by the surgeon upon MMI.
Self-insured employers, TPAs, insurance carriers, NCM companies and brokers.
We offer services in most regions of the US and have provider partners across the country.
We have existing provider networks in select Usual & Customary states.
Because of various WC statutes and fee schedules, cost savings will vary from state to state. In states where we cannot offer significant savings, we can offer the following benefits.
- Predictability in reserves setting
- Care coordination services
- Cost containment (no surprise bills)
- Top quality care by experienced WC providers
- One bill, one check
- Better outcomes
Our provider network has grown organically. We are always looking for opportunities to expand our services and make an impact.
We work hand in hand with NCMs with several of our clients. (Some of our clients are actually NCM companies.) We understand the role of NCMs and we do not serve as a substitute for the nurses’ medical expertise.
We provide support to the NCM – tracking down paperwork, pushing it to the NCM/adjuster and handling all billing components. Our support allows NCMs to focus on the patient. There is no additional charge for our care coordination services. We love working with nurses.
We are told time and time again that they love working with us because we are extremely helpful.
We are very selective in the provider groups we choose to partner with, focusing on outcomes. We understand that WC offers many challenges. As a result, we choose to work with physicians who specialize in WC. We go above and beyond basic credentialing. We engage peers and others in the industry for feedback regarding outcomes, bedside manner, timely work status and clinic notes, office staff, etc. We listen to our clients and are always open to feedback and suggestions.
Upon request, we are happy to provide a list of providers for the states/regions where we have existing networks, detailing the provider groups and individual surgeons.
In regions where we do not have established networks, we can still offer services. We utilize the same vetting process to identify top quality providers, work with clients on referrals and offer recommendations.
Because of the quality of providers we utilize, it is not uncommon for our clients to have existing relationships (and direct pricing) with surgeons in our network.
Let’s say that the rates Objective Surgical secures with a provider are the same as the rates in a client’s existing contracts (or even a little higher). We can still save you money! How? We aggressively negotiate each component of the surgical process, not just the provider piece. This includes facilities, anesthesia, DME, hardware/implants and PT. We also include PPI/PPD rating.
We feel confident we secure the best rates with providers. We offer them volume, pay promptly and offer them T-ed up surgical cases.
We love referrals! If your surgeons are not currently in our network, we can reach out and start the vetting process.
THE GLOBAL BUNDLE AND PRICING
- Initial evaluation, causation is addressed
- Surgeon/Asst Surgeon
- All post-op care including Physical Therapy
- PPI rating
Yes! We are able to provide global invoice pricing information upon request.
Absolutely! We are happy to provide a quote to illustrate the benefits of our all-inclusive bundled pricing.
THE REFERRAL PROCESS
- The referral process is easy. You can submit a referral in the following ways.
- Email – firstname.lastname@example.org
- 800# – 800-639-5191
You can refer a diagnostic through Objective Diagnostics. The study is scheduled within 4 hours of receiving the referral and results are sent within 24 hours of the study.
If the diagnostic has already been scheduled elsewhere and there is an objective finding, send us the surgical referral and we will facilitate scheduling with one of our in-network surgeons.
With our program’s proactive approach, it is more efficient for us to be involved prior to the patient seeing a specialist. In some situations, we can make exceptions.
Yes. We welcome pilots to demonstrate exactly how our program works. The process is very simple.
- You choose your adjuster(s) to work with Objective Surgical and we walk them through the process.
- The adjuster(s) sends a predetermined number of surgeries through our program.
- You agree to pay our global invoice within 30 days of receipt.
- If you have bill review, we send ALL bills associated with each surgery to you to submit to bill review (not our normal way of doing things, but this allows you to compare costs).
- If you do not have bill review, we can provide you with cost savings reports and outcome data specific to the piloted cases.
HOW OBJECTIVE FITS IN
- We simplify the process.
- We give the gift of time to the adjuster/nurse case manager.
- We provide cost containment.
- We provide predictable costs allowing adjusters the ability to set reserves.
- We become the responsible payer. We handle all bills. You write ONE check.
- We ensure patients receive excellent, timely care – allowing for proper healing and a quicker return to work.
- We ensure patients, adjusters, nurse case managers and providers receive superior customer service, compliments of our care coordination team.
- We recognize the importance of scheduling efficiency to allow for timely healing and a quicker return to work. Our processes have been built with this in mind.
With traditional bill review, cost analysis is performed after services are rendered. The bill review company charges fees that often include line item charges, % of savings (typically 10%-35%) and administrative fees, including a charge for checks written.
Our approach is PROACTIVE and has built in cost reduction. All negotiations are done prior to treatment, ensuring deep discounts with predictability. With our services, there are no line item charges, shared savings or admin fees. When you utilize our program, you eliminate the need to pay for bill review services. Please keep in mind, each component of the surgery process is negotiated proactively and they are not eligible for further discounts.
HOWEVER, if it is written that a bill review service must be utilized, we can certainly accommodate that request. A client would simply have to agree to make payment when we send our global bill. Then, we can work in conjunction with bill review and follow the process you have in place, providing CPT codes and U&C charges. We understand processes vary from company to company and we are able to make adjustments to accommodate as needed.
We love working with TPAs and TPAs love working with us. We make adjusters’ lives easier by giving them the gift of time and provide cost savings opportunities for their clients. We have many direct relationships with TPAs, but not necessarily every adjuster.
To take advantage of Objective’s cost containment opportunities, let your TPA/adjuster know that you would like to learn more about our program. Once you do that, we can make arrangements to share additional information.