5 minute read
They are a recent phenomenon within our industry. They bring with them some favorable – and not so favorable – habits and challenges. Restoration peer review companies are used regularly, even by the largest insurers on non-program losses, to review our invoices. There are several ways to approach their usage and make sure they do not compromise your independence or integrity.
The presence of peer review companies in the restoration industry began several years ago, when insurance companies battled with a loss of experienced staff and the reality of internet-based carriers without full adjusting crews. Independent adjusters have been around for a long time, but the recent shift to peer review companies gives the companies the ability to use them as “third parties,” independent and fair-minded, at a fraction of the cost.
WHO ARE THEY?
Who are these companies, and what is their ultimate goal? Restoration peer review companies take the form of several different entities. Many of them are honest, truly independent companies seeking to level the playing field by establishing fair standards for water damage mitigation services. Their mission is to make sure that every company provides a level of service that is both appropriate and just for the homeowner but also not excessive or abusive to the carrier. This “tightrope” effect is tough to manage and balance, given the fact that each party thinks they are being hurt by any review of their efforts.
Other companies providing peer review services are, in fact, actual peers of the restorer. Some of the restoration professionals in our industry provide peer review services to carriers when they are not performing the work. Their intent is usually to stay in the good graces of the carriers, many of whom provide work to the restorer through their own internal programs. They will generate their own invoice estimate based on information provided to them by both your company and the carrier.
Finally, there are restoration peer review companies that exist as hatchet men for the insurance companies. Their sole mission is to lower your invoice by their own means- usually through attacking every line item and creating reasons to reduce your payment.
Once you get a call or email from one of these companies, your first question should be: “What type of restoration peer review company is this?” That answer is not always simple or easy to figure out. It’s easy to want to protect yourself by assuming the worst every time and be on guard against them. Only through experience- or reputation- can your answer be known to you. Please try to get information yourself and not rely on another company’s experiences. Remember, you might be doing everything right and not have many issues, while your “buddy” might be a real mess when it comes to invoicing and is being rightfully beat up.
In the past, there was good reason to simply ignore their presence and refuse to “work with them.” That would force the carrier to respond directly to you and work out the issues. Today, that is not a viable option. If you refuse to communicate with the peer review company, most times the carrier will simply take their work product and issue payment according to that alone. You will be left out and find yourself accepting much lower amounts. This does not mean that you must accept everything they say or propose. Many times, even the fair companies will make unrealistic demands or findings, and you will have to fight back.
Dealing with restoration peer review companies requires intense documentation and invoicing, and any lack of information will result in a lower invoice. If you billed for multiple days of drying, make sure that you can justify, through proper readings, every additional day for each piece. Also, do not insert any unsubstantiated line items that cannot be justified.
Finally, never think that you are going to get lowered on every invoice, so you will insert some “extras” to give the reviewer room to cut. This technique went out years ago and is a sure sign of poor ethics. Bill what you do, and not a penny more!
Restoration peer review companies are a reality today but understanding their roles and powers can give you a sense of calm when they show up. Don’t hate them or fear them; instead, understand them. Play their game better than they do, and you will get most of your money – and your reputation – with minimal suffering.
By: Bill Giannone, Co-Founder The CREST Network, LLC.
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