Ten Medical Cost Containment Strategies To Reduce OVERALL Costs

There are many available techniques to control medical cost in workers compensation.
A search of the internet for Medical Cost Containment will provide a tremendous amount of information but each website is focused on the product(s) or service(s) provided by the particular company. There are many and varied means of controlling medical cost in workers compensation which span a broader range of services than almost any single company can provide.
To be truly effective in controlling the medical cost of workers compensation, employers and insurers should not limit their medical cost containment efforts to only one or a few areas. While state statutes may limit or bar the use of some the methods of controlling cost, the employer or the insurer should utilize as many medical cost containment strategies as possible. All of the following medical cost containment strategies have been shown to save money for the employer or the insurer. (WCxKit)  Spend now to achieve overall lower workers compensation costs. This is how to hold costs down over the long term. This is referred to as the TLC (total loss costs).
Top 10 Medical Cost Containment Strategies
1.  A SUPERIOR Medical Provider Network is a group of doctors, hospitals and other medical providers with whom an insurer or a self-insured employer has prearranged for medical treatment for employees injured on the job AND provides better results than other providers – lower litigation rates, better medical outcome, faster return to work. 
2. Nurse Triage  is used as the very first phone call that is made (after the supervisor). The employee calls an RN who discusses the severity of the injury and the probably type of treatment that will be needed. These aren’t just any nurse, but specially trained ones using medical algorithms and overseen by sophisticated protocol to ensure appropriate referrals are made the the Emergency Dept, clinical treatment or self-care. If every injury is called in to Nurse Triage, the number of lost time claims will be reduced by 40%. The ROI is huge! I’ve toured the Medcor operation and was amazed at the efficiency and the training (I sat in the training room to view the type of training the RNs receive.) I was a guest of Broadspire who uses Medcor for their sophisticated medical protocol partner.  
3. Medical Management is the practice of having an experienced nurse case manager to coordinate and managed the medical care received by the employee. This includes both the senior nurse reviewer who may be dedicated to an account handling all lost time or serious medical claims for that company. They review all care and treatment for injured employees to insure it is appropriate and timely. If additional tests are needed they will advise the doctors. Their priority is getting the employee back to full recover.
4. Utilization Review is the independent confirmation of the need for a medical service. Utilization review includes precertification reviews before the medical care is provided, concurrent reviews while the employee is in the hospital or during on-going medical care, and retrospective reviews to verify the needs for the medical services already provided.
5. Medical Bill Reviews are normally done by companies that specialize in reviewing the medical bill to verify the accuracy of the medical bill diagnostic codes and medical bill charges. The medical bill charges are either compared to the state fee bill schedule or with what are reasonable and customary charges for the medical services provided. Medical bill reviews include both the audits of doctor bill and hospital bill auditing.
6. Pharmacy Benefit Managers are companies that specialize in managing and controlling the cost of medications prescribed for the employee. This includes both obtaining discounts on medications plus providing drug utilization reviews to prevent the excessive use of narcotics and other medications. Using physicians to actively review claims results in proactive pharmacy benefits management, rather than after the fact review of medications already taken, can stop overuse before it occurs.
7. Independent Medical Examinations occur when the employee is sent to another medical provider for a second opinion. Independent medical examinations are most often used when the employee’s medical recovery progress is slower than normal.
8.  Peer Reviews is the practice of sending the medical reports and diagnostic reports to another medical provider for a review of the medical information for the purpose of confirming the appropriateness and quality of the medical care being provided. Using physician review is in my opinion one of the most useful tools an employer can use. They can read he medical reports to find what’s NOT there. They look for other possible causes of injury, appropriateness of care and make sure employees go to the correct specialists.  This service may be called Peer-to-Peer.
9.  The era of computers has created the ability to use technology to obtain information that would not otherwise be available including:
1.      Predictive Modeling is used to identify early on those claims that have a high probability of becoming expensive claims so they can be acted upon quickly.
2.      Data Mining is used to identify high cost medical providers; medical providers who are slow to return the employee to work and to identify other claim related information that impacts claim cost.
3.      Benchmarking is using the known information about your workers’ compensation claims to compare your cost control results against others employers or insurers. (WCxKit)
10. Send me your ideas for YOUR favorite Medical Cost Containment Strategy. Let me know if it’s OK to share your ideas. Please write up to 200 words.

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.  Contact:  RShafer@ReduceYourWorkersComp.com.

WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
Workers Comp Resource Center Newsletter

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.

©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact

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 Broadspire_Info@choosebroadspire.com; www.choosebroadspire.

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

WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
Workers Comp Resource Center Newsletter

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.

©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact

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