How to Gather All Information Necessary for High Quality Claims Management

 

System Creates Repeatable, High Quality Results
A significant improvement in the world of claims management over the years is the implementation of an electronic system for entering and managing claims.  Used by employees of the Carrier/TPA, this is an automated system that assigns risk if certain conditions are present.  These systems allow the claims professional to gather more information in less time, follow up appropriately on responses to high-gain questions, and evaluate the information systematically. 

System Guides the Questions So Nothing is Missed
The person receiving the claim for the Carrier/TPA will have questions that need to be answered.  If the answers are positive for certain criteria, the system will assign the claim a risk number within certain values from the software. The higher the score, the more risk is assigned to the claim. The system will be used initially for 3-point contacts to the injured worker, the employer, and the medical provider.  Positive responses to certain criteria will pop up other questions to ask which ensures the adjuster does not forget anything that can be crucial to the claim.

When the claim arrives at the desk of the adjuster, they already have some risk areas highlighted that can negatively impact the claim.  This streamlines investigation and saves costs as the sooner a problem area can be addressed, the better.   

Adjusters are all under a heavy workload. Claims are in various stages of their lifespan, and some claims will get more attention than others.  This program presents a way for new claims to get the needed attention they require as early as possible.  Like any system, it also takes out a portion of the human factor.  After a while adjusters can get stuck in a rut and a question could be missed or skipped by accident.  The answer to that question could have a huge impact on the outcome of the claim.  This system can prevent those misses, which helps everyone in the end.  In no way does the system replace the need for a qualified adjuster, it does however, make every adjuster better.

Adjusters Can Receive Bonus for Following Best Practices

Bonus incentive can be another positive with the use of this program. Carriers/TPAs often use a bonus system to reward adjusters, and these bonuses revolve around timeliness of their contacts, resolution of their claims, and overall reserve savings by proactive claims handling.  A system that helps the adjuster hone in on what gets them salary bonuses is a nice incentive to ensure they are motivated to follow best practices.


Makes Process Efficient

Claims can also be classified based on their system score.  Medical only claims or minor lost time claims can be routed to the appropriate adjuster, instead of going initially to a senior level adjuster, only to be passed back to the medical only adjuster after contacts have been made.  Many Carrier/TPAs will assign the claim based on what information is listed in the injury report.  This process can be inefficient if the injury report was completed in error.  Time and money can be saved when each adjuster is making the highest and best use of their day.


Outside Vendor Usage Identified Right Away

Outside vendor usage can also be identified right away.  If the system has certain positives, it can trigger assignment to a field nurse case manager right away, instead of weeks after the claim process has begun.  This is another proactive benefit as the earlier a claim can be assigned to a vendor for help the better.  The outside case manager can get involved in the claim at the outset, instead of a month later.  This can equate to large cost savings as this month can include crucial moves within the claim, preventing missed work when a return to work could have been possible.  Another example is when the injured worker needs a medical referral to a specialist. Instead of waiting for the paperwork the case manager can get it at the appointment and send it to the adjuster the same day, instead of when the actual medical reports come in with the bill weeks later.


Summary

Several technological advancements are going on within the claim industry.  As an employer, you should be open to new technology, and trying new things in order to be more proactive in the claim process.  The same can be said for the adjuster.  Oftentimes the adjuster is very set in their ways, and there can be some resistance to the introduction to new techniques and new technology.  These advancements are made to help all parties involved to make the process more streamlined and more effective for the claims profession.


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.
 
Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com.  Contact: mstack@reduceyourworkerscomp.com

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

The Best Tidbits Of News From The Workers Comp Community

 

 
The United States House of Representatives today passed the Saving Medicare and Repaying Taxpayers (SMART) Act as part of a broader legislative effort. The SMART Bill was attached to House Bill 1845 Medicare IVIG Access Bill which provides for…Read More
 
 
 
Create a framework for your organization’s risk management program that aligns with its goals, sets roles and responsibilities for the team and provides communication strategies needed to report to senior management and other stakeholders.  Read more…
 
 
 
Broadspire, a Crawford Company (NYSE: CRDA; CRDB) and leading third-party administrator of workers compensation claims, liability claims and medical management services, announced today that it has been awarded continued accreditation for Case Management, Workers' Compensation Utilization Management, Health Utilization Management, and Independent Review Organization: Internal Review from URAC, a Washington, DC-based health care accrediting organization that establishes quality standards for the health care industry. Read more…
 
 
 
From now thru Dec 2012, if you buy either the 2012 RIMS Benchmark Survey Book or the 2012 Workers Compensation Management Program Book, we’ll send you a second copy at no charge.
The RIMS Benchmark Survey Book and our Workers Comp Cost Reduction Book are the most popular books that we offer, and we're trying to set a sales record in December.
Now thru December 31, 2012 order one copy of either of two books below and receive a second copy of that book for FREE.  Read more…
 
 
 
Tallahassee, FL (WorkersCompensation.com) – The Florida Legislature passed and Governor Rick Scott has signed into law CS/HB 941, which amends sections 440.02(9) and 440.05, Florida Statutes. Effective July 1, 2013, the law changes to include Limited Liability Company (LLC) members as employees.  Read more…
 
 
Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com
 
 
©2012 Amaxx Risk Solutions, Inc. 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 about workers comp issues.

Best Practices in TPA Medical Management

TPA Medical Management Critical for Cost Containment

 

The third party administrator (TPA) who handles your workers’ compensation claims needs to be especially strong in their medical management skills.   The top tier TPAs will have their own medical management division overseeing and controlling the medical cost of your claims and working in conjunction with the workers’ compensation adjusters.

 

The most effective ways to control your medical cost include:

 

  • Telephonic nurse case managers
  • Field nurse case managers
  • Senior nurse reviews
  • Utilization reviews
  • Medical bill reviews
  • Prescription management
  • Physician review
  • On-site clinics
  • Injury triage
  • Wellness programs
  • Preferred provider networks

 

 

Nurse Case Managers

 

Nurse case managers are experienced nurses who are utilized to coordinate and manage the medical care for an injured employee.  There are two primary types of nurse case managers, telephonic case managers (TCM) and field case managers (FCM).  Both TCM and FCM will:

 

  • Coordinate the medical care
  • Consult with the physician on treatment options
  • Prevent over utilization of medical treatment
  • Monitor the employee’s medical recovery
  • Provide frequent updates to the adjuster and employer on the employee’s medical progress
  • Coordinate the employee’s return to work, either light duty or full duty
  • Facilitate communication between the employee, employer and physician
  • Manage the medical rehabilitation of the employee

 

The primary difference between the TCM and the FCM is the location of their work.  The TCM will work from his/her office and perform all activities on the workers’ compensation claim by telephone and e-mail.  The FCM will often meet in person with the injured employee and will accompany the employee to medical appointments when appropriate.  While not a strict division of injury assignments, the FCM is more often utilized on severer injuries.

 

 

Senior Nurse Review

 

With the senior nurse review, a highly experienced nurse provides continuous oversight of medical care. This provides for identification of recovery obstacles early in the life of the claim. Through continuous monitoring of the medical care, the senior nurse reviewer can also verify the quality of medical care if the recovery time exceeds the normal disability duration guidelines.  When a senior nurse reviewer is involved in the workers’ compensation claim, the medical management provider will also have physicians with whom the senior nurse reviewer can consult.

 

 

Utilization Review

 

The medical management company should provide utilization review services.  A utilization review is an independent confirmation of the necessity for medical services.  There are 3 types of utilization review.  They are:

 

  1. Pre-certification Review – an experience nurse will collect all the medical information including the symptoms, diagnosis, test results and the reason a physician is requesting a specific medical service.  The nurse will compare the medical information against the normal criteria for a specific treatment.  If the nurse concurs, the medical service is approved.  If the nurse determines the medical care is not necessary, the matter is referred to a physician for a peer review, and acceptance or denial of the requested medical service.
  2. Concurrent Review – is a review of the medical necessity while it is in progress.  This type of utilization review is often used during hospital stays, or on-going multiple outpatient visits, for example: physical therapy.
  3. Retrospective Review – After a medical service has been completed, but before a payment is made for the service, the nurse reviews the reasons for the service and the necessity for it.  If the medical service was not needed, the retrospective review gives the adjuster justification and documentation as to the reason the medical provider is not compensated for the medical service.

 

 

Medical Bill Review

 

The medical management company reviews and verifies the accuracy of the medical bill diagnostic codes and the medical bill charges. The medical bill charges are compared to the medical fee schedule established by the state.  When there is no fee schedule, the medical charges are compared with what is customary, reasonable and necessary

 

 

Pharmacy Benefit Manager

 

A pharmacy benefit manager provides a network of pharmacies to provide medications at the best possible price.  The pharmacy benefit manager will also monitor the utilization of prescription drugs to prevent the overutilization of drugs through premature fill request, excessive dosages, multiple providers, multiple pharmacies and multiple drugs used for the same purpose.

 

 

Physician Review

 

When an injured worker is not responding to the medical care within the range of normal recovery time, a physician review is often appropriate.  The physician review is a peer review by a specialist who will evaluate and document the medical necessity of the past, current and future medical treatment.  The physician review provides an in-depth evaluation of the medical necessity of the treatment being provided to the injured worker.  The review process can strengthen the return to work program by verifying the appropriateness of an injured worker being on modified duty work. The review process can also be used to evaluate the accuracy of an impairment rating provided by the employee’s medical provider.

 

 

On-site Clinics

 

On-site (employer’s work site) medical clinics staffed by RNs, nurse practitioners and physician assistants have proven they can curb the fast-rising cost of medical care for both personal and work-related injuries and illnesses. The on-site clinic provides the medical care making it convenient for employees who do not have to leave work for care.  Employees are referred to off-site medical facilities only if the injury or illness is beyond the scope of the medical professionals in the on-site clinic.

 

 

Injury Triage

 

Injury triage is the process of having an experienced nurse evaluate the injured employee’s medical needs through the use of algorithms, software and an in-depth interview of the injured employee.  Based on the information obtained, the triage nurse makes decisions on the appropriate level of medical care needed.  While triage nurse can be utilized any time in the course of the workers’ compensation claim, it is most effective when it is conducted immediately after an injury.  The triage nurse directs the employee to the most appropriate medical provide within the in-network of service providers. This prevents the employee from over utilizing medical care while ensuring the employee obtains the medical care needed.

 

 

Wellness Programs

 

A wellness program is a company sponsored effort to improve the health of employees.  A complete wellness program will include nutrition and health education, physical fitness, health screenings and behavior modification.  An employer benefits from a wellness program through both lower cost of health insurance and lower cost in the workers’ compensation benefits.  Additionally, a wellness program will result in lower absenteeism and a corresponding increase in productivity.

 

 

Preferred Provider Networks

 

A preferred provider network is an organization of doctors, hospitals, diagnostic facilities and other medical providers who have agreed with the insurance company or self-insured employer to provide medical services to injured employees covered by workers’ compensation insurance. In exchange for the insurer or employers sending a volume of business to them, the medical providers agree to a pre-determined reduction in their normal charges for services. The reduction in cost can be substantial for the insurer or employer.

 

Employers should select one medical management partner that can provide expertise in all of these areas rather than multiple medical management partners.  A medical management partner that covers all of these areas can integrate the medical cost control services eliminating duplication of services and eliminating gaps in medical cost control.

 

 

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.

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

 

©2012 Amaxx Risk Solutions, Inc. 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 about workers comp issues.

The Best Tidbits of News From the Work Comp Community

 

 
We want to tell our readers a little about you, maybe something that wouldn’t make it you’re your corporate bio.  Where are you from?  Where did you go to school?  What was your first job in the industry?  How did you get into the workers comp TPA business?  I got in the TPA business when I interviewed for a supervisory position for a medical auditing firm…  Read more
 
 
 
In 2012, Network Synergy Group launched an aggressive campaign to build out its provider network to all 50 states. In addition to expanding the network, NSG has also broadened its product suite to include both a Condition Rate Program and a Visit Rate Program. These enhanced products support customers’ needs by enhancing workplace productivity while adhering to medical guidelines. Read more…
 
 
 
Build your personal daily agenda , Receive real-time reminders and updates, Find sessions, events, speakers and exhibitors, and more.  Check out the full list of features to help you navigate the country’s premier Workers Comp event here
 
 
 
 
The Work Comp Analysis group is the largest online discussion group dedicated exclusively to WORKER'S COMPENSATION issues.  It is a "spam free" discussion page used for asking questions and discussing industry issues. It was created on November 28, 2008 by Mark Walls from Safety National.  Congratulation Mark on hitting this milestone!  Join Group
 
 
 
The most difficult cost savings measurement is calculating the savings gained from what did not happen. Call it cost-avoidance measurement. Some say it cannot be done because if it has not happened, it certainly cannot be measured. Read more…
 
 

Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

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

 

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.

The Best Tidbits of News From the Workers Comp Community

 

 
Deborah Pfeifle, CEO of Gould & Lamb, was a guest speaker at the recent American Society of Workers Comp Professionals (AMCOMP) conference. The event took place on September 10th in London, England at the Lloyd's Library.
 
Ms. Pfeifle's presentation, The Impact Medicare Has on ReinsuranceRead More…
 
 
 
Build your personal daily agenda , Receive real-time reminders and updates, Find sessions, events, speakers and exhibitors, and more.  Check out the full list of features to help you navigate the country’s premier Workers Comp event here
 
 
 
Broadspire’s innovative cost containment program provides an opportunity to obtain additional savings above and beyond the fee schedule and usual and customary reductions. When a provider is nonparticipating under a Preferred Provider Organization (PPO) network, our Medical Bill Review (MBR) engages one of our three out-of-network partners that specialize in medical bill negotiations.  Read More…
 
 
 
Now you can quick-search the best medical providers for Workers’ Comp by specialty and geo-zip directly from the Internet anytime! Master Provider Index analyzes provider performance based on data from multiple payers.  Read More…
 
 
 
Brad E. Bleakney, Esq. of Bleakney & Troiani, Chicago, Illinois, was selected for inclusion in Best Lawyers in America for Workers’ Compensation in Illinois for 2013. Mr. Bleakney practices in the area of work related injury claims, Illinois Workers’ Compensation and related third party litigation for accidental work injuries.  Read more…
 
 
 
 
As the commercial insurance market has tightened for a number of key coverages, including global property and some primary and excess casualty lines, buyers have responded by adopting measures to stabilize their premiums. A current survey of risk managers and other corporate insurance buyers by Hanover Stone Partners finds firms have adjusted retentions, accepted restrictive policy wording, or changed insurers to hold their premiums steady.   Read More…
 
 
 

Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

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

 

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.

The Best Tidbits of News from the Workers Comp Community

 

Tampa, FL – Network Synergy Group (NSG), a national physical therapy management company, based in Tampa, announced today that Pat Chavanu has been appointed President. Since 1997, Network Synergy Group has provided physical and occupational management services to the workers’ compensation industry. Read More…
 
 
 
 Texas Workers’ Compensation Handbook by Albert Betts, Jr. and Stuart D. Colburn (Publisher: LexisNexis) is a quick reference guide designed for lawyers & adjusters. You’ll find:
 
-Concise analysis and helpful practice points
-Current practice & procedure
-All relevant workers’ comp statutes and regulations
-Summaries of recent court decisions & Appeals Panel decisions
-Tables and charts
-In-depth index
-Cross-references to Larson’s Workers’ Compensation, Desk Edition 
 
 
 
 
 
Michael J. Hoberman has been named senior vice president of business development for Broadspire, a Crawford Company and leading third party administrator of workers compensation claims, liability claims and medical management services.  Read more…
 
 
 
For those of you who wanted to, but were unable to attend any of the 2012 Jackpot! Conferences, we have made available for purchase the package of educational materials provided to conference attendees.
Attendees have reported back to us that the program (which includes all presentation slides) is "an invaluable resource to have at my finger tips" and "an essential desk reference for anyone involved in Workers' Comp, Liability, Claims, Prescription Drug Management, Conditional Payments or Structured Settlements…and DEFINITELY for Mandatory Insurer Reporting".  Read More…
 
 
 
Over the years, a number of attendees and former attendees of the WCRI Annual Issues & Research Conference have shared with us the difficulties of attending two marquee events back-to-back in November—one in the East and one in the West.
 

To best accommodate our many attendees, we have decided to move the dates of this year’s annual conference from November to February 27–28, 2013, at the Boston Marriott Cambridge.  Since this is a transition year, the conference is being held in February.  But, thereafter, it will be held in early spring.  Read More…

 

 

Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 

 

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

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

 

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.

Broadspire Donates $100,000 to the SOS Childrens Village

 

 
      
 
Broadspire, a Crawford Company and leading third party administrator of workers compensation claims, liability claims and medical management services, recently raised $100,000 for the SOS Children’s Village – Florida during its 2012 Charity Golf Tournament.
 
The second annual event, sponsored by 36 of Broadspire’s vendor partners, had record attendance, with 104 golfers enjoying a beautiful day on the course at the Diplomat Resort and Spa in Hollywood, Fla. Last year’s charity tournament, the first such event hosted by Broadspire, generated a donation of $70,000 for the village.
 
“Everyone at Broadspire is so proud to support such a worthy cause,” said Broadspire’s President and CEO Danielle Lisenbey. “The generosity of the sponsors and attendees was overwhelming. The event took a lot of work and organization and it has certainly paid off. It was a spectacular event and a spectacular success.”
 
Lisenbey recently presented a check to SOS Children’s Village interim CEO Debbie Levine at a ceremony at Broadspire’s offices in Sunrise, Fla. The Broadspire staff joined the staff of SOS and three children from the village, who presented Lisenbey with a thank-you gift on behalf of all the children who reside at the facility.
 
Broadspire began its partnership with the SOS Children’s Village as a part of Crawford’s Global Day of Service in 2009. Since then, Broadspire has helped with several fundraisers and volunteer opportunities. SOS Family Villages – Florida is home to up to 75 foster children who have been removed from their homes due to abuse, neglect or abandonment. The village setting allows for a nurturing environment where brothers and sisters, often separated in foster care, are reunited.
 
 
About Broadspire
 
Broadspire (www.choosebroadspire.com), a leading international third party administrator, provides risk management solutions designed to help clients improve their financial results. Broadspire offers casualty claim and medical management services to assist large organizations in achieving their unique goals, increasing employee productivity and reducing the cost of risk through professional expertise, technology and data analytics. As a Crawford Company, Broadspire is based in Atlanta, Ga., with 85 locations throughout the United States. Services are offered by Crawford & Company under the Broadspire brand in Europe (www.Broadspire.eu), including the United Kingdom (www.BroadspireTPA.co.uk).
 
 
About Crawford
 
Based in Atlanta, Ga., Crawford & Company (www.crawfordandcompany.com) is the world's largest independent provider of claims management solutions to the risk management and insurance industry as well as self-insured entities, with an expansive global network serving clients in more than 70 countries. The Crawford System of Claims Solutions offers comprehensive, integrated claims services, business process outsourcing and consulting services for major product lines including property and casualty claims management, workers compensation claims and medical management, and legal settlement administration. The Company’s shares are traded on the NYSE under the symbols CRDA and CRDB.
 
For more information, please contact:
Stephanie Zercher, PR director
404.300.1908 (office)
954.401.0230 (cell)
stephanie_zercher@us.crawco.com

The Best Tidbits of News from the Workers Comp World

Here are the best Tidbits of news from the Workers Comp world this week:

 

Broadspire® Donates $100,000 to the SOS Children's Village


Broadspire, a Crawford Company and leading third party administrator of workers compensation claims, liability claims and medical management services, recently raised $100,000 for the SOS Children’s Village – Florida during its 2012 Charity Golf Tournament. The second annual event, sponsored by 36 of Broadspire’s vendor partners, had record attendance, with 104 golfers enjoying a beautiful day on the course at the Diplomat Resort and Spa in Hollywood, Fla.  Read More…

 

Medcor Client Hosts 112th U.S. Open Golf Tournament

Medcor congratulates its triage client, The Olympic Club, on hosting the 112th U.S. Open Golf Tournament, which took part this weekend in San Francisco.  As they took care of the tournament, Medcor triage nurses were on standby to take care of their employees!  The Olympic Club is the oldest athletic club in the United States and has hosted many local, regional, national and even international championships.Read More…

 

14th Annual Federal Workers Compensation Conference – July 25 – 27th, Atlanta, Georgia

The 2012 14th Annual Federal Workers' Compensation Conference brings together professionals from multiple Federal departments and agencies, including the Department of Veterans Affairs, United States Postal Service, Department of Homeland Security (TSA), Federal Bureau of Prisons, Department of Defense, Social Security Administration and the National Park Service, to name a few.  Read More…

 

Self-Insurance Institute of America, Inc. (SIIA) Schedules Series of Webinars 

The Self-Insurance Institute of America, Inc. (SIIA) has scheduled a series of webinars to update its members on current legislative/regulatory developments related to stop-loss insurance and discuss the association’s response strategy. Participants will also learn how they can support SIIA’s efforts. Read More…

 

News From Lexis Nexis.  

Quoted from weekly Lexis Nexis Newsletter published by Robin E. Kobayashi, JD, Lexis Nexis Legal & Professional Operations,  robin.e.kobayashi@lexisnexis.com



THE GREAT COMPROMISE

Stahl, JohnMany Work-related Disabilities Go Uncompensated: Compromising "The Great Compromise", by John Stahl, Esq. Evidence that many workers' compensation claimants have not received payments under "The Great Compromise" – the bargain that traded the right to sue employers regarding employment-related harm for the right to timely and appropriate benefits – has prompted calls for reform. An article written by Emily A. Spieler and John F. Burton, Jr. in the June 2012 American Journal of Industrial Medicine analyzed this situation.  Read More…



LARSON'S SPOTLIGHT: TORT ACTION

Tom Robinson thumbnail

Survivors of Deceased Employee Allowed to Bring Tort Action Against Uninsured Employer, by Thomas A. Robinson. In a 4-3 decision, the Supreme Court of Missouri recently reversed the decision of a state trial court that had held a workers' compensation award against a statutory employer barred a wrongful death claim against the deceased employee's uninsured employer. Finding that deceased employee's survivors had not made an election of remedies when they obtained the workers' compensation award against the statutory employer, the majority of the state high court held that the plain language of Mo. Rev. Stat. § 287.280.1 allowed…Read more about this case and other cases involving Illegal Aliens, Benefits for Old Workers, and Non-Dependent Spouse.



STUART COLBURN TO SPEAK AT NATIONAL WORKERS' COMP CONFERENCE

LexisNexis has partnered with the National Workers' Compensation Conference to create an enhanced legal track for attorneys and other workers' comp professionals.Stuart Colburn ColorLexisNexis author Stuart Colburn will be speaking on several panels, includingCausation, Misclassification, and the New Mobile Workforce. View the program agenda. Overall, there are 15 members of the Larson's National Workers' Compensation Advisory Board speaking at this event. You don't want to miss this conference! Take advantage of the special discount for all LexisNexis Workers' Compensation Law Community members. Community membership is free at our site.




Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 

 

 

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

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

 

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.

Workers Compensation News From Around the Net

Input Needed in Providers Opioid Audit
 
The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) acknowledges that prescription drug abuse and misuse, including opioids, is a serious issue in all health care delivery systems, including workers’ compensation.
 
 
The TDI-DWC seeks input and suggestions regarding the development of a new Plan-Based Audit for health care providers prescribing opioids. The Plan-Based Audit sets the scope, methodology, selection criteria, and program area responsibilities as laid out in the Medical Quality Review Procedure. A copy of the proposed Health Care Providers Pain Management Services (Opioid) Plan-Based Audit can be viewed at the TDI website here. [WCx] 
 
 
Broadspire Launches BOLD® Rx Network
 
Broadspire, a Crawford Company and TPA of workers compensation claims, liability claims and medical management services, has launched its BOLD Rx Network to help control the medical costs associated with WC claims. See here for more information.[WCx]
 
 
According to Broadspire, the BOLD Rx Network uses a multi-leveled strategy to achieve superior penetration rates and savings compared to the rest of the industry. “Rather than just partnering with one pharmacy benefit management (PBM) company, as is traditionally seen in the marketplace, Broadspire leverages multiple partners based on the value they bring to clients, creating a stronger pharmacy program,” they write.
 
Federal Court Rejects NLRB Authority to Force Posting of Employee Rights Notice
 
According to a well-written newsletter from McGuireWoods, a world-wide lawfirm with 900 lawyers, in Chamber of Commerce of the U.S., et al. v. NLRB (Dist. S.C., April 13, 2012), a South Carolina federal district court held that the National Labor Relations Board (NLRB or the Board) does not have statutory authority to force employers to post notices that the NLRB claims are designed to inform employees of their rights under the National Labor Relations Act.
 
 
McGuireWoods writes, “The Court’s decision directly conflicts with a recent decision from a separate federal court in the District of Columbia. These developments place all employers covered by the Act in a very difficult position.”
 
 
The regulations are to take effect April 30, 2012. “The conflicting court cases make it unclear whether employers will be required to post the NLRB notices on the current April 30, 2012 deadline. (Click here for more),” they write.
 
 
Columbus Dispatch Notices Lawsuits Against Doctors on Decline
 
Columbus Dispatch reporter Alan Johnson writes here that Ohio’s tort-reform law has reduced closed claims by 41 between 2005 and 2010. He discovered average payments for medical malpractice cases have declined 38 percent over that period.
 
 
Johnson writes, “The legal fight over curbing lawsuits and settlements in medical malpractice cases reached a tipping point in 2003 when the General Assembly passed and Gov. Bob Taft signed Senate Bill 281. The law capped non-economic damages, commonly known as ‘pain and suffering,’ at $500,000 per occurrence.”
 
 
Johnson reports that Tim Maglione, of the Ohio State Medical Association says doctors’ medical malpractice rates have dropped more than 26 percent. “It’s not only good news and a good trend, but it is proof that tort reform accomplished what it set out to do — slow the growth of what we thought were runaway lawsuits and to stabilize the market for physicians,” Maglione said. The numbers have also gone down, he said in the article, because doctors and hospitals are working harder to improve safety and cut down on mistakes. “The best error is the one that never happens.”
 
 
Progressive Medical Releases Annual Workers’ Compensation Medication Trends Report
 
According to Progressive Medical, Inc., WC medication spending declined in 2011. Their annual analysis, found here, reveals changes to medication expense patterns in workers’ compensation claims from 2010 to 2011 for Progressive Medical clients, as well as key factors that may influence future expenditures, such as chronic pain, product mix and government activity.
 
 
Key highlights from the 2012 Workers' Compensation Medication Trend Report include:
  1. Although medication AWP inflation was 5.8 percent in 2011, data shows a 1.3 percent reduction in total medication spend per claim.
  2. There was an overall 3.3 percent decrease in utilization per injured worker from 4.3 percent fewer prescriptions and a 1.1 percent decrease in average days of medication supply received.
  3. Across the industry, narcotics account for 35 percent-40 percent of workers' compensation medication spend while Progressive Medical showed a 3.9 percent decrease in total spending per claim in this drug category. Progressive Medical believes this is due to an emphasis on conducting interventions earlier in the lifecycle of a claim.
 
 
Note: If your company has any developments you'd like to share, please send them to us at: RShafer@ReduceYourWorkersComp.com

 

 

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.

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

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

 

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.

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Industry Leaders Discuss Challenges at Broadspires First Pharmacy Summit

 

pictu1Medications and drugs continue to play an increasingly important role in the overall of medical costs in workers compensation claims. In addition to the increases in costs, the potential claim risks have also increased surrounding the growing use of narcotics in the treatment of pain. These issues impact all involved parties in the claim administration process – from injured worker, to employer, to carrier or payer. How to manage these issues has now become a critical issue.
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On March 22, 2012, Broadspire, a Crawford Company and leading third party administrator (TPA) and medical management services provider, brought together representatives from a number of key industry organizations to discuss the challenges in prescription drug management for workers compensation claims during its first pharmacy summit.

 

 

 

pictu2

The intention of the summit was to focus on global industry issues, trends and developments in the future. In bringing together resources from all aspects of the pharmacy management process, the group was able to have an all encompassing discussion of the issue, and examine the challenges from all perspectives and vantage points. Throughout the day, the group discussed the common threads that tie together claimant, payer, employer and carrier interests. The group also shared ideas that could be put into practice to improve outcomes for everyone concerned.

 

 

 

 

More than 50 brokers, practice leaders, clinicians and others from major insurers, insurance brokerage firms and pharmacy benefit management (PBM) organizations attended the summit, which was held at Broadspire’s Sunrise, Fla., medical management headquarters. The panels were divided into four key areas of focus

 

  1. Pharmacy program design
  2. Opioids and controlled substances
  3. Physician dispensing
  4. Key legislative updates.

 

 

 

pictu3The first session focused on the overall design of an effective pharmacy program. Panelists in the discussion included Eileen Ramallo, Executive Vice President of Healthcare Solutions; Lori Daugherty, President of PMSI/Tmesys; Atermis Emslie, President of MyMatrixx; and Kathy Tiemeier, Clinical Program Manager of Express Scripts.

 

 

 

 

 

 

pictu4Candy Raphan, RN, BSN, ARNP, MAOM Candy joined Broadspire in 1989.  For over 20 years, she has held various management roles within the Broadspire organization in a variety of functional areas, including Occupational and Non-occupational Disability Management, Utilization Management, Medical Bill Review, Quality, and Medical Management Strategic Outcomes.  In her current role as Director of Medical Services, Candy is a Practice Leader for Broadspire’s Comprehensive Pain Management Solution and responsible for the clinical components of the pharmacy program, medical analytics, reporting and other clinical program development.

 

 


In addition to her experience at Broadspire,
 Candy brings a varied background of clinical, managed care and health industry related experience.  She is a certified advanced registered nurse practitioner with a specialty in family practice, Candy holds a bachelor’s degree and advanced practice certificates in nursing from the University of Miami and a master’s degree in organizational management from the University of Phoenix.  Candy is also a member of the National Association of Professional Women and the American College of Healthcare Executives.

End Article
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WORKERS COMP MANAGEMENT MANUAL:  
www.WCManual.com 
MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

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.
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