Madison, CT – The integration of workers’ compensation utilization management/review (UM/UR) systems with bill review and other medical management systems was a key issue detected by Health Strategy Associates’ (HSA) 2012 Survey of Workers’ Compensation Utilization Management/Review (UM/UR).
Conducted on-line, the survey assessed two distinct groups: workers’ compensation executives tasked with overseeing UM/UR and the front-line staff responsible for day-to-day UM/UR processing.
“There’s a big gap between the perceptions of executives and front-line claims managers when it comes to the integration of UM/UR with other medical management systems,” said HSA Principal Joseph Paduda. “Execs are one-and-a-half times more likely than front-liners to report their UM/UR systems are integrated. In fact, the one thing the front-line ‘wished’ their UM/UR vendor was doing was ‘system automation and integration.’ If UR determinations are not getting to bill review in time, unauthorized procedures are being reimbursed.”
Other highlights are:
- UM/UR systems have been in place an average of five years;
- Majority of respondents use UM/UR to control medical costs and ensure appropriate treatment;
- All types of services are subjected to UM/UR from low-cost items, such as physical therapy, to high-priced surgeries;
- A decision to switch vendors would be based on service, results and outcomes and both groups feel it is fairly easy to change vendors;
- No vendor enjoys brand awareness; many were unknown to a substantial percentage of respondents.
The survey was sponsored by CID Management, a URAC-accredited utilization review company, providing utilization management, peer review and per-incident clinical management services to workers’ compensation payers. Paduda will present findings on Wed., Nov. 7, at 2 p.m. and 3:30 p.m. and Thursday, Nov. 8, at 10:30 a.m. at CID Management’s booth (1023) during the National Workers’ Compensation and Disability Conference at the Las Vegas Convention Center. Attendees may pick up copies of the report at the booth.
Source: HSA/King Knight