Wayne, PA – GENEX Services recently announced the launch of the industry’s most comprehensive guidelines for the use of transportation services – by ground or air – for workers’ compensation injuries.
Introduced to the company’s 1,500 internal case managers in January, roll out to all customers is currently underway. GENEX Transportation Guideline is intended to provide research-based assistance about when and where, as well as what mode and vendor is best for injured workers, including ambulance, helicopter and air transport. The Transportation Guideline provides direction on expenses for transportation that have already been incurred as well as for prospective or future transportation expenses.
Because transportation decisions directly affect recovery of the injured worker, they are a critical component of the treatment plan. The decision of when to use transportation service is important for employers and carriers, as it can amount to thousands of dollars per individual claim. According to GENEX’s review of 2014 data on national provider billed charges for transportation services, emergency ambulance transportation costs can exceed $1,100 per mile, non-emergency costs are more than $700, and helicopter use can be as high as $41,000.
GENEX conducted extensive research into best practices in transportation for injured workers, encompassing a wide range of sources, including industry data, recommendations from the Centers for Medicaid and Medicare Services (CMS) and peer-reviewed literature.
GENEX also incorporated Agree II (The Appraisal of Guidelines for Research Evaluation II), the gold standard for evaluating clinical guidelines. It assesses the rigor and transparency used in the development of a guideline.
“The underlying criterion when determining whether ambulance transportation is needed is whether or not it is necessary for the health of the claimant,” noted Dr. Maury Guzick, medical director of GENEX Services. “Clearly a worker with a traumatic injury such as a burn or loss of limb requires an ambulance – perhaps even transport by air – but sometimes the need is less clear, and then we use the clinical and research-based guidelines to help make the decision.”
Guzick notes that there is a wide range of issues to examine, including: Does the claimant have an injury or medical condition that requires medical attention during transport? What if a claimant doesn’t have a car and needs assistance getting to physical therapy? Should the workers’ comp program cover transportation by taxi? By ambulance? What are the costs to the employer in delayed return to work or exacerbation of injury if the injured worker doesn’t get to the doctor?
GENEX has 344 evidenced-based, proprietary guidelines created to help its case managers, adjusters and customers better manage claims. The Transportation Guideline is one of the newest.
Source: GENEX