Nine Questions to Ask When Coordinating Managed Care Providers

Coordinated medical care refers injured employees to specific physicians, integrating the protocols and goals of the overall workers compensation management program and coordinates with health insurance, i.e., managed care.

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“The 6-Step Process To Determine Workers’ Comp Injury Causation”

It means planning before an injury happens and educating your employees about proper procedures.(WCxKit)

Managed care, if set up properly, reduces medical and indemnity costs, fine tunes medical treatment, creates a care-plan, sets a return-to-work date and requires periodic re-evaluation between the physician and case manager.

Having a WC coordinator to post checklists and host employee meetings can go a long way to steering your injured employees and on-duty managers to the right physician.

Finding the right managed care vendor is another matter. In addition to PPO providers, consider onsite occupational clinics. Yes, set your own clinic, really. I’ve worked airlines, state parks and other large organizations, including hospitals that have onsite clinics. It offers convenience and quality control.

Questions for the Managed Care Vendor

1. Does the managed care vendor have enough providers in its network to deliver prompt service and provide adequate geographic coverage?

2. What mechanisms are in place for provider evaluation and other issues related to quality of care?

3. How does the managed care program integrate with the claims administrator?

4. Are providers willing to visit the facilities and learn about the employers’ corporate culture and needs?

5. Do network doctors appear to be caring and concerned, or rushed and rude?

6. Are providers return- to-work oriented? Do they provide transitional duty job restricitons so the employee on the FIRST VISIT so employers can quickly place the injured employee is an open position, e.g. in a job pool for instance.

7. Does the provider have less litigation than others?

8. Do medical costs from this provider compare to other providers — remember you don’t always want lower costs per visit, you want employees to return to health and productivity sooner, and sometimes that may cost MORE per visit, but cost less overall.

9. What are OVERALL costs of employees treated by this provider — in outcome based provider subsets, cost of the overall claims are lower because employees return to work more quickly and need medical care less often.

FREE DOWNLOAD: “The 6-Step Process To Determine Workers’ Comp Injury Causation”

When your company forms a partnership with the right insurance company or claims administrator, they will appoint a dedicated adjuster who understands investigation.

Look to allow a 24-hour turn around time in response to injury reports. Also, be sure your managed care vendor gives the employer the retaining right to choose legal counsel, settlement authority, second injury and subrogation.

Your company must maintain control at all levels of workers compensation to be sure your costs do not escalate. There are many steps in the process that could serve as money sieves.

Fraud, other money sponge, can also be prevented and detected when all parties involved in workers compensation — supervisors, managers, claim adjusters and medical providers, work as a team.

Surveillance by qualified investigators is used to verify the extent of the disability, establish the ability of the employee to do transitional duty work and determine if the worker is working elsewhere may be necessary in some cases.(WCxKit)

Knowing when to implement this type of fraud investigation means planning for it ahead of time and being aware of all legal ramifications of investigative work.

Five questions to ask when coordinating your medical care and other tips to save your workers compensation department money #WorkersComp.

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 or 860-553-6604.

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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.

FREE DOWNLOAD: “The 6-Step Process To Determine Workers’ Comp Injury Causation”