Innovative Program Helps Lower Major Cost Driver in Workers’ Compensation
SAN JOSE, Calif.–(BUSINESS WIRE)–An often overlooked cost driver in workers’ compensation made news recently when a large self-insured employer reported discovering medical payment errors and a cost saving solution to better manage its claims payment process.
Motivated by a 2008 study from Navigant that showed 38 percent of medical payments in the California workers’ compensation system were inaccurate, this payor conducted its own study of 100 files, analyzing all medical payments associated with the cases.
In its study, this self-insured company realized that, because its bill review system did not link to its utilization review, payments were made to medical providers even though medical treatment authorization had not been given nor was an original approval obtained to perform treatments. By establishing connectivity, if there is no match between the utilization review-authorized CPT code and the bill, the payment request is culled out and analyzed for adjustment as appropriate.
The payor’s discovery is familiar to EK Health Services Inc., a company experienced in a process that links and closes the gap between utilization review and bill review, helping lower claim costs.
EK Health, a national workers’ compensation managed care company, developed the innovative program of connectivity that, among other features, automatically flags medical treatment that is unauthorized or outside the guidelines of evidence-based medicine of ACOEM/California Medical Treatment Utilizations Standards (MTUS). EK Health will be discussing its program at the National Workers’ Compensation and Disability Conference.
As part of EK Health’s medical bill management system, the program uses advanced software technology and clinical expertise to automatically match utilization review-authorized CPT (Current Procedural Terminology) with line items on each bill. The process has shown to create a savings of up to 20 percent over and above the traditional bill review, revolutionizing the bill review industry.
“Understanding the benefits of merging these components of workers’ compensation claims management is an important step to helping payors lower the overall cost of the claim,” said Oliver Ostlander, vice president of operations and business development for EK Health. “The connectivity helps the injured worker receive the right medical care needed to get back to work, while ensuring medical providers are compensated appropriately for correctly following and documenting an authorized treatment plan.”
EK Health Medical Bill Management Services can be customized to incorporate state-mandated fee schedule review and non-fee schedule states bills processing. It includes code review and unbundling, fee schedule analysis, PPO management, in-patient and out-patient line item review, enforcement of UR decisions and re-pricing. With its systems reporting capability, the bill processes are transparent and information is available 24/7.
Founded in 1998 and headquartered in San Jose, CA, EK Health Services is a national workers’ compensation managed care company specializing in case management, utilization, peer and bill review services to insurance companies, employers, for-profits and public entities, including California’s State Compensation Insurance Fund.
For EK Health Services Inc.
Mary Estes, 813-839-3324