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For 40 years, The Foto Group has been providing nationally recognized service to
providers, professional associations, government programs, workers compensation,
insurance companies, HMOs, and carrier medical directors. As therapists, our reviewers
are able to offer insight, understanding and solutions beyond the scope of non-therapist
reviewers. We consistently produce accurate, appropriate review decisions that lead
to the best possible outcome for providers, suppliers and patients. We adhere to
all state, national and industry guidelines and hold ourselves accountable to our
own exemplary ethics and standards.
Founded by Mary Foto in 1968, The Foto Group was the first therapist-owned company
in the nation to offer peer review of rehabilitation therapies, assistive technology
(AT), durable medical equipment (DME), and prosthetics and orthotics (P&O).
Today The Foto Group includes over fifty therapists with expertise in physical therapy,
occupational therapy, speech-language pathology, respiratory therapy, durable medical
equipment, assistive technology, orthotics, and prosthetics. We hold national certifications
in specialty areas, such as orthopedics (OCS), hand therapy (CHT), and case management
(CCM) and sit on committees and panels statewide and nationwide, including AMA-CPT,
AMA-RUC, AMA-PEAC, SNF-PPS, HH-PPS, and 700/701 work groups. We also actively participate
in our state and national professional associations.
Our unique perspective as experienced practicing clinicians allows us to assure
accurate reviews of rehabilitation therapy claims that reflect the accepted standard
of care for each individual patient's condition.
Visit the
bios
section of our web site to learn about Mary Foto's qualifications, experience,
and accomplishments.
The Foto Group works with payers and providers to:
- manage workloads accurately and efficiently
- analyze data
- develop target edits/issues
- assess efficacy of target edits/issues
- make accurate, consistent review decisions
- develop educational content and treatment protocols
Our client list includes providers, professional associations, government programs,
workers compensation, national insurance companies, HMOs, and carrier medical directors.
Because we offer a variety of services, we are able to provide personalized attention
to meet each client's specific needs.
These services include:
- Medical reviews of:
- rehabilitation therapy claims (PT, OT, SLP, RT)
- assistive technology (AT) claims
- durable medical equipment (DME) claims
- prosthetic and orthotic (P&O) claims
- developing national and local medical review policies
- developing policies and procedures for medical review
- developing systems of medical review
- providing independent medical reviews and second opinions
- educating providers in reimbursement, documentation and coding
- training payers in therapy-related areas
- maintaining electronic submission and review when possible
- standardizing coding
- containing costs of medical review
- providing cost savings with case management
- helping bring providers into compliance with regulations, guidelines and contracts
- data analysis
- statistical analysis
- health care content development
Our extensive expertise allows us to communicate easily with providers, understand
the needs of patients and help determine appropriate treatment plans. It also enables
us to recognize inappropriate clinical practice and billing patterns. Providers
take extra care to provide and bill treatment that falls in line with acceptable
standards of practice when they know they will be reviewed by The Foto Group.
At The Foto Group, we pride ourselves on providing specialized services that benefit
our clients with accurate reviews, insightful analyses and significant cost savings.
For more information about our services, visit the
Services
section of our web site.
The Foto Group provides personalized service to a variety of client's needs including
government programs, private insurance companies, HMOs, state programs, workers
compensation, providers and suppliers.
Our experienced therapists understand that rehabilitation therapy is different from
other fields of medicine in that patients are not "fixed" with a pill or medical
procedure. Recovery occurs over time and endpoints can be vague to an inexperienced
reviewer.
When non-therapists review rehabilitation therapy claims, they can only use inflexible
guidelines that are not open to interpretation. As a result, they often miss the
subtleties our experienced Foto Group therapists easily recognize. Additionally,
non-therapist reviews are not defensible and therefore lead to more appeals.
Because our experienced therapists speak their language, providers understand our
reviews and are more willing to work toward a mutually agreeable decision to implement
an effective treatment plan in a reasonable time frame using existing contract benefits.
When working with The Foto Group, all parties -- from providers to suppliers to
patients -- benefit from our extensive experience and understanding of the nuances
and complexities of rehabilitation therapy. Our clients know they can depend on
us for specialized service, accurate, defensible reviews, contained costs and strong
relationship building.
Contact
Us
to discuss your needs and determine which of our many services will benefit
you most.
At The Foto Group we pride ourselves on adhering not only to the strictest national
guidelines, but our own exemplary work ethic and standards.
We provide accurate, evidence-based, consistent, defensible reviews by utilizing
and implementing every resource available to us including:
- clinical expertise
- our coding and reimbursement expertise
- peer-reviewed abstracts
- published peer-reviewed scientific studies
- peer-reviewed literature
- medical literature at the National Institutes of Health Library of Medicine
- clinical findings, studies, and research from government programs, educational institutions,
and the private sector
We incorporate ISO 9000 compliant guidelines and techniques and comply with state
laws, and ERISA and URAC guidelines for timeliness. Our turnaround times fall within
the following parameters:
- 24 hrs for phone consultation
- 4 - 5 business days for claim reviews (24 - 72 hrs available for uncomplicated claim
reviews at an additional fee)
The Foto Group reviewers maintain strict confidentiality of all patient records
and comply with all state and federal laws governing confidentiality, including
HIPAA regulations. We hold all records for seven years in a secure location where
they are accessible only by authorized personnel. After seven years, records are
destroyed by a licensed and bonded vendor.
If you have any questions about our practices, feel free to
contact
Us
for more information.
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