Workers Compensation Medical Bill Review

Health Strategy Associates  (HSA) www.healthstrategyassoc.com has unveiled its First Annual Survey of Workers' Compensation Bill Review. Principal Joseph Paduda  conducted the survey, soliciting opinions about the role of bill review (BR) in workers' compensation from a variety of payers. The survey explored pricing, vendors, internal-versus-outsourced BR processing and other aspects of the industry determining reimbursement for $30 billion in workers' compensation medical care each year. The 24 respondents  were executives at 23 workers' compensation payers, including insurance carriers, third-party administrators, large employers, state funds and managed care firms. According to Paduda,  a pair of overarching issues emerged from the survey: a lack of electronic integration and a sense the industry is generally mediocre. Overall, respondents  indicated the industry centers more on processing speed and throughput than on effective medical management and is more reactive than innovative. However, they also noted there have been several vendor acquisitions, mergers and management changes that could improve BR performance. According to the survey,  one of the most troubling issues for payers is the lack of connectivity between BR and medical management. "As difficult as it  is to believe," Paduda said, "very few BR systems are fully and seamlessly connected with medical management systems and processes, such as utilization review, pre-certification, case management, or networks." Among other things,  this means many non-approved medical treatments are performed and reimbursed simply because the system cannot link the determination to the bill, provider or claimant. "Compensation payers spend hundreds of millions of dollars a year on medical management and a significant portion of that money may be wasted due to a lack of effective electronic integration," Paduda noted. This, too, may  be changing. Several vendors and at least one third party have developed technological solutions addressing the issue: a sophisticated business rules engine greatly streamlining processes, increasing the number of bills automatically adjudicated and enforces "best practices." As connectivity improves,  Paduda believes  bill review will become more sophisticated and viewed by payers as less as of a commodity and more of a strategy tool. (workersxzcompxzkit). HSA is currently conducting its Sixth Annual Survey of Prescription Drug Management in Workers' Compensation and will conduct a survey of provider networks later this year. 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@WorkersCompKit.com