• Menu
  • Skip to main content
  • Skip to secondary navigation
  • Skip to primary sidebar
  • Skip to footer

Before Header

  • About
  • Search
  • Resources
  • Privacy
  • Contact
 

Amaxx Workers Comp Blog

Reduce Workers Compensation Costs By 20-50%

Header Right

  • Home
  • Books
    • Big Book
    • Mini Book
  • Training
    • WC Mastery Membership
    • Course Curriculum
    • Certified Master of Workers’ Compensation
    • Certified Master of WC – Best in Class
  • Coaching
    • CompElite Strategic Coaching for Employers
    • BrokerElite Coaching for WC Business Growth
  • Software
  • Blog
  • Advertising

Mobile Menu

  • Home
  • Books
    • Big Book
    • Mini Book
  • Training
    • WC Mastery Membership
    • Course Curriculum
    • Certified Master of Workers’ Compensation
    • Certified Master of WC – Best in Class
  • Coaching
    • CompElite Strategic Coaching for Employers
    • BrokerElite Coaching for WC Business Growth
  • Software
  • Blog
  • Advertising
  • About
  • Search
  • Resources
  • Privacy
  • Contact
You are here: Home / Medical Cost Containment / 4 Areas To Manage Workers’ Comp Medical Costs

4 Areas To Manage Workers’ Comp Medical Costs

July 19, 2023 By //  by Michael B. Stack Leave a Comment

Medical treatment has comprised the bulk of workers’ comp claim costs in recent years, and the trend seems to have no end in sight. Where indemnity used to be the main expense, medical now represents 60% or more.

There are various tools to help manage medical costs; medical bill review, utilization review, provider networks, nurse case management, nurse triage, Medicare Set-asides, and so on. While many of these tools can be effective, they might cost you more than they save. You need to look at your return on investment and ensure the medical management services you use are truly helping your organization save money on medical.

  1. The Doctors: Costs vs. Outcomes

Low-cost medical networks were all the rage in the workers’ comp system for a while. But in recent years, there’s been more and more evidence to show that going cheap on medical providers may come back to bite you.

The latest indication comes from a study in which a 63-year-old woman with low back pain was sent for MRIs at 10 facilities in the New York area to see what, if any, differences there would be. Sure enough, not a single diagnostic finding out of 49 distinct findings reported was identified by all 10. The woman’s actual diagnosis was stenosis; she was given physical therapy and education and is said to be doing just fine. But had one of the 10 interpretations of her MRI been used, she might have been sent for unnecessary surgery and/or drugs — big expenses with a poor outcome.

Click Link to Access Free PDF Download

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

The adage ‘you get what you pay for’ is as true of medical providers as it is for anything. Try to partner with area providers that A: understand the world of workers’ comp — and if there are none, start educating area physicians; and B: have low litigation rates and high return-to-work outcomes.

Likewise, for other medical providers, such as physical therapists. Look at the number of treatments, average cost, and outcomes.

Once you’ve identified the best providers, partner with them and direct injured workers to them where possible. In states where the employer cannot direct care, you can still provide information that lets the injured worker know who the top providers are.

  1. Pharmacy Benefit Managers

Pharmacy benefit managers with good track records can be invaluable to a workers’ comp program. But again, you need to make sure you’re getting one that adds value to your company.

Where PBMs initially added value through lower prices, many have implemented clinical management programs to lower costs further and improve outcomes. It’s important to look at a PBM’s overall program to make sure you’re getting the best for your money.

Consider such things as pharmacy charges vs. pharmacy costs; the percentage reductions below the state’s fee schedule; the PBM penetration rate; cost per script; the percentage of medications dispensed by pharmacies vs. physicians; and the first fill rate.

  1. Involvement of Nurses

Nurses can be brought in to help with a claim — nurse case managers; or they can be the initial source to help determine medical treatment — nurse triage.

NCMs are the point person for the injured worker and medical providers. Those who do it in-office are telephonic case managers, whereas those who go out of the office are field case managers. Evaluating the effectiveness of NCMs is easiest with a large database, to compare things like the cost of claims and number of lost workdays with and without a NCM. Your insurer and/or third-party administrator may be able to help.

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

To find the value of nurse case triage, you can look at the number of calls divided by the number of claims actually reported for workers’ comp, to get the number of claims avoided by percentage. It’s also important to look at the training and experience of the nurses involved. One thing to be aware of is how invested the triage nurse is involved in the claim. Triaging is at the initial stage of the claim, not manage the claim — which is the job of the NCM, if there is one.

  1. Bill Review

Medical Bill Review fees can be hidden and pricey, so it’s important to look for transparency from the claims administrator. There are many claim service providers now that have modified their BR fee structures so the costs are more obvious. Ideally you want a lower administrative cost for BR, combined with maximized savings.

You can find the net savings of your BR service by taking the gross savings (total charges minus total paid) and subtracting the BR service fees. Additional things you can measure to ensure you’re getting value are the percentage of net savings, the turnaround time, and the denied bill rate.

Conclusion

Price alone should not be the deciding factor for medical management tools; a holistic view of your services is best. However, you also want to ensure you aren’t shelling out more money than you are saving. Whether you are evaluating your current tools or looking for new ones, just ensure they lead to improved outcomes and lower costs to get the best from your investment.

Michael Stack, CEO of Amaxx LLC, is an expert workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

©2023 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

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

Filed Under: Medical Cost Containment

Related Articles

Evidence-Based Medicine (EBM) in Workers’ Comp: A Case Study on Partial Rotator Cuff Tear

Evidence-Based Medicine (EBM) in Workers’ Comp: A Case Study on Partial Rotator Cuff Tear

What is Evidence-Based Medicine in Workers’ Compensation

What is Evidence-Based Medicine in Workers’ Compensation

The Role of Evidence-Based Medicine in Transforming Workers’ Compensation

The Role of Evidence-Based Medicine in Transforming Workers’ Compensation

Part 2 of 2: When Not to Use Nurse Case Management in Workers’ Compensation

Part 2 of 2: When Not to Use Nurse Case Management in Workers’ Compensation

Part 1 of 2: Understanding Nurse Case Management and When to Use It

Part 1 of 2: Understanding Nurse Case Management and When to Use It

What’s Your Why? A Collective Portrait of Purpose and Compassion at National Comp 2024

What’s Your Why? A Collective Portrait of Purpose and Compassion at National Comp 2024

Physical Therapy, Occupational Therapy, and Vocational Rehab in Workers’ Compensation

Physical Therapy, Occupational Therapy, and Vocational Rehab in Workers’ Compensation

Hear from Injured Workers and Join Paradigm in Supporting Passion, Purpose, and Kids’ Chance at National Comp

Hear from Injured Workers and Join Paradigm in Supporting Passion, Purpose, and Kids’ Chance at National Comp

Eleven Considerations for Selecting Your Workers’ Comp Company Doctor

Eleven Considerations for Selecting Your Workers’ Comp Company Doctor

Tools & Tips to Manage Chronic Pain in Work Comp Claims

Tools & Tips to Manage Chronic Pain in Work Comp Claims

6 Ways to Get the Most From Medical Treatment Guidelines

6 Ways to Get the Most From Medical Treatment Guidelines
Controlling Work Comp Transportation Expense Is More Than Ordering an Uber

Controlling Work Comp Transportation Expense Is More Than Ordering an Uber

Controlling Work Comp Transportation Expense Is More Than Ordering an Uber

Train to Succeed

BECOME CERTIFIED IN WORKERS’ COMPENSATION

Proven Course Catalog & WC Toolbox Give You The Power To Achieve Lower Costs and Better Injured Worker Outcomes

VISIT WORKERS' COMP TRAINING CENTER

Free Download

The 6-Step Process To Determine Workers' Comp Injury Causation - FREE Download Click Here Now!

Previous Post: « 3 Steps to Discover the Root Cause of Work Injury
Next Post: Use Claim Investigation Tools To Uncover The Truth »

Reader Interactions

Leave a Reply

Your email address will not be published. Required fields are marked *

Primary Sidebar

FREE DOWNLOAD

The 6-Step Process To Determine Workers' Comp Injury Causation - FREE Download Click Here Now!

Our Sponsors

Catastrophic and Risk Solutions, Case Management Solutions, and Specialty Networks
 

Injury Management Solution for Employers

Blog Categories

Search Our Archive

Subscribe to Our FREE Newsletter

Return-to-Work Essentials

Footer

Search Our Archive

Search our continually growing archive of over 5,000 articles about Workers' Comp issues.

Quiclinks

  • Calculators
  • Terms & Abbreviations
  • Glossary of WC Premium Terms
  • WC Resources
  • Best Practices
  • Industries
  • Return-to-Work Essentials

RSS Recent Blog Posts

  • Resume Lies, Fake References, and Hidden Risks: How to Spot Red Flags Before You Hire
  • How to Stop Duplicating Efforts: Coordinating OSHA and Workers’ Comp Data
  • From Data to Prevention: How Injury Tracking Can Reduce Future Claims
SUBSCRIBE TO OUR FEE NEWSLETTER
Let Us Help You Stomp Down the High Cost of Workers' Comp!
Top of Page ↑
  • Home
  • Training Center
  • Search
  • Membership
  • Products
  • Blog
  • About
  • Contact
  • Subscribe
  • Login
Copyright © 2025 Amaxx, LLC. All Rights Reserved. · Privacy Policy / Legal Notice