Workers Comp Bill Review Charges
Workers Comp bill review can be a very important risk management technique. One of the most controversial areas in Workers Comp from what we have observed is when the carrier or TPA charges an employer to do their Workers Comp bill review.
- Price per bill or per line
- PPO Network Access Fee
- % of Savings – this one is abused the most
- Physicians Discount Fee
- Hospital Bill Negotiation Fee
- Many others using different and catchy names
This is one area that if you feel that you do not understand, it is best to call in an expert. We discovered in 1998 a bill review and PPO company that was overcharging a public employer $680,000 per year in just bill review fees. The public employer signed off on the review contract, so there was no $ to be recovered.
Pre-contract signature negotiations tend to be the best time to review what your company will be charged for such fees as in the above bullet points. We heavily recommend that until the fees can be broken out into “plain language numbers” that you do not sign the contract.
Also, watch the automatic renewal clauses if you do not sign a new contract. The automatic renewal fees are not as popular as in the past. They do still exist in some contracts.
There are now “boutique” PPO and bill review companies that are independent of insurance carriers and TPA’s. They are really catching on in California with their recent Workers Comp law changes. These boutique PPO companies work directly with the employers, usually Self Insureds or Large Deductible programs.
These fees may be billed off-claim, which makes them very hard to track. Most providers will offer monthly breakdowns of their fee structure and individual charges on each claim. Some of them are not easy to comprehend. You have to ask for a full report to receive all the information you need to examine your company’s bill review fees.
Next Up – PBM’s – are they worth the fees?
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