Five things not to overlook with workers’ compensation

A great deal of attention in workers’ compensation is focused on premium rates and savings programs. Employers must be vigilant and resourceful to protect opportunities for competitive savings; strict qualification criteria can be threatened by even a single difficult claim. Accumulated delays, preventable costs and lost workdays over time can damage premium rates for several years, even for larger employers.

Smart Business spoke with Lance Watkins, AVP, Client Services, at CompManagement Health Systems, about five areas in which a Managed Care Organization’s (MCO) assistance can help position employers to achieve and maintain lower workers’ compensation premium costs.

What is crucial for employers to understand about post-injury management?

An employer’s initial reaction after an employee injury is a key moment. Following an organized game plan fosters trust, cooperation and understanding. Be prepared to address these three things immediately after an injury:

  • Initial medical treatment — Know available options in the area. Have contact information ready. Call ahead. Make sure the employee has safe transportation.
  • Quick and thorough documentation — Be prepared to assist in completing an injury report. Facilitate filing a clearly legitimate claim through your MCO to help prevent delays, keeping everyone focused on recovery and return to work.
  • Discuss early return to work, transitional work options — Establish an expectation for a quick recovery and return to work. Be flexible and make adjustments as needed to facilitate that return.

Can employers negotiate for early return to work?

When an employee is off work for eight or more days, lost-time costs accelerate quickly and can threaten future savings opportunities. A physician’s initial instinct toward time off work can be negotiated if employers demonstrate a reasonable and safe work environment that facilitates recovery. A formal transitional work policy is an asset for all parties; MCOs can help build that infrastructure and address options with treating physicians.

How can employers control the costs of medical treatment?

Medical treatment for a workers’ compensation injury must be approved through the MCO as appropriate and cost-effective. A claim’s lost-time duration is related to the course of medical treatment. Engaging physicians and advocating for quality treatment that facilitates early and safe return to work is an MCO’s role. It is sometimes appropriate to explore alternative approaches to treatment that may yield improved results in both recovery time and cost. Employers should be involved in this process with their MCO.

What role do employers play in the review of prescription medications?

Excessive medications certainly impact the cost of a claim, but even side effects of prescribed medications can extend lost time. Problems with prescription abuse are well documented. MCOs can review medications prescribed through a claim and contest drugs that are not appropriate or recommend non-narcotic alternatives that may eliminate potentially challenging side effects.

How can the scrutiny of medical bills help control costs?

Actual medical treatment cost for workers’ compensation claims is usually far lower than costs associated with lost work days — compensation and reserves — but it should not be overlooked as a given. MCOs review and re-price medical bills in accordance with the Ohio Bureau of Workers’ Compensation billing fee schedule, but also explore further reductions in medical costs to ensure accurate payment only for related treatment. There are often opportunities for significant savings through the use of universal codes and bundling for efficiency; an aggressive MCO can justify these additional reductions.

Sometimes the key to resolving a claim before it becomes extremely costly is found in the details. Leveraging MCO resources and recommendations can help prepare employers to minimize costs and preserve premium savings options.

Insights Workers’ Compensation is brought to you by CompManagement Health Systems