Do You Control The Doctors…Or Do They Control You?
One of your employees is injured on the job. They report the injury promptly and you immediately take them to the occupational clinic. From that moment on both your employee and the company’s checkbook are in the hands of the treating physician.
The first thing you need to understand is that the workers compensation system is the last bastion of medical cost shifting in the United States. Your employee benefit program probably contains one or more aggressive cost containment techniques designed to curb rising group medical costs. So how does the healthcare industry recoup this income? You guessed it – the workers compensation system. As a result, worker injury medical costs are catching the full weight of increases in healthcare costs – and there is no end in sight. Even if your state has a mandated cost containment schedule doctors are extremely adept at keeping the injured employee in their orbit of control – and you pick up the tab.
To make matters worse, in many state jurisdictions employees can go to any physician they want, making it very difficult to direct the employee to the most cost effective medical service. As a result, your organization will lose a high degree of control over the quality and delivery of healthcare to the injured employee.
Also, the Family Medical Leave Act (FMLA) and the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) impose on the organization potentially strict guidelines on what information can be obtained and how it can be obtained. Many healthcare providers are struggling with compliance of HIPPA in particular and have established very conservative standards as far as what medical information will be released to the organization about an injured employee’s condition. Understanding these laws and knowing how to comply with them in the context of a worker injury can be extremely challenging for the claim management team as well.
Finally, many healthcare practitioners do not understand the workers compensation system or have mastered the art of occupational medicine. They are well trained in diagnosing an employee’s injury and prescribing the appropriate medical care. However, they often struggle with such things as:
- Working with the employer to develop an ADA-compliant accommodation strategy that will get the injured employee back to work as soon as possible;
- The impact that “balance billing” has on the employee’s attitude towards their employer;
- The need to communicate frequently with the Claim Coordinator and claim adjuster throughout the process of employee healing;
- Understanding the different classes of disability and what they mean to effective claim management.
- Understanding the regulatory process associated with workers compensation claims and where they fit into it.
In short, while the workers compensation system can be extremely lucrative to the healthcare system it also is a challenge to your organization. Unless you take control of the claim management and communication process you may be literally turning your checkbook over to the treating physician, driving up your workers compensation costs.
CompEraser provides a host of resources to put you back in control of your workers compensation claim process, including physician services. Resources also include the formalization of your safety team, injury prevention, OSHA compliance, safety training, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.
