Reduce Wasteful Workers’ Comp Practices

Strive for Overall Cost Reduction

With skyrocketing medical costs, employers must coordinate medical care more effectively. The best way to reduce medical costs is to return employees to their pre-injury health as quickly as possible, and that may mean spending more upfront to provide the best treatment possible.

Although you must be familiar with all services, those that focus on improving treatment efficiency and speeding recovery are most important at the early stages of the claim.

10 Best Ways to Reduce Medical Costs:

1. Identify the types of doctors who participate in the workers’ compensation process in your state such as IME*, QME, Panel Providers, Primary Treating Providers, etc.
2. Determine how medical providers are selected in your state.
3. Select a doctor / clinic with a good bedside manner that provides excellent quality medical care and is willing to spend a little extra time with your employees and completing your Work Ability Form.
4. Develop Workers’ Compensation Instructions for injured workers listing names, contact numbers, and office hours for Injury Coordinator, adjuster, and medical providers. Tell workers how to obtain medication, what to do after each medical visit, procedures for referral to specialists, transitional duty requirements, how to get paid and other important information.
5. Retain a part-time medical director** to talk doctor-to-doctor with treating providers, review medical records for alternative causation, and intervene in the IME process. The IME is one of the few points in the workers’ comp process where the outcome can be influenced. 30% of IME’s are unnecessary or untimely.
6. Have the medical director make sure medical records are complete prior to requesting an IME. Most adjusters assume medical records regarding a pre-existing injury are irrelevant as related to a workers’ comp injury. However, it is relevant when the claimant’s acute injury resolves but an underlying degenerative process is still progressing.
7. Make sure emergency room records are in the file before requesting an IME. When initial treatment is received in the emergency room, the account of how the injury occurred is likely to be more accurate than one given later on.
8. Have the medical director write IME cover letters summarizing key information and asking requisite questions concerning the work-relatedness of the injury. A standard cover letter is very general, not highlighting crucial information or asking specific medical questions. In some states, the employer is allowed only one IME every six months. Don’t waste this opportunity to get a complete medical opinion based on all relevant information.
9. Have the medical director review use of all Nurse Case Management to make sure the service is needed and is brought in timely. Often nurse case management is brought in too early or too late.
10. Meet with every medical cost containment service and indemnity cost containment service your TPA uses so you can control when it is used and how much you will pay for services, such as:
    a. Medical bill review
    b. Hospital bill review
    c. Utilization review
    d. Nurse case management (telephonic and field-based)
    e. Negotiated preferred provider networks
    f. Vocational rehabilitation
    g. Work hardening center

The forms and documents you need are in the Medical Care Coordination and Medical Cost Containment Modules of Workers’ Comp Kit^®:

• Work Ability Form
• Introduction to PPO Provider
• Selection Criteria for Medical Providers
• Medical Provider Brochure
• Workers’ Compensation Instructions
• Physician Telephone Questionnaire
• Maximum Medical Improvement Request to Adjuster
• Email Requesting Nurse Case Management Update
• Email Requesting Peer Review
• Letter to Adjuster About Causality

*Go to Abbreviations of Workers Comp Insurance Terms.

**Using an MD proactively usually saves $4 for every $1 spent.

Learn more about our Quality Control Claim Review and Improvement Plan.