Because The Foto Group offers a variety of services, we are able to provide personalized
service to meet each client's needs. From Case Management to Policy and Procedure
Development to Education Outreach to Medical Review, we have a service, or combination
of services, perfectly suited to you.
In this section of our web site we invite you to review the details and benefits
of our services. If you have any questions, feel free to contact us to discuss your
needs.
Electronic Attachments
Over 20 years ago, The Foto Group was the first to introduce a therapy summary to
facilitate Medicare claims reviews through Blue Cross of California. This form was
revised for importation into the Florida Shared Systems (FSS). Because it was a
cost-effective system for claims review, HFCA used the 5097A form as the template
for their electronic therapy attachment allows medical review and decision-making
on a majority of claims without requesting hard copy medical records. To further
manage claims in a cost-effective manner, The Foto Group used the information supplied
by providers on the claims in a cost-effective manner. To further refine the medical
review process, HCFA contracted with The Foto Group to build out a Data Dictionary.
This Data Dictionary was based on criteria sets developed from our experience in
medical review using therapy attachments.
Review Forms
When specialized needs arise, we develop review forms to facilitate case management
in the private payer sector. This need occurred with patients who sustained catastrophic
illnesses and/or injuries, such as traumatic brain injury and spinal cord injury.
Our review forms allowed providers to distill volumes of information into a two-page
summary form that focused on the essence of medical review.
The Foto Group's certified case managers (CCMs) give all cases, short term or long
term, expert focused attention. Due to our experience as therapists we are uniquely
qualified to coordinate the care needs of individuals with catastrophic illnesses,
injuries and conditions that impact quality of life and jeopardize functional independence.
We review all of the issues surrounding each patient's treatment plan, including
the health, safety, and welfare of the client, and work within their benefits to
maximize effective treatment and produce desirable outcomes for the patient, payer
and provider.
Regardless of the severity or complexity of a claim, our CCMs are able to manage
the most agreeable and appropriate outcome for all by:
- identifying patient needs
- determining the appropriateness of proposed care and treatments
- reviewing goals
and discharge plans from treatment commencement
- discussing treatment plans with
the treating clinicians and/or physicians
- exploring and proposing alternative treatment
options
- reviewing contract benefits
- documenting all contacts and decisions electronically
- providing outcome management data
- documenting cost savings when a plan of treatment
is modified
- providing guidance, direction and training to nurse case managers
The Foto Group provides the following Policy and Procedure Development services:
- Operational guidelines for utilization management
- Targeted claim editing guidelines based on identified parameters
- Utilization Management Medical Review Guidelines: Analysis and Validation
- Development of electronic review forms - to help streamline and expedite medical review
- Outcomes Analysis and Management
- Provider Education
- Seminars (via videoconferencing, onsite or satellite)
- Videotapes
- Multimedia
- Medical Policy development and implementation for use in reviews. Extensive research and development, clinical practice surveys, and expert input support each policy. A sampling of policies we've developed and implemented include:
- Sensory Integration
- Neurodevelopmental Techniques
- Cognitive Rehabilitation
- Pain Rehabilitation
- Biofeedback
- Dysphagia
- Wound Care
- Pulmonary Rehabilitation
- Upper Extremity Splinting
- Aerosol Therapy
- Group Therapy
- Functional Maintenance Programs
- Lymphedema Management
- Vestibular and Balance Rehabilitation
- Low Vision Rehabilitation
- Computerized Functional Electrical Stimulation
- Assistive Technology Guidelines
- Constraint-induced Movement Therapy (CIMT)
- Augmentative Communication Devices
Through Education and Training Outreach, the Foto Group works to:
- Educate and train providers and suppliers in billing, coding, coverage and compliance
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Create and modify existing disease and injury protocols
- Identify critical issues
- Communicate effectively and build networks
- Develop training tools
- Analyze feedback
From savings to relationship building, the Foto Group's Utilization Management Medical Review services offer many advantages including:
- Cost Containment
Savings of over $12 million with a single national Insurance company Savings of over $21 million in six months under a government contract
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Speed
Therapist reviewers know what to look for in claims and documentation review
Accuracy
Therapist peer reviews provide accurate, consistent medical reviews that are less likely to result in the appeal of a denial
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Validity
Therapist peer reviews are consistently valid due to:
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Clinical practice knowledge and experience
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Evidence-based reviews
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Literature reviews
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Systems Analysis
Data collecting, profiling and operational analyses
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Targeted Claims Review
Specialized review and analysis of your data
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Coding Expertise
Therapists are experts in standardizing coding of therapy, DME, AT, and P&O claims
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Provider Communication
The Foto Group is known for building and maintaining strong relationships with providers. We speak their language.
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Provider Education
Every review involves educating the provider in documentation, billing, contracts, regulations and/or guidelines. Our decisions document solid clinical rationale.
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Knowledge of Technology and Clinical Practice
As practicing clinicians with expertise in many areas, we work with providers and payers to create win-win partnerships
The depth of knowledge provided by the Foto Group consultants within the rehabilitation arena allows for:
- Compilation of information
- Comprehensive literature review
- Analysis of potential coverage of services
- Policy establishment based on research finds
The Foto Group consultants provide services that are instrumental in identifying, providing and interrupting appropriate statistical measure to direct focused medical review programs and assess programs performance. These measures assist in:
- Establishing medical review edits.
- Examining trends.
- Identification of aberrant practice patterns.
- Group comparisons.
Data driven decisions are key to the success in all industries. Data analysis with both descriptive as well as comparative analysis can assist with trending needs, performance and changes over time. Comparative analysis can allow for describing difference and help offer direction within an organization. The Foto Group is able to perform these types of analysis through the use of various statistical packages and programs.