The easiest way to chase your injured employee to an attorney is to ignore the employee once an injury occurs. Of course the attorney who is interested in maximizing his income, builds-up the employee’s claim by whatever methods are available in the jurisdiction of the injury. The best way to prevent unnecessary attorney representation is through on-going contact with the injured employee.
The employee is human and like all humans craves attention, especially when hurt. In addition to being concerned about the injury, the injured employee is concerned about future employment, future income, ability to take care of the family.
The employee needs reassurance throughout the claim, not just when it is reported. Most companies do a fairly good job of reassuring the employee everything will be taken care of when the workers’ compensation claim is first reported. But, the first report of injury is not the only time the employer needs to be in contact with the employee.
On-going contact with an injured employee actually starts before the injury ever occurs. As apart of the new hire package, the employee should be told what to do in the case of a workers’ compensation injury. The new hire package specifies who the employee reports the work comp claim to, the importance of reporting the claim immediately, the medical treatment providers available (in those jurisdictions allowing the employer to select the medical provider) and the return-to-work program or modified duty program available to them. This sets the stage for active involvement by the employer with the employee throughout the recovery from the work comp injury.
During the initial report of the claim, the employer emphasizes the need for the employee to keep the employer informed about his/her medical treatment and work status. The employee then sees the employer cares about his/her well being, wants a return-to-work as soon as the injured worker is physically able and thus, is much more likely to return to work in a appropriate time frame than to malinger at home off work.
The employer’s work comp coordinator tracks the medical progress of the employee until he/she returns to work. When the employee is going to be off work for an extended period of time, the employer contacts the employee on a monthly basis to see what progress is being made and to confirm the employee’s job is available for return-to-work.
Following a report of the injury, the adjuster contacts the employee within 24 hours of the claim being reported to the adjuster’s office. During this initial contact with the employee, the adjuster obtains all pertinent details about the claim to complete the investigation. With proper people skills the adjuster builds rapport with the employee during this initial contact by taking an active interest in the claim and by obtaining all the information needed to move the claim forward.
The adjuster also advises the employee to call and report any change in the worker’s medical or work status. However, the adjuster does not rely on the employee to report everything happening on the work comp claim. The adjuster as part of a file action plan, in addition to regular contact with the medical provider, plans to contact the employee every 30 days (or less if the situation calls for it) to maintain rapport with the claimant and to ensure a timely forward movement of the work comp claim. (workersxzcompxzkit)
By maintaining on-going contact with the employee, the adjuster is established as the expert on the work comp claim and as the person who will assist the employee with all questions and concerns in regarding the work comp claim. The adjuster is established as the go-to person, creating a positive environment for processing the claim and gives the employee confidence the work injury is important to both the employer and the adjuster. With the confidence built by the adjuster through on-going contact, the likelihood of the employee feeling the need to hire an attorney is greatly diminished and the overall cost of the claim is more effectively controlled.
“FRAUD PREVENTION” PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Private investigator with 25 years experience.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Sometimes, it's not ONLY a workers' comp claim…it's other types of exposure as well. A California woman was arrested last week on suspicion of committing workers' compensation insurance fraud, financial elder abuse and grand theft according to California Insurance Commissioner Steve Poizner. She faces up to five years in prison if convicted on all five charges. It's alleged by a California Department of Insurance (CDI) investigation the woman submitted a false workers' comp claim to the State Compensation Insurance Fund (SCIF) saying she fell off a ladder while employed at a Santa Cruz apartment complex. The investigation alleges the woman faked her injury to obtain money. The woman has allegedly received more than $13,430 in total temporary disability payments and $6,912 for medical treatments. The CDI investigation also revealed that she allegedly portrayed herself as a relative of the apartment complex's owner to get rentals payments and deposits in her name. She allegedly collected $900 from three tenants, cashed the checks and used the money for her own personal use. It also is alleged that she used the name of the elderly owner to obtain utility services for her unit. (workersxzcompxzkit) "FRAUD PREVENTION" PODCAST download now: http://www.workerscompkit.com/gallagher/mp3 By: Private investigator with 25 years experience.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues. ©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Police officers and firefighters in New Brunswick, Canada soon won’t have to wait for compensation if they are injured on the job as officials amend rules.
According to The Canadian Press, the province’s Liberal government has announced an amendment to the Workers’ Compensation Act that would eliminate the current three-day waiting period. The change will apply to almost 500 active police officers and almost 5,000 full-time and volunteer firefighters in the province.
Labour Minister Donald Arseneault reports that unlike workers in other occupations, firefighters and police officers are exposed to high-risk situations every day. (workersxzcompxzkit)
Doug LeBlanc, president of the Atlantic Professional Firefighters Association, says the change is long overdue. According to LeBlanc, few people can afford to go three days without pay and firefighters often limp home and either work injured or call in sick.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
“FRAUD PREVENTION” PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Private investigator with 25 years experience.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Claim Liaisons working either for a broker or TPA play a vital role in the business of claims management. There are times issues require attention that’s simply beyond the scope or expertise of the TPA or a client’s resources and a Claim Liaison may be the ideal solution. The account executive often serves as a liaison.
Ways to Know if You Need a TPA Liaison. TPA Staff serve this role.
The old adage holds true that “the squeaky wheel gets the grease.” Don’t hesitate to bring your concerns to the table for attention. Understand your TPA’s structure and the roles of each person involved with your program and how each can help in strengthening overall results – and your bottom line.
1. If your workers’ compensation claims are spread among multiple jurisdictions, multiple claim offices and multiple adjusters within those offices, a TPA liaison will work to ensure cohesive handling.
2. If claim reviews are an integral part of your program, a TPA liaison can coordinate the reviews with each of the claim offices. Your liaison can participate in the reviews to address non-technical and/or procedural issues arising beyond the responsibility of claim professionals. The best written service instructions (SI) contain areas sometimes subject to interpretation and the liaison helps negotiate resolution or at least makes a recommendation to the TPA management staff.
3. If you require benchmarking or stewardship data or reports, a TPA liaison provides the requested information and even assistance in presenting this information.
4. The liaison helps the TPA staff understand your company’s culture and procedures.
5. If you simply feel your program doesn’t receive the attention necessary to perform at its best and working with the adjuster and management staff didn’t do the trick, a TPA liaison may be the answer. A liaison will provide assistance to you in diagnosing problem areas such as file closure ratios and drill down to the specific office causing the problem. Once you’ve established there is a problem with any area, the liaison can be asked to take responsibility for and work with the TPA’s management staff to put a plan into place to improve whatever problematic areas you’ve identified.
4 Ways to Know if Your Company Needs a Liaison. Brokers serve this role.
1. If total claim costs or the volume of open claims increased during a particular period an internal liaison experienced in claim handling and responsible to set the bar and oversee claims helps reign-in claim costs and regain control.
2. If your field staff responsible for reporting losses is uneducated or under-educated in the world of claims, an internal liaison provides the necessary training for them to know how, when and what to report and also how to appropriately follow up with the TPA.
3. If your company locations are charged back financially for claim costs and would like a better understanding of the process to enable them to assist in controlling claim costs, a liaison may be just the solution.
4. If you’re self-insured or have a large retention or deductible, an internal liaison serves as a strong steward of money spent by ensuring claims are handled well, that cost-savings programs are in place and your management staff is well informed. (workersxzcompxzkit)
Consider the value liaison brings and make a request of your TPA or broker to provide these additional service or hire your own to meet your program needs. The liaison will tighten your program and ultimately reduce claim costs.
Author Robert Elliott J.D. executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
“FRAUD PREVENTION” PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Private investigator with 25 years experience.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Australia‘s WorkCover New South Wales (NSW) has launched an initiative to assist businesses in the waste and recycling industry to improve occupational health and safety. Acting WorkCover CEO Rob Thomson said a 12-month partnership program between WorkCover NSW and the Waste Contractors and Recyclers Association of NSW, would involve more than 130 businesses across New South Wales.
“The partnership program will reach 90% of waste contractors and recycling businesses and will help them meet their workplace safety and workers compensation obligations,” Thomson said. In addition, the partnership will help build industry capability to develop cost-effective and productive safety, injury management and return to work practices to produce sustainable outcomes.
“During 2007-08 there were more than 778 claims reported to WorkCover across the Waste Collection and Disposal Services industry.
Executive Director of the Waste Contractors and Recyclers Association, Tony Khoury, said the agreement would maximize the potential for positive OHS outcomes for both employers and workers in the industry.
“The partnership agreement will help the Association build on its existing relationship with WorkCover and support industry stakeholders in reducing injuries and benchmarking safety,” Khoury said. “The Association is committed to working with WorkCover to improving productivity and safety performance throughout the industry,” he added.
Thomson said although safety rates are improving, 30,000 people are still seriously injured at work each year and more work needs to be done to reduce that number.
”WorkCover is committed to working in partnership with industry to achieve healthier work environments, reduce the incidence of injuries and improve workplace safety,” Thomson said. “Promoting a culture of safety across the waste and recycling industry will help create workplaces in NSW that are safer, more cost effective and more productive,” he said. (workersxzcompxzkit)
Further workplace safety information including a range of free guidance material is available from the website at www.workcover.nsw.gov.au.
Author Robert Elliott executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
“FRAUD PREVENTION” PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Private investigator with 25 years experience.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
A Procedure for Managing Pushback at the Organizational Level
Managing pushback from an organization level is about management dealing with pushback from a group of people resistant to participating in a company-wide workers’ comp management program.
Rule of Thumb: Do Not Assign Ownership to the Conflict, But Assign Ownership to Resolutions
A team approach is always best for dealing with pushback. When you are first approached by a group of disgruntled employees, gather and document their concerns and make sure they know ownership is not assigned to the problem, but to the remedy.
Tell them what they can expect in the future. There will probably be a series of meetings as part of ongoing conflict resolution. Explain there are some things within your control and other things not in your control. Tell them they can expect to receive an invitation to a series of meeting and to calendar these meetings as ‘we participate as a group in resolving our issues.”
The First Meeting
Send the invitation explaining it is a listening session where you attempt to capture concerns on a spreadsheet as a means of establishing and gaining consensus further down the road. Itemize issues by immediate solution, short/long-term solution and issues beyond your control. Tell them we are going to build consensus and resolution as meetings progress.
After the meeting, send a follow up email attaching the spreadsheet. Send an invitation to the next meeting. If you believe the meetings will be recurring, schedule them in advance so participants can plan to attend.
The Second Meeting
Tell invitees the second will be a confirmation and brainstorming session. Be honest with them. Reiterate how you’ve grouped concerns by immediate and short/long term and beyond your control. Using a projector put the matrix up on a screen to be seen by all members. Go through each concern, (immediate, long/short/term, and beyond your control) and confirm that these are the actual concerns.
Now elicit brainstorming ideas from members. You will be surprised at the ideas coming from the group. Type in solutions step-by-step, and as you do, begin to task members, assigning ownership of action items at this time. When they offer a suggestion, ask if they would be able to help with it. In this way, they become de facto involved with the workers’ comp initiative.
The Solution Matrix
Look for common threads among issues and remedial strategies. You may be able to sort by common threads, and group in this way. When possible group them, asking the group if this is acceptable. Matrix as you go along, so all members can see the working document.
End the meeting by reiterating tasks, and owners. Then follow up with the new matrix to accompany a reminder of the third meeting. If you can, put the matrix on a shared drive and send the location to participants. They can go in an update the matrix as new developments and solutions come to fruition.
The Third and Subsequent Meetings
By the third meeting, resolutions should be underway as evident on the matrix when you project it. Task owners will have gone in and posted the status, so now is a time of discussion of obstacles, and workarounds.
How to Criticize (Critique) Constructively
1. Allow employees to voice their concerns.
2. Listen carefully and repeat their concerns back to them.
3. Put concerns in writing word-for- word to emphasize they have been heard. Keep concerns neutral.
4. Meet consecutively to (a) capture additional concerns and reiterate; (b) confirm, find common threads to group; (c) task members with ownership of resolutions, and meet periodically until resolutions come to fruition.
5. Be very careful how you critique or criticize. Always lead with something positive, and couch your criticisms in a question, “Couldn’t we do something like this?,” giving an opportunity to answer you as an equal. Listen to what they say, and write it down, and try to find a place in the middle where you can come to an agreement.
6. Try to bring push back to a place where you both can ask, “What can we do to resolve this?” Again, it’s always a good idea to stay issue specific, and have participants write down their concerns and solutions to those concerns. If you all wish – keep them anonymous. Have participants throw them into a hat.
Heading off Pushback – a Proactive Approach
If you thinka bout it, by the time you are dealing with pushback, you are coming from a reactive stance. Wouldn’t it be nice to be proactive about pushback and head it off before it becomes an issue. Here is a way many large corporations are dealing with push back today:
Management has begun to build Employee Involvement team meetings into their annual performance measures. Before the kick off meeting, employees drop topics into a box in the cafeteria or department/units identify topics. You will find most suggestions come under the auspices of global concerns such as — cost reduction, safety, workers’ comp management, morale improvement, and everything else is a wild card topic.
Sponsor a half-day kick-off meeting for each department. Include coffee and donuts, and, if possible, have the meetings off site.. Have a table, easel, and chart paper and markers for each table.
Group employees into teams. The teams rotate, going from one table to another, suggesting solutions to the topics and the possibilities are written on charts stationed at each table.
By the end of the meeting, each team has brainstormed solutions for each topic. Then each topic and its possible solutions are matrixed to an Excel spreadsheet.
Invite employees to join involvement teams meeting or twice a month. At the first meeting, employees review all the solutions for their topic. Based on group response, some solutions are discarded and redundancies summarized.
Members take ownership of one or more of the solutions and research them. The matrix is kept on a shared drive where solution owners can input their research updates as they go along. (workersxzcompxzkit)
By the end of the year, many solutions are generated. Discarded solutions are those made as a team decision. No matter the reason, (solutions discarded due to cost or timing, or impossibility of implementation) it is a team decision.
Author Robert Elliott can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
“FRAUD PREVENTION” PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Private investigator with 25 years experience.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agents about workers’ comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Title II Genetics Information Nondiscrimination Act Prohibits Discrimination by Health Insurers, Employers
U.S. Equal Employment Opportunity Commission (EEOC) has assumed responsibility for enforcing Title II of the Genetic Information Nondiscrimination Act (GINA), the first legislative expansion of its jurisdiction since passage of the Americans with Disabilities Act (ADA) in 1990.
GINA, signed into law in May 2008, prohibits discrimination by health insurers and employers based on individuals’ genetic information. Genetic information includes the results of genetic tests to determine whether someone is at increased risk of acquiring a condition (such as some forms of breast cancer) in the future, as well as an individual’s family medical history.
“GINA affirms the principle central to all employment discrimination laws – that all people have the right to be judged according to their ability to do a job, not on stereotypical assumptions,” said Acting EEOC Chair Stuart Ishimaru. “No one should be denied a job or the right to be treated fairly in the workplace based on fears that he or she may develop some condition in the future.”
Specifically, the law prohibits the use of genetic information in making employment decisions, restricts the acquisition of genetic information by employers and others, imposes strict confidentiality requirements, and prohibits retaliation against individuals who oppose actions made unlawful by GINA or who participate in proceedings to vindicate rights under the law or aid others in doing so. The same remedies, including compensatory and punitive damages, are available under Title II of GINA as are available under Title VII of the Civil Rights Act and the ADA.
Acting Vice Chair Christine Griffin added, “Title II of GINA is an ideal complement to the ADA Amendments Act. With both laws now effective, American workers are protected if they experience discrimination because of their disability or because of impairments they may develop.” (workersxzcompxzkit)
On March 2, 2009, the EEOC published a Notice of Proposed Rulemaking to implement Title II with proposed regulations and received over 40 public comments in response. The final regulations implementing Title II are currently under review by the Office of Management and Budget and will be issued as soon as the review process is concluded.
Author Robert Elliott can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
“FRAUD PREVENTION” PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Private investigator with 25 years experience.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Audit your workers' compensation programs before you go to incentive programs, fraud control programs, third party administrators or managed care services.
By auditing your current program, the risk manager learns why workers' compensation costs are high and what is needed to correct the situation.
Don't look at workers' compensation as a small area. It's really saving your capital – your human capital resources.
Eight tips for conducting an audit:
1. Companies should know what their losses are, which divisions are accruing the most losses.
2. Review the loss data to see what's sticking out like a sore thumb.
3. Ask about "sore thumb" topics when conducting audit interviews. An interview is only one way of finding out information.
4. Review a few of the files or have the company doctor review a couple of the files before you begin.
5. Use focus groups.
6. Talk to employees, management and the insurance company.
7. Develop a brief questionnaire with open-ended questions. How do you feel about the company? Have they treated you fairly? Do they listen to what your needs are? Elicit that information in a more informal discussion group, either one-on-one or in a focus group.
8. The insurance company is a valuable source of information. Chances are they know very well what the morale is in the group because they work with the people who have tiled claims.
Some problems uncovered through the audit:
1. Companies don't know what the full range of options is. They'll buy an incentive program when they don't need an incentive program at all. First, you really need to understand why your problem is a problem and a big part of it is value systems in the workplace. (workersxzcompxzkit) I met with a company today paying over $500,000 in workers compensation premiums and a 1.6 Mod, that had no idea whether to ask their broker, their carrier or others (like myself) how to reduce their workers compensation cost. The problem, "they don't know what they don't know," so they can't ask for specific assistance. The broker and/or insurance company SHOULD recognize this and offer help, but often they do not.
2. A company with poor morale could turn up in an audit as people exaggerating the length of their claims. Here you may need a fraud control program, not an incentive program. In other words, you might need to use the stick instead of the carrot.
"FRAUD PREVENTION" PODCAST click here: http://www.workerscompkit.com/gallagher/mp3 By: Private investigator with 25 years experience.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues. ©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Workers' Compensation Board Members Approve 1.8% Reduction In 2010 Average Premium Rate Saskatchewan WCB chairperson David Eberle announced the 2010 average employer premium rate will fall from $1.66 to $1.63. This is the fourth decrease in five years and the WCB's second-lowest average premium since 2001 ($1.62). "This decrease reflects a seven-year Saskatchewan trend of fewer time loss injuries and a falling injury rate. As the Mission: Zero vision inspires greater safety and prevention efforts, more Saskatchewan workplaces become safe, healthy and injury-free. This is the best way to reduce the cost of workplace injury in our province," Eberle said. In the 2010 premium year, 88% of employers covered by workers' comp will benefit from lower or unchanged premium rates. Over 33,000 employers in 35 rate codes will pay lower rates ranging from 0.9% to 32.3%. The rates stay at 2009 levels for 2,200 employers. Weak injury prevention performance and higher projected compensation benefit costs in 13 rate codes will increase the premium rate for 4,700 employers. "Making workplaces safer is the key to lower premium costs and fewer lives disrupted by injury," WCB chief executive officer Peter Federko said. "By strengthening Saskatchewan's safety culture, more injuries are prevented and the number of zero injury workplaces grows. Over three quarters of WCB-registered employers are injury-free now and we want this number to multiply." Saskatchewan is one of three compensation boards in Canada to lower its 2010 average premium. As the only western province WCB to lower the average premium in 2008, 2009 and 2010, Saskatchewan's workers' comp premiums are competitive and affordable. Since 2004, the Saskatchewan WCB average premium has fallen 20.5% and remains the fourth-lowest in Canada. (workersxzcompxzkit) The decision to lower the average premium rate follows the WCB's annual premium consultation meetings with stakeholders held in October. Employers will receive notice of their 2010 premium rates in December. The rates take effect Jan. 1, 2010.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
"FRAUD PREVENTION" PODCAST click here: http://www.workerscompkit.com/gallagher/mp3 By: Private investigator with 25 years experience.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues. ©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
So, you’ve watched your prescription costs rise beyond the consumer price index and surpass other medical cost increases and realize a Pharmacy Benefit Management (PBM) component to your managed care program is the way to go.
Several questions to ask your broker or insurance company are: What percentage of medical costs are related to pharmacy costs. Ask for a report. Do a full evaluation of the program currently in place, if there is one. Determine if you are in a “mandatory” state where substitution of generics is mandatory. If not, you’ll ask the PBM how substitution is monitored.
Before choosing a vendor, do your homework and review several programs to compare services. Three important considerations are:
1. Program penetration and what the PBM will do to increase program usage. Your employees have to use the program for it to be effective. Most PBMs mail cards, some provide a letter or card to be handed to an employee at the time of injury designed to cover a first-fill up to a set dollar amount and others offer further personalized service to increase penetration.
2. Ease of use for the adjuster. The more automated the process, the better.
3. Advanced technology and what it can do for you all the way from seamless transactions to management reports. Online access to data with an agile system allowing you to dissect and analyze information will go a long way in helping manage pharmacy costs. You should have the ability to detect high cost claimants and prescribers, be confident employees are given the proper medication in accordance with your formulary and know non-compensable prescriptions will be refused. Be sure to have a conversation with your TPA to inquire about data interface.
4. Run a pilot program for 60-90 days to confirm there will be actual savings as promised in the sales presentation. Savings reports should be based on reductions below any applicable fee schedule and generics should replace brand name drugs whenever possible. Your PBM should produce benchmarking and industry comparisons as well, at your request.
Once you’ve selected a program, your TPA is on board and electronic interface is accomplished, work with the claim staff to be sure processes are in place to notify the PBM of claim denials, settlements or if prescriptions are no longer covered for whatever reason. Establishing a predetermined period the card can be used and allowing the adjuster to extend or limit that period is an effective management tool. Be sure to capture the first fill to maximize savings.
5. Prospective and retrospective components — your program should have both. An example of a prospective component is: formulary, prior authorization programs (clinical team makes recommendation to adjuster or medical advisor who approves). Examples of Retrospective components are: targeted medication review, intervention programs such as in network and out-of-network transactions, risk assessments, prescriber “alerts” about employee going to other doctors and obtaining multiple RX, screening for fraud and abuse and comprehensive medication reviews.
Using a PBM as part of your overall managed care program is an excellent tool to reduce pharmacy costs. Choose the best provider for you and encourage employee participation. Be sure to use the management reports to spot areas for further attention such as the high cost prescribers and monitor your savings! (workersxzcompxzkit)
Author Robert Elliott,executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
“FRAUD PREVENTION” PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Private investigator with 25 years experience.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in
Communication with Employees, Coordinating Medical Care, Litigation Management, Medical Cost Containment & Managed Care, Medical Issues |
