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Medical Fee Schedules December 30 2014

Most states adopt a medical fee schedule to set limits on the amounts paid to medical providers for their services. The medical fee schedules cover the cost of medical equipment and medical supplies. They vary in complexity and services covered by jurisdiction but also are similar.

Fee schedules provide some measure of cost control in workers compensation but also complicate the medical billing process. Employers must understand what medical fee schedules are and how they operate.

All jurisdictions attempt to apply fee schedules to all workers compensation injuries. Issues arise as to which medical fee schedule applies when employees, such as truck drivers and traveling sales people, are based in one state and injured in a different state. Normally, the fee schedule of the state where medical treatment is provided applies. However, some jurisdictions require their medical fee schedule to be used if the employee is claiming indemnity benefits in their jurisdiction.

 

The above information is from the Comprehensive Version of our
2014 Training Manual: Mastering Workers Comp Costs

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Completing The First Report of Injury December 30 2014

Problems with most workers' compensation claims are traceable to incorrectly completing the First Report of Injury (FROI) form.

The employer's First Report of Injury determines, more than anything else, the claim's future course.

Unchecked boxes or the word "unknown" are the main reasons claims take a long time to settle and have unexpected hearings extending into months and even years seeking clarification.

Nearly all FROI questions can be answered with a bit of diligence by the person completing the form.

The FROI often has sixty or more boxes to complete, with little space for complicated answers. Therefore, let documents answer the questions and, to assure their availability, staple them to the report form, with a notation to "see attached."

 

The above information is from the Comprehensive Version of our
2014 Training Manual: Mastering Workers Comp Costs

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Retraining Programs Are a Last Resort December 06 2014

If an employee with restrictions can perform essential functions of the pre-injury job, with or without accommodations, employers are required to provide these accommodations. It is best for the employee and the employer to get the employee back to work in their original job as soon as medically possible.

Retraining is expensive and is often unsuccessful in returning the employee to the workforce. Retraining is an option only if jobs based on the employee's skills and abilities are unavailable in the employee's field or in another field. Retraining is considered the option of last resort.

Retraining educational programs must be attended year-round with no summer breaks. The employee must attend classes, achieve good grades, and complete the program.

Retraining's main obstacle can fall short of meeting the primary return- to-work goal: bringing injured employees back to work in some capacity. Sometimes employees may want retraining in a different field to improve their earning capacity. While commendable, they may not do so at the expense of the company by continuing lost-wage benefits while being retrained. Employers do not have an obligation to retrain them to a higher earning capacity although some may chose to do so.

In most states employers do not have to retrain employees if appropriate employment is available; however, a company may choose to extend the offer of retraining as a good will gesture. BUT,remember: Put the Employee's Needs FIRST!

 

The above information is from the Comprehensive Version of our
2014 Training Manual: Mastering Workers Comp Costs

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How to Manage Legal Fees for Work Comp: Insurance Thought Leadership Publishes Article by Rebecca Shafer December 01 2014

 

How to Manage Legal Fees for Work Comp (opens in new window)The trade website Insurance Thought Leadership (InsuranceThoughtLeadership.com) recently published an article by Rebecca Shafer about how to manage legal fees for workers' compensation claims.

The article discusses some of the areas and activities that can help you cut costs, including:

  • Have in-house counsel monitor outside counsel.
  • Review outside counsel financial arrangements.
  • Conduct an independent audit.
  • Review whether opportunities for agreement between counsel are ignored.
  • Review whether defense counsel makes unfounded accusations against claimant.
  • Look at whether the attorney charges for lots of research, on many files.
  • Adjusters — with sufficient authority — should attend all hearings with defense counsel.
  • Risk managers (or the company human resources manager or the workers’ compensation coordinator) should attend all hearings.

You can read the full article here: How to Manage Legal Fees for Work Comp.


Essential Intake Considerations for Workers Comp Claims November 18 2014

 

How your claims are reported is an important decision, and can make the difference between whether your employees return to work rapidly or whether they are out of work for an extended and often unnecessary period of time. It is almost as important as selecting the best TPA, so evaluate procedures carefully: do not automatically choose the TPA's default procedures unless you are sure it meets your needs.

Here are several considerations when developing new procedures and evaluating vendors.

  • Hours: The call center should be open 24/7/365. Languages: Intake representatives should include bi-lingual staff as appropriate to your workforce.
  • Escalation Procedures: Based on established procedures critical losses must be escalated for immediate attention. 24-hour pager contact must be available.
  • Recorded Calls: Each service call is recorded and some are rated for voice tone.
  • Call Scripts: Employers provide customized questions depending upon workforce needs and post injury response procedures.
  • Answer Time: Calls are answered within a maximum of 25 seconds, but usually less.
  • Quality Control: Every claim is reviewed for location code and policy number accuracy before it is assigned to an adjuster.
  • Nurse Triage: Immediate contact with medical personnel ensures employees are directed to the right type of treatment.

 

The above information is from the Comprehensive Version of our
2014 Training Manual: Mastering Workers Comp Costs

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Plan Your Workers Comp Communication Strategy November 13 2014

 

One indicator of success depends largely on how well you bring employees into the communication loop, since they are the primary beneficiaries of injury management.

Plan a communication strategy before work-related injuries occur. In this way, your company can establish and maintain open channels of communication with employees.

Proactive Communication:
The first type is "program communication," where you proactively disseminate to employees the policies, programs, and procedures so everyone knows what is expected of them in the event of a work-related injury.

Reactive Communication:
Secondly, "post-injury communication," in which your company establishes and maintains communication with injured employees so they remain psychologically connected during their recuperation, and they remain focused on the final objective of returning to work as healthy, productive employees.

 

The above information is from the Comprehensive Version of our
2014 Training Manual: Mastering Workers Comp Costs
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Medical Provider Brochure November 13 2014

 

Injury management requires following best practices for maximum effectiveness. One piece of this puzzle is the Medical Care Coordination and the Medical Provider Brochure.

The Medical Provider Brochure should be given when you make a personal visit to your company's medical providers. Here are some additional tips:

  • Customize and distribute a brochure to medical providers explaining your company's transitional duty program and the benefits to both your employees and company.
  • Have treating physicians visit your operation to document physical requirements for performing jobs.
  • Encourage doctors to suggest transitional duty tasks based on those physical requirements and potential physical limitations.
  • Monitor medical bills to determine if those medical bills are reduced to the state-mandated fee schedule by your claims management staff.
  • Determine available claims adjuster services needed to coordinate medical care and reduce medical costs, and use those most useful for your company.

 

The above information is from the Comprehensive Version of our
2014 Training Manual: Mastering Workers Comp Costs

View Table of Contents and Sample Pages

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Hidden Costs of Workers Compensation November 02 2014

 

Each workers compensation accident results in the reduction of profits due to various hidden costs paid by the employer. These costs include:

  1. Time/productivity lost by the employee's supervisor and co-workers responding to the accident and providing immediate aid.
  2. Time lost by co-worker distractions watching and discussing the emergency response.
  3. Time lost by the employee for the remainder of the workday, time normally paid by the employer.
  4. Reduction in morale as co-workers realize and think about risks related to their jobs.
  5. Continuation of the employee's benefits while the employee is off work recovering from the injury.
  6. Supervisor, management, and witnesses' time to report the injury & process paperwork.
  7. Increase in the experience modification factor when calculating workers compensation premiums.
  8. And more . . .

An OSHA study showed the hidden cost of workers compensation claims is 4.5 times direct cost (medical/indemnity benefits). Other studies place hidden cost between 3-10 times direct costs.

 

The above information is from the Comprehensive Version of our
2014 Training Manual: Mastering Workers Comp Costs

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Plan a Workers Compensation Vendor Day November 02 2014

Consider planning a "Vendor Day" and invite your insurer to attend. You not only develop a better relationship with your vendors and insurer, but Vendor Day is a great way to learn more about workers compensation cost control techniques.

Some services are owned by your insurer/TPA, while others are affiliated with them. What's on the Vendor Day Agenda? Have the insurer explain the benefits of each service, how to request a service, when each service is routinely provided, and the cost of each. And do not forget this is a great time to request product samples!

Ask your insurance company to invite service-providers they use, participants in workers compensation initiatives, such as RTW, utilization review, and medical and legal services.

 

The above information is from the Comprehensive Version of our
2014 Training Manual: Mastering Workers Comp Costs

View Table of Contents and Sample Pages

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Monitoring and Managing the Workers Compensation Program November 02 2014

 

Monitoring is critical for continued cost control. Once you have built a program lowering costs, you will want to maintain control over those aspects contributing to your success.

The steps in the Monitoring and Management Phase involve post- implementation support and monitoring of processes, injury claims, and lost-time data.

After implementation, your company should be able to demonstrate continued results through

  1. Declining lost workday rates.
  2. A shift in the return-to-work ratio showing most injured employees return to work sooner.
  3. A significant decline in the cost per employee.
  4. Improvement in reporting time and network use.

 

The above information is from the Comprehensive Version of our
2014 Training Manual: Mastering Workers Comp Costs

View Table of Contents and Sample Pages

RIMS Member Discount 10%