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Introduction to Effective Medical Claims Management

Introduction to Effective Medical Claims Management. Presented by Dianne Lindsay. Workers’ Compensation Services. How time off impacts your place of business. Loss of experienced employee(s) Hiring and/or training of replacement workers Extra labor costs Loss of productivity

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Introduction to Effective Medical Claims Management

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  1. Introduction to Effective Medical Claims Management Presented by Dianne Lindsay Workers’ Compensation Services

  2. How time off impacts your place of business • Loss of experienced employee(s) • Hiring and/or training of replacement workers • Extra labor costs • Loss of productivity • Workflow disruption • Supervisor distraction Workers’ Compensation Services

  3. The importance of employer involvement • Claims costs impact the amount you pay for workers’ compensation • One claim can prevent your from being eligible for group rating • An increase in premium from an adverse claim can impact your rates for 4 years Workers’ Compensation Services

  4. Importance of Employer Involvement • Ensuring prompt reporting • Educating supervisors and staff • Individualized reporting packets • Identification of potential safety issues Workers’ Compensation Services

  5. Importance of Employer Involvement • Maintain contact with IW • Development of preferred provider network • Contact with Provider • Job Descriptions Workers’ Compensation Services

  6. Importance of Employer Involvement • Accommodating restrictions • Modified work • Salary continuation • Identify barriers to RTW Workers’ Compensation Services

  7. VocationalRehabilitation • 15k program-Pros & Cons

  8. Red Flags • Relationship of accident/incident unclear • Treatment is excessive and/or exceeds nationally accepted treatment guidelines • Continuous medical/chiropractic treatments without documentation of improvement Workers’ Compensation Services

  9. Red Flags • Multiple medical providers, ancillary services and ER visits • Medical and non-medical issues seem to complicate recovery • Delay in return-to-work Workers’ Compensation Services

  10. Red Flags • Pre-existing conditions • Multiple medical conditions and diagnoses and treatment is excessive or unusual Workers’ Compensation Services

  11. Red Flags • Recovery is slow without medical indication • Unable to contact Workers’ Compensation Services

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