An analytic study by Options and Choices, Inc. (OCI) found that over 4% of all workers’ compensation claims have a duplicate bill sent to a group health plan.
OCI conducted the analyses on a large employer from their proprietary Reference Database on duplicate workers’ compensation and healthcare payments. The purpose of the study was to determine how frequently and how much greater costs occur if and when providers are billing both workers’ compensation and healthcare providers for the same services, patient or claimant.
The results of the study were presented at a recent meeting of the Fraud Assessment Commission, under the California Department of Insurance Fraud Program. The study found the following:
1. 4.2% of ALL workers’ comp claims have a duplicate healthcare claim.
2. Over half of the duplicate claims filed received payment.
3. The employer paid over $1.2 million dollars in duplicate payments.
4. One-third of the duplicate claims filed were paid more than what was billed.
5. The employer paid over $100,000 in overpayments on duplicate claims
“There is an occurrence of duplicate billing on the exact same workers’ comp claim, same date of service, same ICD-9, same billing codes, same provider also billing to group health,” says Archie Anderson, president of OCI. “This was an aged claim analysis, meaning all the payments have been made. This particular employer was not even aware.”
The cause of duplication cannot be determined from the data, however the claim set is easily identified for follow up. (workersxzcompxzkit)
According to OCI, to prevent duplicate claims, an employer or organization must commit to integrating its workers’ comp and healthcare billing and claims data to identify where the duplicate billing and payments occur.
Author: Robert Elliott, J.D.
Reduce Your Workers Comp: www.ReduceYourWorkersComp.com/
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All state laws vary.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
New Louisiana Law Provides Cost Controls and Quality Medical CareThe American Insurance Association (AIA) applauds passage of Louisiana’s SB303 workers’ compensation medical treatment legislation designed to ensure the timely delivery of quality medical treatment to injured workers while controlling rising employer costs. Governor Bobby Jindal is expected to sign the legislation.
The legislation aims to achieve these goals by requiring medical treatments to adhere to a new treatment schedule and such treatments must be in accordance with the principles of evidence-based medicine (EBM).
“Adoption of SB303 will help injured workers receive high quality medical treatment when it’s most needed without bureaucratic delay,” said John Marlow, assistant vice president for AIA’s Southwest Region. “This legislation is a good first step in reforming Louisiana’s workers’ compensation system,” added Marlow. “SB303 represents a common-sense agreement between labor, employers and the medical community as to what’s best for Louisiana’s workers,” said Marlow.
The legislation requires the director of the Office of Workers’ Compensation Administration to establish a medical treatment schedule, in accordance with EBM principles, which the Administration must formally adopt by September 30, 2010.
The director will also be responsible for appointing a medical advisory committee, contract with a medical director in order to oversee the development and mandated bi-annual review of the treatment schedule. ”AIA will work with advisory committee members to ensure the new medical treatment schedule adheres to sound evidence-based medicine principles,” said Marlow.
“The committee can also take steps to reduce costs by applying Medicare fee schedules to reimbursements, requiring Medicaid rates be used for pharmaceutical reimbursements, and compelling the utilization of employers’ designated physicians and treatment networks,” added Marlow. (workersxzcompxzkit).
“Louisiana’s workers’ compensation system now has a significant opportunity to advance access to quality treatment while reducing employer costs,” Marlow concluded.
Author: Robert Elliott, J.D.
Visit Our Websites: ReduceYourWorkersComp and WorkersCompKit
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Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Even if emergency services are not required following an on-the-job injury, your company is not off the hook. You are still responsible for treating the employee fairly.
However, as always, procedures put in place before work-related injuries occur, aid supervisors in following and properly documenting the chain of events.
Seven Steps To Follow When Emergency Services Are Not Required
1. Direct the employee to preferred medical providers where statutorily permitted.
2. Work Ability Form (WAF) must accompany the employee.
3. The treating physician must sign and return WAF to the supervisor within 24 hours of treatment.
4. The employee also brings the Transitional Assignment Form (TAF) to the physician.
5. Physician must complete and sign TAF.
6. Employee must return TAF to supervisor within 24 hours of treatment.
7. The supervisor then faxes TAF to injury coordinator and works with injury coordinator to assign an appropriate transitional duty position to injured worker.
Author: Robert Elliott, J.D.
Click on these links to try it for yourself.
WC Calculator: www.ReduceYourWorkersComp.com/calculator.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Mayo Clinic to Provider Network Added to Provider Network
Heritage Summit HealthCare Inc. has added Mayo Clinic in Jacksonville, Florida to its provider network. The agreement with Heritage is Mayo Clinic’s first with a workers’ compensation-only provider network. Heritage is a subsidiary of Florida’s largest workers’ compensation provider, Summit Consulting Inc.
The Workers’ Compensation Specialty Care Program at Mayo Clinic is led by Robert Chapa, M.D., a leader in Florida’s workers’ compensation medical community. The program offers an integrated approach to medical care with patients having access to a multidisciplinary team of specialists trained to identify and treat even the most complicated work-related injuries.
In Florida, Heritage (contracting with some 4,500 doctors, hospitals, clinics and ancillary specialty services) operates on a managed-care arrangement for workers’ compensation meaning employers insured with Summit-managed carriers send their injured workers to medical doctors and facilities within the Heritage network. (workersxzcompxzkit) Heritage ensures quality care by accepting only medical providers and facilities after they pass an in-depth credentialing process.
Author: Robert Elliott, J.D.
New Links
Visit Our Websites: ReduceYourWorkersComp and WorkersCompKit
Try Our FREE Workers’ Comp Best Practices Quick Check
See Our: Workers Compensation ToolKit
View the Entire Blog: RYWC BLOG
More FREE tools to try: WC Calculator; TD Calculator; WC 101
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Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
As is well known, the keys to managing your workers' compensation costs are documentation and following procedures. Eight Important Steps for Managing an On-the-Job Injury
1. The supervisor makes the decision about obtaining medical care, such as on-the-spot first aid, when a subordinate is injured on the job.
2. Follow your location's procedures for notifying emergency services such as an ambulance.
3. Remain with the employee until medical professionals arrive and you are satisfied the employee is receiving adequate care.
4. Obtain the name of the contact person at the medical facility to contact about the employee's condition over the next few hours/days. In some companies, the president or owner will go to the hospital to see if the employee is OK.
5. Obtain the name and address of the medical facility treating the employee.
6. The supervisor must have ready and give the employee a copy of your company's Injury Instructions, Workers' Compensation Brochure, and Work Ability Form.
7. Supervisor also sends the Work Ability Form directly to the medical provider with instructions to complete and return to the supervisor within 24 hours of treatment. (workersxzcompxzkit) 8.
Supervisor faxes report package (Work Ability Form and Employee Report; Supervisor Report and Witness Report) to injury coordinator.
Author: Robert Elliott, J.D.
Click on these links to try it for yourself. WC Calculator: www.ReduceYourWorkersComp.com/calculator.php TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php WC 101: www.ReduceYourWorkersComp.com/workers_comp.php Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Without proper documentation a company is essentially asking for problems when a work-related injury occurs. Out-of-line workers’ compensation costs can be held in check by carefully recording every thing, step by step when an injury takes place: from the time the injury happens until the employee returns to work either in a transitional duty position or to full duty.
Seven Minimum Steps You Must Take
1. Document the incident in writing. Obtain information about the incident, the injury, and medical attention sought.
2. Complete these documents:
- Post Injury Interview
- Employee Report of Incident
- Witness Report Form
3. All witnesses and any persons who were nearby complete the Witness Report Form, even if they claim not to have witnessed the incident; the absence of witnesses is important also.
4. Documents are forwarded to the workers’ compensation manager.
5. Give the injury coordinator all necessary information report the claim.
6. Follow all protocol to identify and correction hazards connected with the injury. (Example: removing or repairing malfunctioning objects or equipment.) (workersxzcompxzkit)
7. Notify the injury coordinator when those steps are completed.
8. If you have a Medical Advisor who particpate in a “triage program” contact the Medical Advisor also.
Author: Robert Elliott, J.D.
Click on these links to try it for yourself.
WC Calculator: www.ReduceYourWorkersComp.com/calculator.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
It Isn’t “US” Against “THEM”
Look around. Are there horror stories of how employers, insurance companies and government agencies stick spokes into what should be a smooth-running workers’ compensation process? Oh yes!
Recently the city of Atlanta spent more than $171,000 over a five-year period fighting the claim of five gravely injured city workers – we are talking about one being brain damaged and the other four in wheelchairs. So, what’s the point? The workers have serious, life-altering injuries. Are they likely to return to their jobs? No. It would be better to settle the claims and move them onto permanent disability status thus giving them and their families peace of mind.
Every employer needs to ask: “What is the bottom-line GOAL in resolving injured employees workers’ compensation claims? Reducing the COST & LENGTH of claims and returning the employee to work. While it may be all about the money, it’s also very much about the employee.
Create a Positive, Effective Response When Employees Are Injured
Proactive Communication: Inform employees of the policies, programs and procedures expected of them in the event of a work-related injury.
Be interested in the injured worker’s concerns such as: Who will pay my medical bills? How long will I be out? Will I lose my job? How will I support my family; Do I have a workers’ comp claim? If I can’t do my regular job, is there another one for me?
Have a Plan
1. Know what to do when the injury occurs.
2. Make sure the worker receives prompt, adequate medical care.
3. Send a company representative with them to the medical facility.
4. Complete all relevant paperwork.
5. Arrange for personal items and car to be taken home.
6. Answer questions, be reassuring and convey interest in their well being.
Reactive Communication: Following the injury establish and maintain communications with the injured employee so s/he remains psychologically connected during recuperation and focuses on the final objective of returning to work as soon a medically able as a healthy, productive employee.
1. Remain in weekly telephone contact.
2. Send a get-well card.
3. Set-up weekly meetings at the workplace.
4. Make sure the injured worker keeps all medical appointments, even if you arrange transportation.
5. Arrange for a transitional duty assignment when the worker is medically able.
Employers with a plan can answer questions when they arise (and they will) and allow the parties to resolve them without resorting to lawsuits or other harsh methods. ( workersxzcompxzkit).
Engaging injured workers in an adversarial battle of wit and wills is a death knell to reducing costs and does nothing for the workplace environment, the employee’s attitude or the employer’s reputation. And, sends people running for their lawyers.
Author: Robert Elliott, J.D.
Click on these links to try it for yourself.
WC Calculator: www.ReduceYourWorkersComp.com/calculator.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Employers have a vested interest in assisting workers injured at work to promote their healing and return to work. One of these ways is by making sure they receive the workers' compensation due them in a timely manner, with a minimum of hassle. HR 2641 addresses this in terms of workers' compensation Medicare set asides and payments. A coalition of attorneys representing injured workers, employers, insurance carriers, defense attorneys, and other interested parties are applauding the introduction by House Representative John Tanner (D-TN) of HR 2641. HR 2641 is designed to resolve the serious delays and confusion in the review of workers' compensation Medicare set aside by the federal agency responsible for administration of Medicare, the Centers for Medicare and Medicaid Services (CMS). "The Medicare Secondary Payer and Workers' Compensation Settlement Act of 2009 will provide clear and consistent standards for CMS' administrative process," according to Douglas Holmes, president of Strategic Services on Unemployment and Workers' Compensation (UWC) and coordinator of the Coalition for Medicare Secondary Payer (MSP) Reform. According to Holmes, "CMS takes too long to review proposed set-asides, fails to provide consistent standards for determining amounts to be set aside, and provides no avenue for appeal of their determinations. The process results in injured workers not receiving funds, additional costs for states and workers' compensation payers, and additional liability for employers, insurance carriers, (italics added) and attorneys in contravention of the state workers' compensation exclusive remedy principle. A legislative solution to this problem is needed." Ed Romano, president of the Workers' Injury Law and Advocacy Group (WILG), the national association of attorneys representing injured workers in workers' compensation cases, noted that too often, injured workers bear the brunt of the delays caused by the current system and reforms are needed now. "This bill is about process improvement and fair treatment of all parties," Romano remarked. "We applaud Representative Tanner for taking on this issue. "In case after case we hear of delays in approval, uncertainty of the amount to be reimbursed by injured workers, and changes in amounts to be set-aside after settlements have been approved." Holmes believes the current MSP procedure does not allow for any recourse, noting, "There is no avenue to compel a timely decision or appeal a bad one. The legislation introduced by (workersxzcompxzkit) Representative Tanner corrects this situation and many other costly problems and delays, for the benefit of all parties involved – most importantly the injured workers." To view the entire bill, visit: http://www.govtrack.us/congress/billtext.xpd?bill=h111-2641. Click on these links to try it for yourself. WC Calculator: www.ReduceYourWorkersComp.com/calculator.php TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php WC 101: www.ReduceYourWorkersComp.com/workers_comp.php Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Before There is an Injury
Employees are the primary beneficiaries of an injury management program since the goal of injury management is to mitigate the fall-out from work-related injuries. By following a list of best practices, workers’ compensation incidents run smoothly and lead to a better work environment – both mentally and physically.
Three Steps to Provide and Require of All Employees
1. All employees receive in-service post-injury response training.
2. All employees sign an acknowledgment stating they have received post-injury response training.
3. Apply procedures to all injuries so every injured employee becomes familiar with the procedure, assuring every employee receives good quality medical care the moment an injury occurs.
After There is an Injury
By keeping the well-being of your employees in mind, there are employee expectations the company can maintain, despite a work-related injury.
Suggested Strategies Injured Workers to Follow
1. ALL injured employees participate in a weekly telephone conversation when out of work due to a work-related injury.
2. Injured employees must bring the Work Ability Form to their medical provider and check to ensure the form is completed and faxed back to the proper authority.
3. Injured employees must participate in the employer’s return-to-work transitional duty program.
4. Injured employees must participate in weekly in-person meetings at the facility when on transitional duty.
5. Employees must understand even if they are out of work, unless bed-ridden, they are expected to come to the facility for weekly meetings. (workersxzcompxzkit)
6. Although injured, employees still participate in all employee meetings and activities while on transitional duty or out of work unless prohibited by medical restrictions.
7. Employees must understand they are expected to return to work in transitional duty or full duty position as soon as medically able.
Author: Robert Elliott, J.D.
Click on these links to try it for yourself.
WC Calculator: www.ReduceYourWorkersComp.com/calculator.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Steps in a Well-Designed Plan The Maxco story concludes with these last three steps. In future blogs we will explore in more detail and depth some of the internal and externals tools, forms, and practices Maxco implemented to make their workers' compensation cost cutting effort so successful across all divisions. Safety Management No workers' compensation cost control program is complete without an effective loss control program and an in-plant safety program. While MaxCo has a good loss control program, it also realizes there will still be claims from time to time, and each division has to be prepared to properly manage these inevitable claims. MaxCo utilizes the services of its insurance broker's loss control subsidiary and has loss control inspections at every facility several times a year. Home office personnel follow up on these audits and spend time with the division personnel reviewing workers' compensation claims and safety procedures. Each division is encouraged to have an active safety committee, a workers' compensation coordinator, and an incentive program to reward safe performance. In some states, a safety committee and other safety loss control activities are mandatory. Performance Goals The results of MaxCo's program are measured in three ways: severity rate, return-to-work ratio and cost per employee, with goals as follows:
- The severity rates should be below 40-100, depending on the industry groups.
- Return-to-Work ratio: 70 percent to 90 percent of injured workers should return to work within 10 days after an accident.
- The cost per employee should be below $300.00 or half the industry average. Industry averages are based on 2009 RIMS Benchmarking Survey.
One of the most effective tools to use is a list ranking all of the divisions by how well they are doing on their workers' compensation costs compared to all other divisions. Know as a "Best to Worst" list, it's an effective tool because no division wants to have the worst record and it creates peer pressure to improve the rankings. (A sample of the "Best to Worst" list can be found on the website.) Workers' Compensation ‘Helpline" Of vital importance to the success of the program is the continued assistance and monitoring from the corporate office, know by MaxCo as its workers' compensation "Helpline." MaxCo reviews the insurance division's loss runs and claims reports on an ongoing basis and contacts each division periodically to discuss strategy for resolving each claim. MaxCo also is available to its divisions when they have questions about the claim strategy being using. MaxCo wants to ensure each division becomes familiar with using a variety of claim resolution strategies. There are many "roadblocks" which can occur in each claim, and each division needs to understand the process of how to eliminate these "roadblocks." Author: Robert Elliott, J.D. Sign up for the online newsletter at www.ReduceYourWorkersComp.com to become familiar with workers' compensation issues. Click on these links to try it for yourself. WC Calculator www.ReduceYourWorkersComp.com/calculator.php TD Calculator www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php WC 101 www.ReduceYourWorkersComp.com/workers_comp.php Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com �
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