The cost of insurance fraud including workers compensation, automobile, and home owners insurance is estimated at 80 billion dollars a year. That is enough money to pay the salaries of every CEO of America’s 500 largest companies for the next 16 years!
Insurance fraud is often broken down into two types, intentional fraud and exaggeration fraud. Intentional fraud, also known as hard fraud, is where a person makes a deliberate attempt to fake an insurance claim for the purpose of defrauding the insurance company. For example, a hotel maid is in debt and decides to fake a back injury accident without any witnesses in a hotel room to receive a workers compensation settlement.
Exaggeration fraud, also known as soft fraud, occurs when there is a legitimate insurance claim, but the claimant decides to increase the size of the claim. For example, a construction worker falls off a scaffold and injuries his knee. The worker decides since he is going to be off work anyway to tell the doctor and adjuster he also injured his back. The worker has had back problems for years, but now has a chance to get it taken care of and paid for by the insurance company.
The people who commit workers compensation fraud often think they are just taking money from the “big insurance company”. They do not realize that the insurance company money is collected in the form of insurance premiums from the employers. For the insurance company to stay in business, the cost of insurance fraud is passed from the insurance company to the employers. The more employers have to pay for workers comp premiums, the higher the cost of the product or service the employer produces. The higher premiums force employers to reduce the number of jobs available and reduce the other benefits they provide to the employees.
Dishonest employees are not the only ones committing workers compensation insurance fraud. Employers who underreport the size of their payroll or the number of employees for the purpose of lowering their workers comp premiums are committing fraud. Employers who misclassify workers (for example high-rise window washers who are classified as janitors) are also committing fraud.
Workers compensation fraud is also committed by organized rings of lawyers, doctors, chiropractors, physical therapists and other medical providers. The workers compensation claims they are involved in can be either intentional fraud or exaggeration fraud. The medical treatment is either not provided or is inflated to increase the insurance billing. The amount of permanent partial disability from the injury is overstated for the sole purpose of defrauding the insurance company.
Recently in the insurance news there have been a lot of articles about the run-away cost in workers compensation of prescriptions drugs and narcotics in particular. Prescription fraud is a part of the problem. Employees fake injury claims, and have frequent visits to the doctor, (especially to pain management clinics) not only for the purpose of collecting the indemnity benefits, but also to obtain prescriptions for OxyContin, Vicodin and other narcotics they can sell on the black market. The diversion of narcotics, both for street resale and for recreational use is one of the fastest growing areas of insurance fraud.
Employers should be ever vigilant against the possibility of workers compensation claim fraud. The most common indicators of fraud include (WCxKit)
- Several prior claims
- Accidents without witnesses
- Accidents where the only witness is a friend
- Witness(es) heard but did not see the accident
- Poor attendance record prior to the injury
- Disciplinary action prior to the injury
- Problems with co-workers
- Performing a task that is normally not a part of the job
- In a work area that the employee does not work at
- Upcoming layoff
- Recent termination
- Missed promotion or transfer
- Passed over for a pay raise
- Monday morning accident
- New employee
- Resist light duty work
- Complaints of injury out of proportion to actual injury
- Nature and/or extent of injury is increased after it is originally reported
- It should be noted that none of these indicators is proof of fraud. However, with any of these indicators it is prudent to investigate the workers comp claim thoroughly.
There are steps the employer can take to reduce the cost of workers compensation fraud. The employer who has a strong safety program reduces the scenarios an employee can use to create a fraudulent workers comp claim. A strong and well known return to work program with a transition duty job for every injured employee reduces the financial incentive for workers comp fraud. Any suspected fraudulent claim should be discussed with the claims adjuster and special investigative unit. Any case of proven fraud should be prosecuted to the maximum to prevent copycat claims.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contactInfo@ReduceYourWorkersComp.com.
Employers who let the injured employees control their own medical care have higher workers compensation medical costs then the employers who are actively involved in the medical care of the injured workers. There are numerous techniques an employer can use to properly control and direct the medical care provided to injured employees.
The states are about even divided between states where employers select the medical provider(s) and the states where the employee chooses the medical provider. Some states even try to give both the employer and the employee a voice in the selection of the medical providers by the use of doctor panels. In the states that use a doctor panel, the employer selects a group of doctors, and the employee then selects a doctor from the employer’s group of doctors (panel).
The first action an employer should take is to identify the reputable, conservative doctors in their area. Both the nurse case management team and the defense counsel can provide you with valuable information on which doctors you can trust, and which doctor’s rely on referrals from plaintiff attorneys for their income. Start with having defense counsel provide you with a list of recommended emergency clinics, general practice doctors and orthopedics, then have the nurse case management team cull the list to remove any doctors that are difficult to get along with and/or keep the employees off longer than necessary. Defense counsel can also tell you if you are in one of the few states that allow absolutely no input by the employer in the selection of the medical provider.
There are additional important considerations in determining the doctor that should be considered. You want the doctor(s) to be and do the following.
- responsive to the employee’s medical needs
- spend the necessary time with the injured employees
- have flexibility in scheduling appointments for the employees
- review the job descriptions in order to provide light duty work as soon as feasible
- have a professional and pleasant manner
Post the list of preferred medical providers on the bulletin board for everyone to see. (Some states require a particular format or poster design for the posting of workers comp doctors; check the specific state requirements for formatting the list of medical providers). In the states where the employer has the right to designate the medical provider or is required to post a panel of doctors, the list should be titled “Required Medical Provider(s)”. In the states where the employee selects the medical provider the list should be title “Recommended Medical Providers”. Some networks have exceptional doctors noted, so if these doctors are available consider including them in the panel. [WCx]
Establish rapport and dialogue with the medical providers (they will be glad you do as it makes their jobs easier) before the injuries occur. The medical providers will remember you, as way too many employers have no interaction at all with them. The medical providers will understand that you care about the general welfare of the employees and you care about getting the employees back to work. When you show an interest in the employee’s medical care several positive things occur including.
- medical reports are provided to you timely
- you gain cooperation with the return-to-work program
- phone calls are returned
- any forms or documents you need completed get done
There are many other steps the employer should take to control and direct the medical care of injured workers. The new 2012 edition of Manage Workers Compensation Program, Reduced Costs 20-50% has an entire chapter on directing medical care. The book includes both Ten Considerations for Your Company Doctor and Eleven Reasons NOT to Select a Doctor. Please contact us for your copy.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact info@reduceyourworkerscomp.com
One of the most difficult aspects of being a risk manager, workers compensation coordinator or workers comp manager is finding adequate resources on the subject of workers compensation. With each state having their own unique way of doing things, finding specific information can be daunting. Of course you can Google any workers compensation subject and you will get a ton of information with some of it being useful or on point, but usually most of it does not apply.
Good sources of information on workers compensation are available. The U.S. Chamber of Commerce publishes annually an excellent guide called
Analysis of Workers Compensation Laws, which is packed with tables showing how each state applies the law in different categories. A new print version is published only once yearly which may be a drawback for some, and it's published in the middle of the year, so the 2011 is the most current version until about July.
Also, each state will have their own website for workers compensation with some being more user friendly than others. Many state specific websites will cite the law by chapter and paragraph, but unless you are an experienced lawyer, that does not do much good. [WCx]
Other great source of information online are found at
www.WorkersCompensation.com and their paid service
Workers Compensation Research which provides updated state information as well as fill-in flash forms. Many carriers and self-insured employers use these forms and research tools.
There are technical schools, both on-line and classroom settings, that offer workers compensation training, but these courses are usually geared toward people who need state specific training to pass the state examination for a workers compensation adjuster’s license. In a similar vein are the on-line webinars designed to teach you the basics in order to get the adjuster’s license or agent’s license. These schools do not address the primary need of business, workers compensation cost control.
If you do an internet search for workers compensation cost control, you will find various articles on safety, or efforts to sell you a workers comp insurance policy with an insurance carrier.
Recognizing the need for a multi-facet resource on workers’ compensation that employers can use to control their workers’ compensation cost, we created a detailed guidebook that is geared toward the needs of employers, Manage Your Workers Compensation Program, Reduce Costs 20-50%.
Our guidebook is focused on the information the employer needs to control workers compensation cost. It will show you how to plan and implement the workers compensation cost control strategy. There are in-depth chapters available.
- Working with adjusters or TPA
- Injury management best practices
- Communicating with employees
- Post-injury response
- Reporting claims
- Directing medical care
- Return to work programs
- Medical cost containment
- Other cost containment services
- Physical rehabilitation and physical therapy
- Pharmacy benefit management
- Fighting fraud
- Training staff to control workers comp
- Claim resolution and settlement
- Safety and loss control
If you are just starting a workers compensation management program or realizing the need to overhaul the existing program, our guidebook will assist in assessing company needs, designing and developing the program, training and implementing the program, and monitoring and managing the workers comp program.
Workers Compensation Management Program, Reduce Costs 20-50% places in one handy resource the information you need to control workers compensation cost. You could spend hundreds of hours researching on the internet and not find all the information we have compiled for you. We believe our guidebook is the best available. Please contact us to learn more about Manage Your Workers Compensation Program, Reduce Costs 20-50%.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
In NY workers comp, “return to work” measures (RTW) can achieve unprecedented savings – for the employer and the employee but only if the employer takes the initiative. Employer involvement is many times more effective than what a carrier, TPA, consultant, etc. can provide especially with restoring a worker to employment.
Recently in NY, new court decisions point to a recognition that a worker collecting wage loss benefits cannot lightly refuse a job offer without risking reduction of benefits. But the cases involve claims where the original employers made the offers. Those employers, of course, were in a far better position to know what offer would be within the capabilities of one of their employees. (WCxKit)
Many employers have ignored the advantages of proactive job offers. The reasons lie in the fact that any program will fail sometime, in someplace, for many reasons. But that is no reason to balk. What is not tried will ALWAYS fail. If the employer will not make the effort, who will?
This will be the opening of a series which will outline the steps for an employer-initiated return to work program. A series has to begin somewhere and the starting point must be to stress that the employer’s role is central and cannot be delegated. The employer alone has the knowledge of the person, the job, the requirements and the ability to make essential modifications often necessary for success.
Editor's Note: The next part of our Tips from Ted, will deal with pre-incident planning.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. medsearch7@optonline.net
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.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
Author Karen C. Yotis writes, “When a workers’ compensation maven of Rebecca Shafer’s caliber shares her expertise about implementing cost containment best practices, industry professionals can’t afford to do anything but listen.” She, of course, also continues to say, “risk managers, adjusters, vendors, attorneys, agents and brokers, carriers, and employers can’t afford to do anything but
click here to purchase the book, and start reading.”
We like her.
Yotis explains our book is a roadmap that has sharp teeth and notes that its author, Shafer, has more than 25 years of experience in the industry. “This is NOT an intellectual discussion about workers comp issues and trends, but rather a hands-on practicum written from years of field research with a host of companies.” Yotis writes.
She goes on to review and explain both parts of the manual, An Action-Oriented “How To” Template and Cost Containment from Soup to Nuts noting where updates from previous editions make this the one to buy.
To read her full review, follow the link
here. Or, just click on over
here and get your own copy!
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
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.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
Every adjuster who has been handling workers compensation for a while has heard a disgruntled employee say, “I am going to sue that doctor.” As Americans have some of the best medical care in the world, a lot of people expect their doctor to make their pain go away and their injury heal without any residual. Often that is not the case. Even the best doctor will not alleviate all medical conditions.
An employee’s failure to recover to pre-injury physical condition is not medical malpractice. For medical malpractice to exist, there must be some degree of professional negligence. Other than the physicians, there can be medical malpractice by hospitals, therapists, dentists, nurses, chiropractors, and other medical providers. (WCxKit)
Four qualifications to designate medical malpractice that could impact a workers compensation claim:
1. The doctor, hospital, or other medical provider is assigned to provide the medical care requested.
2. The doctor, hospital, or other medical provider has failed to provide the medical care at the same level of medical expertise that another medical provider in the same medical specialty would have provided.
3. Failure to provide the expected medical care resulted in an injury to the employee.
4. Failure to provide the medical care at the appropriate level resulted in damages (Note: if there are no financial damages the employee will be unable to find a lawyer to pursue the claim).
In those instances where a surgeon performs a laminectomy that fails, or the employee develops reflex sympathetic dystrophy or fibromyalgia, it does not mean there is medical malpractice. It usually means the employees physical condition was not sufficient to withstand the stress the surgical procedure caused his body.
However, in the rare cases when a medical provider gave inferior medical service, the employee is right to obtain an attorney to pursue a medical malpractice claim. Unfortunately, the attorney will usually talk the employee into allowing the attorney to also represent them in their workers' compensation claim.
When the attorney for the employee starts pursuing a medical malpractice claim in conjunction with the workers' compensation claim, it is absolutely essential that the adjuster and nurse case manager work closely with a utilization review specialist. The reason for this is to keep the medical care for the workers' compensation claim, and the cost associated with it, separate from the cost of the medical care needed to correct the alleged medical malpractice. The reason to do this is to document what can be recovered through subrogation. If the adjuster does not carefully document the additional cost due to the medical malpractice, the workers compensation insurer can get shut out of any financial recovery from the professional liability insurer when the medical malpractice claim is settled.
All states will compel the workers compensation insurer to pick up the cost of additional medical care needed due to a failed effort to medically treat an injury. The workers compensation board or industrial commission will not get involved in the question of medical malpractice.
Because damages an injured employee can recover from a medical malpractice will greatly exceed the potential recovery for the workers compensation claim, the attorney handling a medical malpractice claim will generally spend most of her time and attention on the medical malpractice claim. However, to maintain the value of the medical malpractice claim, the attorney will delay the settlement of the workers compensation claim for as long as possible. This has a negative impact on the workers compensation claim as the longer the claim stays open, the more it will cost. (WCxKit)
If you hear an employee threatening to sue the doctor over “medical malpractice,” suggest to the adjuster and to the employee the need for another doctor to evaluate the employee. When the second doctor evaluates the employee's medical condition, in 99 percent of the cases they will find the first doctor acted with appropriate medical care.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
No matter what season whether it is winter, spring, summer, or fall, it is some company's “busy” or peak season somewhere. Unfortunately for niche businesses, this peak time can also be a prime time for workers compensation injuries.
New staff is hired to meet the upcoming demands, and the company employees are working longer hours to meet the demand. The equipment begins to require more maintenance and repair during this “busy” period. It is imperative not to forget about workplace safety during this time. Here we discuss a few ways to curb the exposure to injuries.
1. Solid hiring practices
When demand is high for the work product, it is easy to forget focusing on important aspects of the business. The peak time of year means hiring new full time and part time employees. These employees may be referrals from other employees or simply walk in with little to no experience.
Evaluating the job candidates is critical. On average, first-year employees have a higher incidence of injuries than more experienced or tenured employees. This may sound obvious, but hiring practices are key in preventing workers compensation injuries. Workplace safety must be part of the screening process as well as physicals and drug screens prior to hiring. Monitor the potential employee’s attitude toward safety during the interview process and while touring the workplace. The way the employee behaves during this time could be a sign of carelessness that could lead to a workplace injury. (WCxKit) One company had 80% of injuries occuring to employees with less than one year's tenure.
2. Proper orientation and safety training
Safety comes first and the facility should maintain safety at all times of the year. Focusing on safety only during a peak time is ineffective and potentially hazardous. Protocol for repairs, maintenance, and inspections should happen consistently throughout the year.
Employees should be reminded about safe work practices and be trained in proper safety techniques. Emergency procedures, safe work practices, protective equipment are key to preventing injuries during the peak time and anytime of the year. Mock injury set ups can be educational and reveal how employees will respond in an emergency situation. Having a plan in place will help employees know how to respond properly and effectively should an injury occur.
3. Proactive and involved supervision
Supervising and enforcing safe work practices is a key component to reducing the risk of injuries. Every employee is responsible to work safely, even if it is not the easiest and fastest way. Managers and supervisors onsite should be aware of an employee's every move. Operational guidelines such as proper guards for saws and safety glasses are crucial. If a supervisor catches an employee working unsafely, the employee must be disciplined. Employees will only take safety seriously, if there are serious and automatic consequences.
The employee should be allowed to provide feedback keeping the lines of communication open. Employees are not prisoners, and employees most likely has ideas on how to change workstations to increase safety standards. Providing incentives like raffles for free gas cards is an easy option. A supervisor can implement a new safety technique and the results will travel to senior level management. By giving the employee a chance to weigh in, work safety techniques will be more successful overall.
4. Super fast accident response
As mentioned above, employees must understand what to do should an accident occur. If an employee using a saw cuts a hand and tells a supervisor about the accident, the supervisor will then tell the HR person and take the employee to receive medical care. The first report of injury is completed and called in to the insurance carrier. The employee returns to the shop bringing the medical slip to the HR person, who then faxes or emails the adjuster. Within 24 hours, the adjuster already has the injury report, statements from the supervisor and HR, and the medical slip. These items are crucial to a claim being handled properly after an accident.
This example may sound like workers compensation 101, but it is surprising how many employers do not stick to this process. Having a proper procedure in place following an injury prevents a delay. And any delay affects wage payments, medical coverage, and a return to work. Take time to have a step by step process and mock injuries, so that when an actual injury occurs, everyone knows exactly what to do. (WCxKit)
Summary
Peak work seasons elevate the exposure on many levels. With proper hiring practices, solid orientation, thorough training, proactive supervision, and fast accident response, and reporting everyone knows how to respond to an injury in the workplace. It sounds simple, but practice makes perfect. Do not wait until an injury happens to figure out how to handle it.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Peru – Medcor CEO Philip Seeger testing Medcor’s telemedicine software with an Imarsat/BGAN satellite system on the bank of the Elto Madre river in the Amazon jungle. Seeger and his team also tested their telemedicine system with Iridium sat phones.
Working in the creature-infested and disease-prone Amazon jungle is not all just fun and games – no indeed – someone might get hurt (just as they might at a less remote worksite).
And that is what companies such as Medcor are for.
Founded in 1984, Medcor operates more than 170 non-traditional clinics located on-site in client locations around the United States. Medcor’s staff, systems, and software in these clinics help employers control costs, improve outcomes, provide rapid access to medical care when necessary and avoid claims when they are not necessary. This means planning ahead, even when the worksite is very different from the typical office.
Privately held with 400 full-time and 400 part-time employees, Medcor does $54 million in business per year, and claims to save its clients several hundred million in workers compensation and general health care costs every year. In addition to its on-site clinics, the company provides telephonic injury triage to more than 80,000 triage worksites from a wide variety of industries across the US.
Although its core business is focused on providing on-site medical clinics to large worksites and providing injury triage to small worksites across the country, Medcor has a great deal of expertise in the fascinating field of wilderness medicine.
The company provides on-site medical services at Yellowstone National Park, supports a clinic at the base camp of Mount Everest, and has provides medical services to remote projects such as oil pipelines, windfarms, and highway construction. The company has provided medical support to government projects on Kwajalein and Midway Island in the pacific ocean. Medcor has also has served those affected by hurricanes Katrina and Rita, and provided on-site medical services at the World Trade Center after 9-11. Medcor is currently deployed helping the flood relief efforts in Minot, ND.
Currently, Medcor is working for the Zoological Society of San Diego. The society hired Medcor, to establish a wilderness medical program to support a research station in the jungle, at Cocha Chashu in the Amazon jungle of Peru. Zoo officials asked Medcor to help assess the medical needs and response options for people at the station as it is very remote, requiring four days travel from the U.S., the last two being by small boats 10 hours a day.
The zoo is assessing the risks to the participants — zoo employees or visitors — and planning to provide for the safety of everyone there. These goals include providing medical services to the program.
Executive Vice President Curtis Smith says there are many challenges to such a remote project.
First, he says, most medical providers are trained and experienced to work within a broader system. Here, there is a 911 system to call in emergencies, there are specialists to refer to or to consult with by phone. In the US, X-ray, lab, and other diagnostic tools are readily available, and well-stocked pharmacies exist nearby. If on-site clinic staff in the US rely on those off-site resources too much, they negate many of the benefits of resolving cases on site, avoiding unnecessary claims, and reducing costs, Smith says.
If they rely on those systems in remote locations, they are really in trouble, Smith says. Clinics operating in remote locations cannot rely on traditional off-site resources, forcing the on-site staff to be self-reliant. Those efficiencies help Medcor’s on-site clinics perform better back in the U.S.
13 common challenges to setting up a remote medical clinic include:
- Recognizing the hazards and limitations of the area.
- Determining a scope of care that minimizes risks and costs – then writing standards and protocols to match.
- Figuring out the logistics of getting there and back routinely, and during medical emergencies..
- Determining the equipment and supplies that are truly needed and what is extraneous.
- Developing practical reliable emergency plans based on the logistics, staff, and supplies that are available.
- Establishing the method, reliability, security, and cost of various communication methods.
- Selecting the right staff – not only in terms of medical skill and experience, but with the personality to get along with the client team at the remote site, and the character to function independently.
- Training the staff in advance of deployment so they are not learning the basics, such as equipment, software and procedures, on the job. The on-site staff will have to learn the specifics of each site once there, which will be tough enough.
- Handling turnover – in the event that the medical staff leaves, for whatever reason.
- Finding valuable and rewarding work for the medical staff to do when not treating patients so the staff stays engaged and motivated to remain on the project.
- Establishing clear goals with clients – often they, too, do not understand everything about the remote site.
- Language barriers between the employees and local medical providers, if not English speaking, need to be addressed.
Another common challenge to setting up remote clinics is being underbid by people who grossly under estimate the work involved and resources needed.
Each site and project can be very different from others. Long-term assignments are very difficult to staff because the medical personnel miss their families, friends, and “professional life,” Smith says. Short term assignments are difficult because they interrupt or prevent long term work elsewhere.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Here's What You Do When a Worker is Injured
Even companies with the strongest safety programs will have some workers comp claims. When an injury occurs, the immediate actions taken by the employee's supervisor or co-workers has an impact on the outcome of the claim. The employer must require a tight injury process, including:
1. Obtain immediate medical assistance for the employee – send the employee to designated doctor or medical facility if statute permits. Pre-screen medical providers and learn everything you can about your TPA or insurance company PPO (preferred provider network). Some PPO's have SUBSETS of providers with better outcomes. For example, the BOLD network is the expert network of one TPA, Broadspire, which has better outcomes. USE THESE SUBSETS IF POSSIBLE. Make sure "panel cards" are in vehicles or available in the workplace, and make sure the panel cards are updated.
2. Do not permit employee's with minor injuries or soft-tissue strains to wait to obtain medical assistance – most will end up going to the unapproved hospital emergency room or their own doctor. An excellent way to do this is to use a nurse triage service and have ALL injuries called into the service. The nurse triage will determine if medical care is needed and if so what type of care is needed. They will then identify a network emergency facility, medical clinic or individual provider and provide address, phone number and directions to the facility. This helps keep all employees in your network "loop" so you can maintain control.
3. While the employee is enroute to the treating physician, advise the treating physician of any temporary jobs you can offer during recovery (WCxKit) Some companies have video tape of each jobs. This is an excellent tool to educate the doctor of all positions at your company. In addition to this though, you should speak with the doctor and/or office manager so they know your employee is enroute. A supervisor can accompany the employee to the clinic, and should do so to aid the employee and drive him back to the facility.
4. Advise the treating physician of modifications you can make to the existing job to accommodate the work restrictions the physician gives the employee. The doctor should have visited your facility when your program is set up, or soon afterward, to become familiar with all regular positions and modified positions.
5. Have a goal of returning to work all employees within 1 to 3 days after the injury unless they are medically unable to perform any role for the employer. Offer the employee a transitional duty job immediately when he returns from the medical appointment. Instruct him to come to the facility after the medical appointment unless he is on bedrest or cannot drive.
Follow these simple steps to achieve effective injury management and a quick return to work of injured employees and lower work comp costs.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.
Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
©2010 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 need every edge in reducing their costs of workers compensation, given our stagnant economy. Medical billing and coding is perhaps an overlooked area of cost control. One tiny error can lead to a very big problem in a medical bill — i.e., kicking the bill back for re-processing thus delaying payment.
An employer can do one of two things: rely on an outside source,– billing departments of doctors, nurses, therapists, hospitals, etc.– to produce correct, timely medical invoicing with accurate coding and risk paying more, paying for the wrong procedure, or waiting longer for a work comp claim to close. However, an employer still need to provide oversight, will be one of many other clients, must be sure the staff understands workers comp issues – in other words, you’ll be bird-dogging. (WCxKit)
Another and better way is to have your own in-house staff whose job is to review and analyze all medical bills submitted by health care providers before they are approved for payment. Either hire or train a person to vet all medical bills. Training a current employee has the advantage having someone already familiar with the company’s workers comp procedures and works only for the employer.
Whether you hire or train, there is a high demand for workers who are medical billers and coder, a field described as “recession proof.” Look for a person with a:
Certification of Completion in Medical Billing and Coding
Someone with this certification comes ready to start work with these skills:
1. Knowledge of the universal alphanumeric medical coding system.
This is a system used in all areas of health care so there is little discrepancy or room for errors. Doctors and nurses uses these codes to know more about the patient's medical history and current afflictions, while insurance agencies use these codes to determine how much to pay their clients on their insurance claims.
2. Training in basic medical terminology to understand medical terms in the fields of biology, anatomy, physiology and pharmaceuticals.
3. Training in the latest billing technologies, every-changing in today’s healthcare climate.
4. Good organizational skills for implementing and maintaining filing systems.
5. Detailed oriented and very accurate. Remember, just one tiny error can delay a bill “forever” so to speak.
6. Basic computer skills in word processing and spreadsheets for record keeping. (WCxKit)
7. Good communications skills for dealing with healthcare personnel.
If you decide to train from within there are affordable and flexible one- or two-year MBA programs, many offered on line allowing an employee to continue in a current position.
Worker Comp Kit Blog thanks and welcomes
Jenna Devoss who helps run and maintain
MedicalBillingandCoding.org, for her insightful contributions. MedicalBillingandCoding.org is a reliable source for medical billing and coding training programs, careers and future job outlooks.
©2010 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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