Accessing Quality Diagnostics in Workers’ Compensation

02 Jan, 2024 Tanisha Dilbert


Contributing Author: Tanisha Dilbert, Operations Manager for Apricus, an Enlyte company

When an employee is injured on the job, obtaining timely and accurate imaging is crucial for developing an effective treatment plan. It is often the first step in evaluating an injury and is why access to quality diagnostic imaging facilities is so critical to the success of a workers' compensation claim. 

Frequently Used Imaging Services in Workers’ Compensation

Diagnostic imaging offers key insights into injury causation, severity, informing treatments, and speeding up recovery times. Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Electrodiagnostics (EMG & NCS), and other imaging services like X-rays, Ultrasounds, and PET scans are commonly used in workers’ compensation. Each is unique in terms of the images it captures, the equipment it uses and the conditions it helps radiologists diagnose. More detailed information regarding these imaging services can be found in our recent Specialty Spotlight.

These techniques aid radiologists and other health care professionals in providing precise treatments and empowering employers with informed choices for the welfare of injured employees. A specialty service provider can serve as a key partner by offering imaging knowledge and expedited access to a wide range of diagnostic imaging solutions nationwide. These solutions play an important role in aiding claims professionals, nurses, and case managers in successfully reintegrating injured employees back into the workforce.

Accurate Diagnostics and Claim Outcomes

Unfortunately, outdated or inappropriate imaging equipment remains a challenge, and injured employees may be sent to a facility with old or outdated equipment if it is not properly vetted. If an imaging facility produces a low-quality image, the injured employee’s condition may be misdiagnosed or missed altogether, leading to further complications and higher claim costs. Treating physicians may not have detailed information to diagnose and properly treat injured employees, or a bad scan could cause them to miss important diagnostic information for the condition. 

Having a specialty care coordinator that can guide an injured employee to the right diagnostics provider is crucial. A good example is determining the appropriate quality of a an MRI machine, which relies heavily on its magnet strength, or its tesla. Greater magnetic strength leads to improved image quality. For most examinations, a 1.5T MRI scanner serves as the standard imaging tool. However, in specific situations, such as when greater magnet strength is required, a 3.0T scanner becomes necessary. For even more substantial magnetic strength, higher tesla scanners are available, reaching up to 7.0T.

Working with a specialty solutions provider ensures that diagnostic imaging providers have current and appropriate equipment to produce the necessary quality scans.  Specialty care coordinators work with claims professionals to schedule imaging services with reputable in-network imaging facilities that meet these strict requirements.

Advances in Imaging

Despite challenges, advancements in imaging technology offer great promise. The latest equipment enables healthcare providers to diagnose and treat patients with greater precision, providing unprecedented visual and functional information on a patient's condition. This also facilitates faster, more intelligent imaging services that support medical decision-making and improved outcomes.

In addition, the integration of artificial intelligence (AI) into diagnostic imaging offers an opportunity for this technology to support imaging professionals and alleviate workloads, which may aid in the medical imaging shortage challenges currently being felt. In addition, AI in diagnostic imaging could be applied to volume of studies, reporting and classification, deeper image reading, big data, and cost reductions.

Access to quality diagnostic imaging will continue to remain a critical component in correctly assessing, documenting, and evaluating an injured employee’s response to treatment moving forward, and utilizing specialty solution providers that can address these challenges as well as advancements in technology will ultimately produce better overall injured employee outcomes with lower claim costs for payers.

Coordinating the Right Services for Injured Employees

Payers look for solutions that provide expedited access to a wide range of diagnostic facilities, equipment, and procedures to assist physicians, nurses, and claims professionals as they return injured employees to function and work. Specialty solution coordinators vet diagnostic providers to ensure they have up-to-date equipment that can produce high-quality scans. Additionally, they arrange services with claims professionals to schedule imaging with a network of reputable facilities that have undergone rigorous credentialing to ensure proper licensure, certifications, and insurance. For example, when an imaging referral is received, an Apricus Care Coordinator will promptly contact the injured employee, determine the most appropriate facility, and schedule the requested studies in a timely manner for the claims professionals or case manager to ensure a streamlined experience for all involved. This type of coordination plays a pivotal role in the successful reintegration of getting the injured employee back into the workforce.

About the Author

Tanisha Dilbert is the manager of operations for Apricus and oversees its Durable Medical Equipment (DME) and Diagnostic Programs. Her responsibilities include managing day-to-day operations, improving operational efficiency, performance management, and enhancing customer experiences. With over 17 years of experience in the workers’ compensation industry, including 13 years as a people leader, Tanisha is a passionate advocate for process improvements and employee development.

Tanisha is also a regular contributor to our Specialty Solutions Spotlight where portions of this article originally appeared. To ask and find the answers to more work comp specialty questions visit our website and subscribe to our monthly series.

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