New Comp Coverage in Ohio for Some Employers

Good news for some businesses doing work in the Buckeye State.

 
A new workers compensation coverage insurance option is now available to eligible Ohio businesses for their employees who work in other states. The new offering will simplify workers comp for these employers, ensuring their employees are protected without the need to manage policies in multiple states with varying laws.

 

Effective as of March 1, employers can apply for this coverage through policies issued by the Ohio Bureau of Workers Compensation (BWC) through a program with United States Insurance Services (USIS) and Zurich Insurance.

 

“By contracting with insurers licensed in other states, BWC is able to ensure employers have proper coverage wherever they’re operating,” said BWC Administrator/CEO Steve Buehrer. “Addressing this longstanding concern of many Ohio employers is one of many steps we’ve taken at BWC over the last five years to ensure workers comp is not a barrier to business expansion, inside and outside of the state.”

 

BWC does generally provide coverage for employees working temporarily outside of Ohio; however, complications can arise when the injured worker files a claim in another state. Treatment can be delayed and businesses can be subject to penalties by the other state.

 

A law enacted last year granted BWC the authority to contract with an insurer to provide this coverage. USIS and Zurich submitted a program proposal and were selected through a request for proposal process. USIS first installed another state’s coverage option in Maryland in 1996, and first began its agency relationship with Zurich in 2010.

 

Employers must have the majority of their business in Ohio to be eligible for the coverage option.

 

Interested employers will apply directly to BWC, which will determine eligibility and the premium cost for the optional coverage. BWC will issue a Zurich policy to cover out-of-state exposures and Zurich will respond to any claims filed out of state.

 

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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Ohio Worker Suffers Multiple Broken Bones, Company Fined

A 39-year-old Ohio worker suffered multiple broken bones after he fell more than 40 feet while conducting maintenance on a crane at TimkenSteel’s Faircrest Plant.

 
The U.S. Department of Labor’s Occupational Safety and Health Administration found the company failed to provide the worker adequate fall protection. The Aug. 7, 2015, injury was the second life-threatening injury at a TimkenSteel plant since May 2015.

 

OSHA cited the steel manufacturer on Jan. 29 for two repeated and three serious safety violations. TimkenSteel faces $129,500 in fines as a result of OSHA’s investigation. Investigators found crane maintenance workers were exposed to falls due to lack of guardrails, and protective equipment. They also found workers were not protected from operating parts of cranes during service and maintenance because locking devices, guards and other safety procedures were not used and equipment was not powered down properly.

 

“TimkenSteel needs to fix their safety program immediately,” said Howard Eberts, OSHA’s area director in Cleveland. “OSHA will monitor these plants until the company makes protecting workers a priority. No worker should die or suffer life-altering workplace injuries because their employer fails in its responsibility to protect their employees.”

 

In May 2015, another TimkenSteel worker was severely injured when a crane’s safety latch failed and 1,000 pounds of equipment fell on him at its Gambrinus plant.

 

In October 2015, OSHA placed TimkenSteel in the agency’s Severe Violator Enforcement Program, after investigations at the Harrison and Gambrinus plants found several violations resulting in proposed fines of $393,500. The company has contested those violations.

 

TimkenSteel was spun off from The Timken Company in 2014. Prior to this inspection, the three plants and corporate offices now operated by TimkenSteel had been inspected by OSHA 29 times since 2005, resulting in the issuance of 76 violations.

 

The manufacturer of large steel bars and seamless mechanical tubing was mostly recently cited by OSHA in November 2014. Its Harrison steel plant melts, rolls, produces and finishes steel, and its Gambrinus plant performs cold steel finishing.

 

The company was given 15 business days from receipt of its citations and penalties to comply, request an informal conference with OSHA’s area director in Cleveland, or contest the findings before the independent Occupational Safety and Health Review Commission.

 

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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Structured Settlements Protect Injured Workers & Save Work Comp Costs


Michael Stack:   Hello, Michael Stack here. Principal of Amaxx, founder of COMPClub, and co-author of “Your Ultimate Guide to Mastering Worker’s Comp Costs”. One of the core philosophies that I believe is that a better outcome for your injured worker will lead to lower worker’s compensation costs for your organization. Again, a better outcome for your injured worker will lead to lower worker’s compensation costs for your organization. And structured settlements certainly fall under that criteria and that philosophy. I have a special guest joining me today, the Senior Vice President of National Marketing at Ringler Associates, Duke Wolpert. Duke, thanks for joining me. I’d love for you to share with me what is a structured settlement, a little bit of context there.

 

 

What is a Structured Settlement?

 

Duke Wolpert:   Sure Mike, my pleasure. Thanks for having me today on the program. A structure settlement, essentially, is a cost-effective alternative to a lump sum settlement, a cash settlement. The series of tax-free future periodic payments, established between an insurer or self-insurer, and an injured party, a claimant or plaintiff, as part of either a worker’s compensation settlement, or a personal injury settlement.

 

They’re designed to protect and offer security to injured parties, so that they can meet their financial obligations in the future. Essentially, they bridge the gap to settlement, and any way parties can move closer to settlement by simply a change in the way the settlement is funded certainly is a step in the right direction.

 

Michael Stack: Absolutely. I agree with that, and I think these points you made are very good ones. Alternative to cash, really that lump sum settlement as an alternative to that, this point I think the tax free periodic payments in really a strong benefit to this, and then not to really be understated is that protection and security issue that really those structures offer throughout that settlement process, so thanks for sharing those point, Duke. Now, tell me, really how are these used then in the worker’s compensation space, really to leverage these benefits that you mentioned?

 

 

How Are Structured Settlements Used in Workers’ Compensation?

 

Duke Wolpert:   Yeah, what we’re seeing in the worker’s compensation space is a growing use of structured settlements, when it comes to the funding of Medicare set aside allocations. In addition to the MSA, the Medicare set aside allocation, oftentimes there are non-Medicare allowable expenses that aren’t part of the Medicare set aside allocation cost projection, that need to be quantified, and many times, we actually structure those non-Medicare allowable expenses as well as the MSA’s that we see.

 

On the indemnity side of the cases, we oftentimes are pulled into permanent and total claim scenarios, widow benefits, minors, in catastrophic claims, burns, amputations, traumatic brain injuries, for instance, are certainly cases that we’re asked to get involved in, to customize proposals that assist in meeting the financial needs of the injured parties in the future.

 

On occasion, we see situations involving injured parties with drug dependency, or competency issues, folks that for one reason or another cannot manage their own money, and there is certainly a value, the funding of those settlements with periodic payments and structured settlements.

 

Finally, the use of the structured settlement is growing in conjunction with the growth of Medicaid entitlement and the Medicaid programs in the states. In order to protect entitlements for Medicaid recipients, oftentimes the funding of the settlement has a direct correlation with their eligibility status, so the funding of a settlement would be using periodic payments, a structured settlement, certainly provides some protection to injured parties when it comes to ongoing incontinuity of Medicaid entitlement.

 

Michael Stack:   I think a couple of things that you said there … this competency issue, and we talked about it in regards to drug dependency, but I think we hear these stories so often of the lottery winners who get this huge sum of money, and a couple of years later, the people go bankrupt, and it’s just a very common story, and I think the value here is really in that protection, which we talked about in those benefits initially, and these catastrophic cases that Duke mentioned  … I think very valuable when you really put that in a context of leveraging this for those better outcomes for those injured workers, so let’s talk about that now, Duke. How do we now leverage these tools? How do we leverage this tool then in the context of really creating those better outcomes, both for the injured worker, and then creating those lower worker’s compensation costs?

 

 

How Do Structured Settlements Reduce Workers’ Compensation Costs?

 

Duke Wolpert: Absolutely. When we look at outcomes on the insurance, self-insured side, the primary payer side, oftentimes the use of structured settlements offers a reduction in the pay loss dollars in the claim, the lost dollars associated with a claim file. That oftentimes leads to improved cycle times or closing ratios for claims professionals, and what we find is that it at times avoids unnecessary expenses, especially in cases in litigation, either litigation costs or ancillary expenses related to the litigation, so clearly there’s value from a cost containment and cycle time claim inventory perspective, when it comes to the use of structured settlements.

 

Michael Stack:   I agree. Now, let’s talk about those injured workers, so we’re saving money through the use of these tools in loss dollars and the comparison of using an annuity versus a lump sum payment, and really leveraging the interest that leads to those savings. Now, let’s talk about those injured workers on that perspective and some of those benefits in creating a better outcome for them as well.

 

 

How Do Structured Settlements Lead to a Better Outcome For Injured Workers?

 

Duke Wolpert: Yeah, understanding that the plans that we develop are individually customized, they’re done that way to meet the needs of the injured parties, and every plan is a little different. In conjunction with the structuring and work up for the pricing of the Medicare set aside, there are oftentimes non-Medicare allowable expenses and other needs on the [inaudible 00:06:18] side that we need to address with the injured parties, as well as their own financial needs that will lead to the establishment of the creative design, the structured settlement proposal, and by doing that, it bridges the gap of the settlement. It gets the parties closer to resolving the claim in hand.

 

Michael Stack:   I think that really summarizes it nicely in the sense of really customizing those needs. I think when we talk about objections that injured workers might have, that would be a fear of mine certainly if I was offered a settlement, that I want to make sure that my needs are protected. As you said … I think one of the things you said there was I think was key, was it’s really individual to that individual person. Do they need some money up front to pay for certain things? How much money do they need over time? … And really customizing it to meet those needs, and as we said, at the same time saving those worker’s compensation costs for the payer organizations.

 

Duke, thanks for joining me. I’d love to just ask to share some final thoughts as we wrap up here.

 

 

A Structured Settlement Could Be the Last Check an Injured Party Ever Receives

 

Duke Wolpert: My final thought would be that we need to remember that an injured party who’s been disabled for a period of time, that receives a settlement, may not be going back to work. This could be the last check, the last payment that they receive for the rest of their lifetime, so protecting their financial future certainly is something that we want to be part of, and structured settlements absolutely do just that.

 

Michael Stack:   Yeah, I couldn’t agree more, and I think that point of really thinking that this is a last check that individual can receive is a very powerful point, and really leveraging this tool to create those better outcomes for that individual person, and as we mentioned, at the same time, lowering those worker’s compensation costs for the payer organizations. Thanks again, Duke for joining me today, and remember, your success in worker’s compensation is defined by your integrity, so be great!

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Trio of Midwestern States Looking Harder at Workplace Safety

The increased likelihood that workers in high-hazard manufacturing industries – such as food, furniture, fabricated metal, nonmetallic mineral, machinery and computer products – will be injured on the job is leading federal safety and health inspectors in three Midwestern states to increase its focus on industry outreach and inspections to reduce injury and illness rates.

 
More than 340 workers died in fatal manufacturing incidents nationwide in 2014, the Bureau of Labor Statistics reports.

 

On Jan. 25, the U.S. Department of Labor’s Occupational Safety and Health Administration launched a new Regional Emphasis Program in Kansas, Nebraska and Missouri.

 

Regional and local emphasis programs are enforcement strategies designed to address high-risk industries; OSHA’s regional and/or area offices implement the programs.

 

Programs Start with Three-Month Education, Outreach Activities

 

Each begins with a three-month period of education and prevention outreach activities to share safety and health information with employers, associations and workers. OSHA encourages employers to use this period to bring their facilities into compliance with federal safety and health standards, if they are not already.

 

“Workplace injuries, illnesses and deaths are preventable when employers train workers and provide a safe and healthy work environment. This region-wide emphasis program provides 90 days of outreach and education to assist employers in high-hazard industries to eliminate hazards that can cause worker injuries and illnesses,” said Marcia Drumm, regional administrator for OSHA. “The program will also re-direct OSHA’s resources and increase the probability of inspections at establishments in high-hazard industries with more than 10 employees and those that have not had a comprehensive inspection since 2011.”
OSHA prioritizes general industry inspections using the most recent BLS “Days Away, Restricted or Transferred” rates and its “Days Away From Work Injury and Illness” rates. Hazards related to lifting and other ergonomic stressors will also be evaluated.

 

The emphasis program focuses on manufacturing industries where injury and illness rates exceed the average for the private sector. Included are manufacturers of the following products: food, furniture, fabricated metal, nonmetallic mineral, machinery, and computer products as well as printing and related support activities.

 

This three-state emphasis program ends Sept. 30, 2016, unless extended. OSHA area offices will continue to open inspections in response to complaints, hospitalizations and fatalities.

 

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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WCRI Study Zeroes-in on Illinois Medical Services

A new study from the Workers Compensation Research Institute (WCRI) compares the workers comp fee schedule rates and Medicare rates for a variety of medical services in Illinois as of 2015.

 

The medical services covered in the report, Evaluation of the 2015 Fee Schedule Rates in Illinois, are professional medical services, hospital outpatient and ambulatory surgery center (ASC) facility services related to surgical procedures, and hospital inpatient services. The analysis focused on the common services delivered to injured workers within each category.

 

Additionally, to provide some context on where Illinois stands with respect to other states, the study compared the fee schedules in Illinois relative to Medicare (as of 2015) with fee schedule rates relative to Medicare in other states (as of 2011) for professional medical services. The study computed the workers’ compensation fee schedule rate as a percentage above or below the Medicare rate.

 

The following are among the study’s findings:

 

  • In 2015, the workers comp fee schedule rates for professional services in Illinois were on average 69 percent above the 2015 Medicare rates for the same set of services in the state.

 

  • As compared with July 2011, Illinois moved down in the interstate ranking for overall professional prices in 2015 but remained among the states with relatively higher workers comp fee schedule rates relative to Medicare.

 

  • The difference between workers comp fee schedule rates and Medicare rates varied tremendously across seven groups of professional services in Illinois, ranging from near Medicare for evaluation and management services to 339 percent above Medicare rates for major surgery.

 

  • In 2015, the Illinois fee schedule rates for the hospital outpatient facility services associated with common knee and shoulder surgeries were on average 157 percent and 110 percent higher than Medicare rates for similar knee and shoulder surgeries, respectively.

 

  • At the procedure level, the difference in workers comp fee schedule rates over Medicare rates for common surgeries performed at ASC settings varied substantially, from $2,368 to as much as $5,282.

 

In 2015, for hospital inpatient stays associated with common inpatient procedures, Illinois set fee schedule rates 54 percent to 119 percent above Medicare.

 

For more information about this study, or to purchase it, visit http://www.wcrinet.org/result/eval_2015_IL_FS_result.html.

 

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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Employee’s Role In Workers’ Comp Cost Containment

We tend to think of workers’ compensation cost containment programs as an endeavor best left to the employer. While the employer must design the program, the employee also has a role.

 

However, to be successful, employees must also participate in the program. The following components must be followed by employees for the cost containment program to work.

 

 

Know What to Do In Case of Injury

 

Employees must know exactly what to do if they are injured on the job. Keep employees informed of their step-by-step responsibilities through employee brochures, safety trainings and handbooks. Supervisors should reinforce these requirements through regular meetings and during safety plan trainings at the start of every new project. The “What to Do in Case of An Accident” brochure should be posted throughout the work site and sent to every employee annually. This post-injury response training is crucial to ensuring the best possible outcomes for the employee and the employer when an injury occurs.

 

 

Sign an Acknowledgement of Responsbilities

 

All employees should be required to sign an acknowledgment form of these responsibilities. This should be done during their new employee orientation when they are given their brochure and at every safety meeting.

 

 

Know Where to Seek Medical Care

 

The employees need to know where to seek medical care in case of an injury. They should be required to seek care from the employer’s medical provider or their own primary treating physician, if allowed by law. The name, address and phone number of the employer’s medical provider should be included in the brochure and safety plans. If employees are working offsite, the name of the nearest hospital or medical provider to the offsite location should be included in the safety plan.

 

 

Keep the Employer Informed and Updated of their Condition

 

The injured worker must let the employer know their medical status and any changes in their condition. This is especially important to determine if the injured employee can return to work in any capacity. On-going contact with the injured employee allows for discovery of any problems – such as not keeping medical appointments or difficulty with healing or medications prescribed – before they get out of hand.

 

 

Complete Forms

 

The injured employee must complete all forms required by the employer truthfully. Make sure that the employee gets the Work Ability Form completed at every doctor’s visit.

 

 

Attend Weekly Meetings

 

This keeps the employer informed of their condition and any obstacles to return to work full duty. At weekly meetings the employee and employer can determine and address any reasonable accommodations the employee needs and whether the employee can return at modified duty. It also keeps the employee connected to the workplace and coworkers. If they are physically unable to get to the work site, the employer should provide transportation or have meetings by phone. One alternate means of having weekly meetings is by using computer technology such as skype, which allows the participants to see each other over the internet.

 

 

Participate in Transitional Duty

 

This must be a condition of employment. The employee must return to work in either transitional duty or full duty as soon as medically able.

 

 

Attend All Medical and Rehabilitation Appointments

 

Obviously, the injured worker must get required medical care to improve, including physical therapy. Identifying any barriers to attending medical appointments can be addressed at the weekly meetings. The employee should provide the work ability form to the supervisor or claims coordinator after each doctor’s visit.

 

The employee should perform all other tasks as required by the employer and allowable by law such. Each state is different.

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Ohio BWC Reminds Workers That Comp Fraud Doesn’t Pay

Ohio Bureau of Workers Compensation (BWC) Administrator/CEO Steve Buehrer recently reported that four individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers compensation system in January 2016. These court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID).

 
The following are cases that resulted in guilty pleas or convictions during January:

 

Consuelo “Connie” Griffin and David Lusk (Cincinnati, Hamilton County) both pleaded guilty Jan. 14 in the Hamilton County Court of Common Pleas to counts of theft after they were discovered cashing BWC benefit checks for an injured worker who had died. SID opened an investigation after receiving an allegation from BWC’s claims department, which was unable to contact an injured worker receiving permanent total disability for a workplace injury. The claims department reported that worker’s phone was disconnected. The investigation found that while the injured worker passed away in June 2014, the BWC checks that were mailed to his home continued to be cashed. Griffin and Lusk lived in the same apartment complex as the deceased and when he was hospitalized, Griffin signed a power of attorney document giving her control over his finances. Griffin also had the injured worker’s mail forwarded to her address and the pair moved into his apartment when he was hospitalized. Griffin confessed to signing Harrell’s name on the checks and cashing them. Griffin also took money out of his bank account while he was ill and wrote checks from his account to herself for cash. His account was soon closed because Griffin and Lusk spent all the money and failed to pay any of his nursing home expenses. Lusk pleaded guilty to count of theft and one count of theft from the elderly, both fifth-degree felonies. Griffin also pleaded guilty to two counts of theft, both fifth-degree felonies. The court sentenced them to 10 months in jail, suspended, and ordered them to repay restitution of $5,072.62. They also received three years of probation.

 

Michelle Green (Columbus, Franklin County) pleaded guilty Jan. 13 in the Franklin County Court of Common Pleas to attempted workers compensation fraud, a first degree misdemeanor, for working while receiving benefits. SID’s Intelligence Unit received data from the Ohio Department of Job and Family Services (ODJFS) that indicated Green had received wages while receiving BWC benefits. The investigation confirmed Green was employed with Good Hands Home Health Care Service in Columbus. Evidence obtained during the course of the investigation also showed that she intentionally misrepresented and withheld her employment in order to continue collecting benefits. She was ordered to pay restitution in the amount of $1,899.99 and $100 in court costs.

 

Randy Gates, dba Gator’s Auto Repair and Towing (Caledonia, Marion County) pleaded no contest on Jan. 21 in the Marion Municipal Court to a second-degree misdemeanor count of failure to comply for operating his business without workers compensation insurance coverage. BWC’s Employer Fraud Team (EFT) identified that Gates continued to operate his business, Gator’s Auto Repair and Towing, without valid BWC coverage after two previous investigations for the same issue. He had been previously referred for prosecution in 2005 for failure to comply for operating a business without the required BWC coverage. The EFT attempted to work with this employer to become compliant with state law but Gates refused to submit completed outstanding payroll reports in an effort to calculate accurate premiums owed. The employer also failed to attempt to pay his balance with the BWC. On Jan. 21, 2016, Gates entered a plea of no contest to failure to comply, a second-degree misdemeanor. Gates received a 180-day jail sentence which was suspended, and was ordered to pay fines and court costs. Gates currently has an estimated balance due of approximately $36,000 and is working with the BWC to submit outstanding payroll reports for calculation of exact premium due.

 

To report suspected workers comp fraud, call 1-800-644-6292 or visit bwc.ohio.gov.

 

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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Reducing Future Medicals through Medicare Secondary Payer Automation

RitaWilson

Rita Wilson, CEO, Tower MSA

…on reducing future medicals through Medicare Secondary Payer Automation

 

Handling Section 111 reporting, conditional payments, physician peer reviews, and Medicare Set-Asides in separate technology silos leaves room for errors and delays.  Organizations can resolve these problems with a Medicare Secondary Payer solution that automatically and seamlessly connects all compliance, intervention, and MSA processes from the initial identification of a Medicare beneficiary all the way through closure and settlement.

 

An all-encompassing MSP Automation Suite should:

 

  • Capture, store, and manage all data points in a paperless environment
  • Easily integrate with any claims system
  • Enable clients’ business rules to be overlaid onto the vendor’s business processing rules
  • Prompt for missing data
  • Escalate medical and pharmacy issues when triggers occur
  • Initiate and seamlessly track pre-MSA interventions
  • Drive oversight until evidence of treatment changes has been confirmed
  • Provide end-to-end visibility into claims
  • Create an audit trail for each claim
  • Benchmark CMS trends to ensure compliance

 

Tower MSA’s sophisticated technology encompasses all of the above to ensure timely, complete and accurate reporting.  It enables Tower’s legal and clinical specialists to quickly and thoroughly analyze conditional payments and negotiate appropriate reimbursements.  The system even drives and tracks pre-MSA medical and pharmaceutical interventions, which can save hundreds of thousands dollars on a single claim.  Integrating all these processes into a single system ensures 100% MSP compliance, reduces MSA costs and expedites settlements.

————————————————————————————————-

Reducing Future Medicals through Medicare Secondary Payer Automation

 

Workers’ compensation claims continue to be driven by the “cost” of medical benefits.  This is especially the case when dealing with issues of Medicare Set-asides and future medicals in workers’ compensation claims.  This has resulted in many claim management teams to seek service providers who understand this concern and have innovative solutions to satisfy Medicare’s interests.  One such solution is a complete suite of services that cover the entire life of a claim.

 

 

Barriers to Effective Medicare Secondary Payer Compliance

 

Members of the claim management team need to track the movements of files submitted for Medicare Secondary Payer compliance matters.  This is based on the nature of the work being performed by a service provider and its time-sensitive nature.  Common complaints by claim handlers include:

 

  • Lack of creative solutions on the front-end of compliance to reduce the cost of a Medicare Set-aside allocation;

 

  • Inability to track files and determine the status of work being performed; and

 

  • Ineffective communication between the parties to implement cost-saving mechanisms.

 

 

Cost Savings Starts with MSA Triage

 

The concept of “triage” was developed in World War I as a means to better assess a wounded soldiers condition and direct appropriate medical care.  This concept was such a success that it has been applied successfully to other areas, including Medicare Secondary Payer compliance.  By using an effective case triage model, a Medicare Secondary Payer service provider is able to review a case and identify barriers that may delay settlement.  The net result is real savings to the claim management team through a better reserve system and efficiency in settlements.

 

 

Effective Medicare Secondary Payer Case Management

 

An effective Medicare Secondary Payer service provider will also implement strategies for cost savings beyond the initial in-take and triage phases.  These additional steps strive for efficiency via computer-based technologies that include assistance with the following matters:

 

  • Physician peer review;

 

  • Drug utilization review; and

 

  • Clinical oversight.

 

A fully automated process should make case specific recommendations for further intervention when reasonable and necessary.  These suggestions will result in the lowest defensible Medicare Set-aside allocation.  The use of these system processes will also keep the claim handler involved in the process and allow for greater transparency.  This includes the identification of missing data elements, conditional payment searches/resolution and medical/pharmaceutical interventions.

 

 

Other Benefits to Complete Medicare Secondary Payer Automation

 

Automation of Medicare Secondary Payer compliance services offer members of the claim management team a number of benefits.  From the onset of the claim, it provides the opportunity for the client to receive front-end services that reduce costs over the life of a workers’ compensation claim.  Other attributes include:

 

  • A holistic approach that ensures consistency in Medicare Secondary Payer compliance services;

 

  • Moves the claim forward through the final step of compliance, which is Section 111 Mandatory Insurer Reporting; and

 

  • Allows for 24/7, end-to-end visibility that keeps the workers’ compensation claims team engaged and updated during the entire compliance process.

 

 

 

Conclusions

 

Medicare Secondary Payer compliance services are moving beyond providing clients with an a la carte list of services.  More advanced service providers are able to offer solutions throughout the entire life of a claim.  This also allows members of the claim management team to be active in the claim and aware of what is taking place.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Two Workers at Kansas Facility Suffer Amputations, Another Burned

A leading supplier of frozen specialty foods is facing more than $172,000 in fines after two workers at its Salina, Kansas facility suffered amputations in separate incidents and a third suffered lacerations and burns.

 
The U.S. Department of Labor’s Occupational Safety and Health Administration cited Schwan’s Global Supply Chain Inc. for three repeated, four serious and one other-than-serious safety violations on Feb. 9. Agency inspectors found Schwan’s exposed workers to amputation and other serious hazards.

 

The company is a subsidiary of The Schwan Food Company, a multibillion-dollar private company that sells popular frozen food brands in North America, including Red Baron, Tony’s and Freschetta frozen pizza and Mrs. Smith’s desserts.

 

“Three women’s lives were dramatically altered because their employer failed to protect them from hazardous operating machinery parts,” said Judy Freeman, OSHA area director in Wichita. “Each year, thousands of workers like these suffer amputation and other injuries that are preventable when basic safety guards are in place and proper procedures are followed. Schwan’s needs to protect their workers, and they need to do it now.”

 

The inspections that resulted in the citations found:

 

  • Aug. 11, 2015: A 55-year-old worker was picking up pizza crumbs and crust that had collected around the oven when her work glove was caught in the unguarded conveyor chain and sprocket drive assembly. Surgeons had to amputate her right hand. She was unable to work for 55 days.

 

  • Sept. 30, 2015: A 49-year-old employee reached into the area of the conveyor to clear a jam of pizza pans. She sustained a laceration, fractures and burns to the palm of left hand. Investigators determined safety guards were not installed on operating parts between the top and bottom conveyors. The machine should have been prevented from operating while unjamming the pizza pans. She was unable to work for 46 days following the injury.

 

  • Oct. 23, 2015: A 55-year-old employee was walking under a conveyor in the “new bakery” area, when she reached up to get her balance. As she attempted to stand, her hand inadvertently contacted an unguarded chain and sprocket on the underneath side of a conveyor. As a result, the employee’s middle finger on her left hand was de-gloved and amputated.

 

During its inspections, the agency also found other safety hazards. These included workers with personal protective equipment that did not properly fit, storage of oxygen cylinders near highly combustible material, and had exit routes that did not meet height and width requirements.

 

The Schwan Food Company has over 13,000 employees with 1,300 of them at the Salina processing facility. Based in Minnesota, the company sells frozen foods through grocery stores, supermarkets and the food-service industry.

 

The company was provided with 15 business days from receipt of its citations and penalties to comply, request an informal conference with OSHA’s area director, or contest the findings before the independent Occupational Safety and Health Review Commission.

 

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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Winning Workers Comp Claim Outcomes With The Team Approach

Hello, Michael Stack here, Principal of Amaxx, Founder of COMPClub and co-author of Your Ultimate Guide to Mastering Workers’ Comp Costs. Some great news was released recently, actually the Work Comp Roundup was ranked number one in the best blogs contest that was put on by WorkersCompensation.com.

 

I was super-excited about that, I was obviously very happy to hear that news, and I wanted to really say thank you. I wanted to thank the Work Comp Roundup community, I know how many demands are on your time, I know how much information is thrown at you on a day-to-day basis so to take the time to read our materials, to subscribe to our newsletter and specifically those who nominated our blog in that contest, I very much appreciate that. I very much appreciate you and want to thank you for your participation.

 

 

Winning Outcomes With The Team Approach – Managing Claims

 

For my lesson today, I want to talk about this concept of winning outcomes with the team approach and how this really functions in two different capacities in the claim side and then also how I use this on the Work Comp Roundup blog itself. Let’s talk about the claim side and how this should work in your organization and how it works to create those winning outcomes in your claims and in your work comp management program.

 

 

The technique to use here, the technique to implement and leverage is called Claims Calls or it’s also called A Claims Roundtable. The idea here is that you’re bringing together the expertise knowledge and perspective of different individuals to work together towards a winning outcome and a common goal. Again, you are bringing together the expertise, the knowledge and the perspective of different individuals to work together towards a common goal of creating a winning outcome in your individual claims.

 

 

Meet Regularly

 

Here is how this looks. You’re going to want to meet regularly. On this team that’s meeting regularly, those different perspectives, that different expertise and those different knowledge, that includes your adjuster, that includes your risk manager or a representative from your employer certainly, that includes your TPA account and case managers, and you’re also going to want a medical advisor in order to bring that medical perspective to this team that’s working together, meeting regularly towards that winning outcome, that common goal, so you are going to want to meet regularly.

 

My recommendation is that this is done weekly and you are going to set a specific time, be that Tuesday at 10:00 a.m., Thursday at 3:00 p.m., whatever that time is that works for your team, but set that time and have it on your calendars. If you are meeting monthly, that should be at a specific time, maybe it’s the first Wednesday of each month at 11:00 a.m., whatever that time is, but have it on your calendar so there is that expectation that that meeting will occur.

 

 

Share Knowledge

 

Second thing is you are going to want to come to the table, those individuals that I reference are going to want to come to the table with the right attitude of sharing that knowledge, sharing that expertise and working together towards that winning outcome, that common goal. Finally, the agenda for each one of these calls, for each one of these claims that you’re discussing, and five to ten claims is a good place to start. Obviously the more claims that you can work on together, the better the outcomes for those claims, but five to ten is a great place to start. You are going to want to discuss the status of that individual claim, where the things currently stand now. You’re going to discuss the strategy for that claim, and then finally the action steps.

 

 

Discuss Status, Strategy, and Action Steps

 

You are going to want to discuss the status, the strategy and the action steps. Then for each action step, if you are meeting again the following week, you are going to discuss the status of those action steps and where things stand and continue to work towards pushing that claim forward towards that winning outcome. That team approach, gaining those perspectives will give you the best outcomes in your claims.

 

Now as I mentioned the Work Comp Roundup blog itself recently did have a winning outcome, and I want to let you know that I also leveraged this team approach in the creation of the content on the Work Comp Roundup itself. I want to recognize those individuals, those parts of mine who very willingly and openly share their expertise and share their knowledge to help in the creation of the content itself.

 

 

Winning Outcome With The Team Approach – Work Comp Roundup Blog

 

Those individuals include the senior leadership team at Broadspire: Danielle Lisenbey, the CEO; Chief Medical Officer, Dr. Jake Lazarovic; and Senior Vice President of Medical Management, Erica Fichter. From Ringler Associates, the Senior Vice President of National Marketing, Duke Wolpert; from Express Scripts President, Steven Webb; Senior Vice President, Joe McCullison, and really the rest of the Express Scripts team on the workers’ compensation side; from Tower MSA, Rita Wilson, who is their CEO; from MedSource National President, Tony Riccardi. Last but certainly not least, the Executive Vice President at Medcor, Curtis Smith.

 

As I mentioned those individuals have very openly and willingly shared their knowledge, shared their expertise and opened up the doors of their organizations to share their best practices. Thanks again for your participation and the Work Comp Roundup community. Remember your success in workers’ compensation is defined by your integrity, so be great.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

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