Ohio CompTalk
Monday, August 30, 2010
Handicap Reimbursement Claims - How Hard Is Your TPA Working For You?
A recently published BWC report shows that ORM files a higher percentage of Handicap Reimbursement claims than other Ohio TPAs. Here are just a few examples:
TPA - Percentage of Handicap Reimbursement Claims Filed
ORM - 16%
Matrix - 13%
Spooner - 6%
Comp Mgt. - 3.2%
Careworks - 2.4%
The Handicap Reimbursement claim program reduces the employers risk costs on historic and current claims without reducing benefits to injured workers. A TPA can file a Handicap Reimbursement claim if the injured worker has a pre-existing condition that may have attributed to a work-related accident, occupational disease or death, or if the pre-existing condition may contribute to increased costs or a delay in recovery.
ORM proves once again, bigger isn't always better in Workers' Compensation claims management. How is your TPA working for you ?
Thursday, May 20, 2010
The MCO "Spin Game"
Spin #1: Medical Cost Savings: An MCO claims to be able to save the Employer (through their ‘exclusive’ provider network) a larger percentage of savings on fee bills, below the BWC fee schedule, thus reducing the premium you pay.
Logic to Consider:
a You get what you pay for. Many employers are already struggling to find providers in their areas that will even accept workers’ compensation claims because they do not want to accept the current fee schedule for their services. If an MCO is again undercutting that fee schedule, what service/treatment are your injured workers really receiving?
a Most provider networks have a very limited number of providers who have agreed to accept a reduced fee schedule which reduces or eliminates the probability that they will be chosen to provide treatment to your injured workers in your community.
a Employers are not directly charged for medical claim costs. You pay a premium to the BWC that is based on your industry type, payroll size, and Workers’ Compensation experience.
a Employees in Ohio have a freedom of choice to select any BWC certified medical provider to treat their Workers’ Compensation claim.
a Medical costs make up only a portion of your Workers’ Compensation experience which includes the last four years of claim activity.
a To achieve the savings offered by an MCO that claims they could have reduced your Workers’ Compensation medical costs by 10% thus saving you $$$ in BWC premium, you must assume that every injured worker will seek treatment from a provider who accepts reduced fees over the next four years to receive a premium savings in 2016.
a Are discounted providers willing to work with you on objective return to work and treatment durations?
Spin #2: Our MCO is better than your MCO because our BWC Report Card statistics are better.
Logic to Consider:
aBWC Report Card statistics are based on averages and claim volumes. The majority of all Workers’ Compensation claims are medical only (no lost time) reported immediately and turned around in less than one business day.
a An MCO with a large claim volume will have more medical only immediate report claims to offset the few lost time and delayed reporting claims which will produce a better average.
a A small volume MCO has the same types of claims and can provide the same service but has a higher average only because of a reduced volume discrepancy.
Remember, Bigger is Not Better. Vantage Occupational Health Plan (VOHP) offers hands-on personalized service for all of our employers. Vantage can guarantee a more efficient claims management process that will achieve a more cost effective outcome.
We invite you to visit our website to see how our clients define our quality of service at http://www.ohpinc.com/.
Friday, April 30, 2010
Our Clients Define Our Customer Service
“Thank you for responding to my email so quickly! I also appreciate the way you responded to each of my questions, directly, and with no political fluff.”
~Custom Farm Services – On becoming a new client
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“I am very grateful for all you have done for me. Because of you I feel hope and feel I may be able to be normal again. Thank you for your kindness and for giving me a chance to feel no pain. Thank you for being there for me!”
~Injured Worker excerpt from letter to VOHP Claims Manager
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3/2010
"Believe me, you make my job easier. I appreciate everything you do for us!"
~Ruth Pinnick, Pac Van - Integrated Client
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"Thank you for the updates." It's good to know someone is on the job."
~Rodhes Market - Integrated Client
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2/2010
"Thanks again for your excellent counsel regarding our injured worker's Workers' Compensation Claim. Your professionalism, courtesy, and outstanding customer service are always appreciated by Dane and I. We look forward to our continued, professional relationship."
~Larry Etchison, Director of Human Resources & Safety
American Welding & Tank, Fremont Plant - Integrated Client
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"We are very happy with your companies and are looking forward to consolidating MCO and TPA services with OHP this coming year."
~Northcoast Lighting - Integrated Client
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"We are very pleased with your services!"
~Metso Minerals - Integrated Client
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1/2010
"Although frustrated with the Ohio system, I'm very pleased with your integrated services, and proactive and attentive management of claims."
~Atlas Railroad Construction - Integrated Client
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"We're very happy with VOHP's services and understand the benefits of MCO/TPA integration, services we'll explore when the economy turns around. Thank you for taking the time to visit us!"
~Nelson Manufacturing - MCO Client
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"We are delighted with the integration of your MCO and TPA services. Thank you for taking the time to present your Policy and Procedures manual to us. Great disability management policy! We will be incorporating your Injury Reporting packet into our procedures."
~Volunteers of America - Integrated Client
*All testimonials are unsolicited, however some have been edited for clarity and/or length.
Monday, April 12, 2010
Evaluating Ohio Managed Care Services
This information is interesting, however, it does not include the basic customer service quality values an employer should be concerned about. We have outlined some MCO quality questions for an employer to consider:
1. Do you receive timely and informative notification of a reported claim from your MCO claims representative?
2. Do you work with a consistent claim representative that manages all of your active claims and is aware of your work environment and return to work policies?
3. Is your claim representative “pro-active” in managing your claims and persistent in achieving an objective return to work outcome?
4. Does your MCO assist you in understanding the Ohio BWC system?
5. Is your MCO assisting you in managing claims in a objective and cost effective manner?
These are the issues that directly relate to satisfaction with your Workers’ Compensation managed care service. The BWC report card will show you how one MCO compares in size and volume to other MCO’s in addition to claims processing statistics. A lot of the statistical averages are skewed based on the variance of claims processed between large and small MCO’s.
Friday, February 26, 2010
BWC Changes in Rate Calculation and Reserving
Split Rating Plan
The BWC is planning to implement a new rating calculation plan for private employers in July of 2011, with public employers likely following suit in January of 2012. Unlike the current rate calculation formula, the new plan will consider injury frequency in addition to claim cost severity. The goals of this “split” rating plan are to ensure better accuracy in determining employer premiums based on the risk their operations present, to provide less volatility from one significant claim, to add greater incentive to prevent workplace injuries, and to be more consistent with rating plans in other states. Further updates on the BWC split rating model will be provided as more detailed information become available.
As a “heads up” to those employers remaining in the $15K Program:
Although the parameters of the split rating plan are still under development, one component places a cost threshold on medical only claims for which they may be excluded from the experience calculation. Early recommendations have been to place a $1,000 threshold on each medical only claim. If implemented as recommended, this creates further disadvantage to continued participation in the $15K Program, as these claims would no longer have a significant impact on rate calculation.
Reminder on BWC Reserving System Changes
Effective July 1, 2010, all medical only claims will be eligible for a reserve. However, bear in mind that most medical only claims will not carry a reserve by the time they enter an employer’s experience period based on BWC statistical analysis. This change will first impact private employers for the rating year July 1, 2011 to June 30, 2012, and public employers for the rating year January 1, 2012 to December 31, 2012.
Salary continuation paid in claims with dates of injury on or after January 1, 2011 will be eligible for a reserve. Claims with dates of injury prior to January 1, 2011 will be grandfathered and continue to have reserves suppressed when salary continuation is the only compensation paid. In most cases, a salary continuation claim would only reflect a medical reserve unless the BWC issues some other form of compensation. The costs savings in avoiding the indemnity reserve by paying salary continuation may still provide financial benefit. This change will first impact private employers for the rating year July 1, 2013 to June 30, 2014, and public employers for the rating year January 1, 2013 to December 31, 2013.
Also effective July 1, 2010, all claims with living maintenance or living maintenance wage loss indicated as the last compensation type paid will no longer have a 50% reserve reduction and will be charged full reserves. This will impact private employers beginning with the July 1, 2011 rating year, and public employers beginning with the January 1, 2012 rating year.
ORM will continue to provide employers with assistance in determining which options are best for your company as we assess this new information. If you have questions regarding any of the BWC Programs or proposed changes, please do not hesitate to call Brandy Jordan directly at (614) 602-8273 or via email at bjordan@ohpinc.com.
Tuesday, November 3, 2009
BWC to Lower Group Rating Discounts for Ohio Employers
Some BWC proposed changes:
1. The BWC is considering reducing the base rates for the 2010 rate year.
2. The maximum Group Rating discount for 2010 will be dropping from 77% to 65% for private employers. Some employers eligible for 2010 group rating may actually find a larger discount remaining outside of group rating, considering the base rate reductions and other program participation.
3. A Break Even Factor (BEF) will be applied again for the 2010 rate year. As you may recall, the BEF’s purpose is to offset the base rate reductions for employers that are eligible for group rating, and is applied after the group rating discount is determined. This means that a private employer with no claims in the experience period qualifying for a maximum 65% discount would actually receive about a 51% discount once the BEF is applied.
4. The BWC is planning to apply reserves to all Medical Only claims within the current and future 5 year experience period to impact rate determination beginning in 2011. This has the potential to include medical claims in the $15K Medical Deductible Program. This potential reserve, coupled with new federal Medicare/Medicaid reporting requirements, dramatically reduce the return on investment value of the $15K program.
If you are currently enrolled in the $15K Program, we strongly encourage careful consideration of continued participation in this program based on these new proposals and regulations.
5. The BWC will begin applying MIRA Reserves to claims where the employer has paid salary continuation in lieu of Temporary Total Compensation, affecting rate determination beginning in 2011. The BWC will not suppress these reserves as they have in the past. Although this will likely decrease overall cost savings seen in previous years for employers utilizing this option, salary continuation may still offer viable savings for some employers.
ORM will continue to provide you with assistance in determining which options are best for your company as we assess this evolving information. We will look at all options to help you determine the best financial solution possible.
If you have questions regarding any of the BWC Programs or proposed changes, please do not hesitate to call Brandy Jordan directly at (614)602-8273.
Stay tuned for further updates as we get them.
Monday, September 21, 2009
Making the Case for an Employer-Preferred Medical Provider Relationship
How many risk management seminars have you gone to over the years that have stated that the secret to successfully managing your workers’ compensation claims cost is early intervention?
This is not a new idea for any of us who have been in this arena for very long but it still remains one of the most challenging to implement within a bureaucratic workers’ compensation system that allows an employee up to two years to report an injury and/or occupational disease. These types of claims are the ones that keep us up at night and can quickly put a small employer out of business.
Experience has taught us that there is no one strategy that will solve all the complex issues that can occur in a workers’ compensation claim.
One Logical Solution: Have you tried developing a Preferred Medical Provider relationship with a local occupational health provider?
What is a Preferred Medical Provider Relationship?
A Preferred Medical Provider relationship between an employer and a local occupational health provider establishes familiarity prior to a work related injury. The Provider is given the opportunity to understand the company, what the employees do, the demands of the jobs, the environment in which work occurs, and what is expected in managing the care of an injured worker.
The Bottom Line
The most beneficial part of the Preferred Medical Provider relationship is the establishment of a trust between the employer, the provider and the injured worker.
1. The Employer trusts that the injured worker is getting quality, appropriate care and that there will be a safe and efficient return-to-work outcome in the claim.
2. The Provider has been informed about the company and their policies and practices and is secure that there will be full support and trust in their professional position.
3. The Injured Worker trusts that they are receiving appropriate treatment and that they have the full support of their employer.
These three players have the most influence in obtaining a successful claim outcome. An important best practice is the establishment of a working relationship of all parties with the mutual goal of ‘optimum services within the optimum evidence based duration of disability time frames’. All parties benefit from this type of relationship.
For assistance in establishing your Preferred Medical Provider relationship or to discuss any part of your risk management program, please call Brandy Jordan at 614.602.8273.