Work Comp/Auto Medical Bill Review: Initial Takes

We are about a third of the way thru interviews for the third Survey of Medical Bill Review in Workers’ Comp and Auto; here are a few initial takes.

• Bill review has progressed a lot in the last decade, with key advances in:
  • Auto-adjudication of more bills
  • Better coordination/integration with document management
  • Ability to more readily connect with other key systems e.g. treasury/finance, state reporting, claims
• One area that still needs a lot of work – automated integration with UM/UR applications
• E-billing is leading to more auto-adjudicated bills, but headaches as well.
• In general, respondents don’t see a lot of differentiation among bill review vendors.
  • But some respondents point to key differences between vendors and application providers that should be top of mind for payers
• The most common pricing methodology? so far, it’s a flat fee per bill for bill review and the old percentage of savings for everything else.
• that said, there are some pretty innovative approaches to pricing out there that bear watching

The last time we did this survey was six years ago.  We will be comparing and contrasting results to document what’s changed and where things are going.

If you’d like to participate, shoot an email to infoAThealthstrategyassocDOTcom.  Substitute symbols for the caps.

Joe Paduda, the principal of Health Strategy Associates and president of CompPharma, is a nationally recognized work comp expert and speaker with considerable expertise in medical and pharmacy management. Joe consults with managed care organizations, providers, insurers, employers, and private equity firms and conducts an annual payer survey on managing work comp pharmacy. In addition to writing the popular and controversial www.ManagedCareMatters.com, he is a founder and contributor of www.HealthWonkReview.com, a collaborative blog on healthcare policy