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Rising Healthcare Costs and How Medical Bill Review Can Save Employers Money

27 Jan, 2011 WorkersCompensation.com

                               
Rising healthcare costs are a key problem in workers compensation. Medical costs have increased 21% from 2004 to 2009, according to the Bureau of Labor Statistics. Media sources have the medical increases for injured workers rising as much as 50% for the same time period. A Medical Bill Review (MBR) program can help reduce unwarranted charges associated with workers compensation, general and auto liability.
 
When planning to hire an outside medical review service consider these points:
 

1.     Vigilant medical bill reviews.

2.     Comprehensive network and pharmacy programs.

3.     Industry-leading medical bill savings.

 
 
You want a medical management team who 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% above network discounts for a total savings of 61.7%.(WCxKit)
 
 
A medical management team consists of experienced registered nurses and physicians using their knowledge to conduct comprehensive reviews. Every bill is scanned and digitized giving you the ability to track the process in a paperless file. The bills are then reviewed for unbundling of charges, for duplicate charges and 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 qualities and abilities:
 

1.     A revolutionary, state-stratified, multi-tiered approach to networks.

2.     Contracts with regional networks and offers occupational and non-occupational providers in each state to meet your employees' needs.

3.     Instead of one blanket approach, contracts with primary, secondary and Medical Price index 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 you like to be the employer who achieved a 73.4% penetration rate with savings well above the national average, because they employed such a service?

There are two 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; that 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, to examine all items and help ensure 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.
 
 
It's predicted workers compensation medical costs will by 70% 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/
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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 Info@WorkersCompKit.com.

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