What does an employer need to know about an MCO?

oh_mco_AndreaKienerAn MCO plays a vital role in the Ohio workers’ compensation system. When a job-related injury occurs, the MCO is responsible for the medical case management of that injury, and that injury becomes a workers’ compensation claim and treatment is covered under the employer’s Ohio Bureau of Workers’ Compensation policy. MCOs act as an agent of the BWC to ensure injured workers get the care they need, that providers are paid promptly for service and that the injured worker can return to work safely.

All Ohio employers who pay into the state fund are required to have an MCO. If they do not choose one when they receive their BWC policy, the BWC will assign an MCO to them. MCO services are included in their premium payment to the BWC, so the BWC pays the appropriate MCO.

While all MCOs have to meet certain BWC criteria, the way services are provided and the ancillary services MCOs provide can vary greatly. These differences are important to review when selecting an MCO because medical claims management can have a direct impact on the premiums an employer pays for their workers’ compensation coverage. Each claim is different, so employers should work with an MCO they trust will give them personal attention.

How does an employer look for an MCO that will deliver what it promises?

Any MCO will provide managed care per BWC requirements. However, you should ask MCO representatives to provide examples of what they claim makes them different. For instance, Sheakley UniComp believes that having board-certified physicians involved can make a big impact. We have what we call Employer Disability Advisors. Engaging EDAs in the claim process brings specialized knowledge in occupational, rehabilitation and sports medicine to the claim. In addition, they offer peer-to-peer contact with treating physicians ensuring workers may return to work as soon as safely possible.

For example, a client had a claim from an injured employee who needed to restart treatment four months after going back to work. Upon reviewing the patient’s MRI, the EDA was able to determine the extent of the injury did not require the extensive physical therapy initially ordered from the treating physician. The EDA was able to help create a plan for modified duty with the employer, approved by the treating physician, and the employee was promptly released to return to work. In this claim, missed work time — one of the leading causes for high claims costs — was minimized and additional physical therapy costs were avoided.

Andrea Kiener is director of client programs for Sheakley UniComp. For information, visit www.Sheakley.com/mco.