Rising Healthcare Costs and How Medical Bill Review Can Save Employers Money

Rising healthcare costs are a key problem in workers compensation. Medical costs have increased 21 percent from 2004 to 2009, according to the Bureau of Labor Statistics. Media sources cite medical increases for injured workers rising as much as 50 percent in the same time period. A Medical Bill Review (MBR) program can help reduce unwarranted charges associated with workers compensation, general, and auto liability.

When hiring an outside medical review service consider these 3 points:

1. Vigilant medical bill reviews.

2. Comprehensive network and pharmacy programs.

3. Industry-leading medical bill savings.

A company needs a medical management team that fuses expertise, advanced technology, a customized-rules engine, and proprietary reimbursement methodologies to reduce costs far beyond basic state-mandated reductions. Recently, one such team saved their clients over 44.8 percent above network discounts for a total savings of 61.7 percent.(WCxKit)

A medical management team consists of experienced registered nurses and physicians who use knowledge to conduct comprehensive reviews. Every bill is scanned and digitized giving the ability to track the process in a paperless file. Bills are then reviewed to unbundle charges, for duplicate charges, and can be compared to the claim and medical chart to make sure treatments are appropriate for the injury.

Provide your employees with the best in network services by looking for a provider who has these 4 qualities and abilities:

1. A revolutionary, state-stratified, multi-tiered approach to networks.

2. Contracts with regional networks that also offer occupational and non-occupational providers in each state to meet employees’ needs.

3. Instead of the one-blanket approach, look for contracts with primary, secondary, and medical price indices — even sometimes third or tertiary networks to gain breadth and quality.

4. Uses ancillary networks to create customized clinical protocols and savings for cost drivers including: home health, durable medical equipment, physical therapy, diagnostic imaging, and more.

Wouldn’t any company like to be the employer who achieved a 73.4 percent penetration rate with savings well above the national average because they employed such a service?

2 Types of Reviews:

Specialty Bill Review: another important part of a superior program, delivers savings beyond state-mandated fee schedule or usual and customary reimbursements. Reviews done by a registered nurse and certified coders, confirms charges and itemized bills are consistent with the medical record. All treatments are supportive of the diagnosis and documented.

A Specialty Bill Review also includes a detailed review of itemized bills validating all charges and implant reviews, and examines all items to help ensures the implantable meets regulations, definitions, and the operative report correlates with invoices.(WCxKit)

When a provider is outside the network, be prepared to have several ways to continue to negotiate with them. Use multiple reimbursement databases, to reference the established price for a treatment in the particular geographic area. Providers may also be contacted for additional individual negotiations.

Workers compensation medical costs are predicted to reach 70 percent of total costs by 2016. Employers MUST act NOW to reduce all costs as efficiently as possible.

Contributor: Broadspireproviding workers compensation third-party administrative services. For more information, contact Broadspire by calling 1-866-625-1662 or emailing us at [email protected]; www.choosebroadspire.

WC IQ TEST: http://www.workerscompkit.com/intro/

WORK COMP CALCULATOR: http://www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR: http://www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP: http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
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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.