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Most Workers Comp Bill Review Overcharges Need To Be Examined


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.

We have seen overcharging for things such as:

  • Price per bill or each line of the bills
  • PPO Network Access Fee
  • % of Savings – this one is abused the most
  • Physicians Discount Fee
  • Hospital Bill Negotiation Fee
  • Many others use different and catchy names
Vector Graphic of Cell Phone Workers Comp Bill Review Calculator And Dollars

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” 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” PPOs and bill review companies that are independent of insurance carriers and TPAs. They are 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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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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