What Is Medical Cost Containment?
We practice medical cost containment by looking for opportunities to reduce the number of treatments your injured employees receive or to reduce the cost of those treatments. Simply put an employer looks for ethical ways to save money by cutting medical costs. Many problems I experience between employers and TPAs and insurers is a direct result of the employer not knowing the services that are available. They don’t ask for them because they don’t know them.
What Kinds of Services Are Available to Help Reduce Costs?
1. Preferred Provider Organization (PPO): Physicians who are part of a large network of medical personnel. It may be possible to negotiate treatment fees if the level of participation you offer is significant.
Find out about networks — or subsets of doctors — that have better performance than others.
2. Third Party Administrator (TPA) find out if they have services to reduce medical costs. You may have to pay extra. The services they offer may or may not be tied to them and you should find out if cost and quality would be affected.
3. Telephonic Nurse Case Management: Nurses remotely manage workers’ comp cases to coordinate medical care and determine extent of disability. This is not a substitute for a claims adjuster.
4. Hospital, Medical, Review Services: Each reduces the medical and hospital provider bills to the fee schedule amount or to “usual and customary” (U&C) fees. (workersxzcompxzkit)
5. Utilization Reviews: Used late in the treatment cycle to determine whether a treatment was, in fact, necessary, or whether a requested procedure is indicated.
6. Nurse Triage and Senior Nurse Reviewer: Nurses that care part of the initial intake can reduce medical only and lost time claims, turning them into “self-care” claims.
7. Medical Advisors and Peer-to-Peer Doctors: These doctors help interpret medical records, speed IMEs, eliminate unnecessary IMEs and speak with other doctors to discuss return to work, treatment, and many other things.
Make sure to ask how these services are communicated to the workforce. Get samples of the materials! Ask the regional coordinator to visit your workplace to show and explain all of their services.
“REDUCING FRAUD” Podcast or Webcast
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By: Private investigator with 25 years experience.
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.
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