6 Strategies to Reduce Workers Compensation Medical Costs

Jan. 3, 2012 - PRLog -- Depending upon how your claims are managed can dramatically impact your profitability as a company.  In some cases, the cost of the claim can be as much as four (4) times the cost of the claim itself.  Below are ways that employers can help gain control over this very important issue.

1.   Workers Comp Fee Schedules:  In most states, there are caps placed on the dollar amount that can be charged for medical services provided for a workers’ compensation injury.  In Florida, for example, it is known as a “Fee Scheduled State”.  The medical provider is limited to billing you the workers compensation fee schedule, which is much less than what they would charge for a non WC injury.  There are medical bill review companies that can compare your bills to the medical codes provided on your invoice.  Bottom line, make sure the medical provider is aware the claim is workers comp related.  Most will be aware of this issue and bill you accordingly.
2.   Medical Triage:  Rather than having the majority of your injured employees seek medical treatment from a hospital or emergency clinic, you may consider using a trained triage nurse to arrange initial medical care.  A trained triage nurse can reduce the cost of claims by redirecting care to just as effective, but less expensive treatment. Triage nurses can play an important role in the initial management of a claim by not only advising on initial care, but can assist with directing employees to proper medical facilities within your carrier’s network.  They can also assist with follow up care and providing thorough documentation to the carrier adjuster.
3.   Utilization Review:  Utilization reviews can be a worthwhile process if you find yourself questioning the medical care that is being provided to your injured employee.  A utilization review is the review of the medical care by an outside company to provide a second opinion on the appropriateness of the care.  Utilization Reviews can be done before, during and after treatment is done.
4.   Independent Medical Exam:   An independent medical exam can be utilized for a number of reasons.  #1, an insurance company may select an independent medical exam to validate the diagnosis and treatment received by the injured employee.  #2, carriers may want to confirm the impairment / disability rating provided by the attending physician.  This can help in keeping settlements “in line” when negotiating closure on a claim.
5.   Medical Provider Network:  An effective way to control the cost of medical care is to make sure you are sending your injured employee to a medical provider that is in your insurance company’s network.  It is common that groups of medical providers (hospitals, urgent care clinics, doctors, etc.) will join together and provide billing discounts for care in return for group referrals.  These discounted fees result in lower medical costs which means lower workers compensation costs.
6.   Nurse Case Manager:  A nurse case manager can be considered to be the most important person who can positively impact the ultimate cost of your medical care.  They can be helpful in  to coordinating the medical care for your injured employee, as well as getting the employee back to work as soon as possible if time off from work is needed.  In some cases, you can request the insurance company to provide a nurse case manager for your injured employee.
Controlling the medical cost of your Workers’ Compensation claims is critical if you value your profitability as a company.  The 6 strategies referenced above can help you reduce your costs, but there are many claims management strategies being utilized today to reduce claim costs.  

For more information, call Rick Dalrymple at 407-998-4108 or email to Rick.Dalrymple@ioausa.com.  www.RichardDalrymple.com

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