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Workers Compensation Bill Review Charges Can Be Expensive


Insurance Company and TPA Workers Compensation Bill Review Charges

Workers Compensation bill review fees can be exorbitant.  The fees an employer’s TPA or insurance company charges for bill review have always been one of my sore spots when we do reserve and/or claims handling reviews for employers.

Picture of Dollars Workers Comp Bill Review And Medicine

This is an area that seems to be the most confusing and misunderstood in the Workers Comp claims process. It is a good idea to check these fees very closely when looking at your loss runs. However, are the bill review charges under Medical or Expense? There is a great amount of inconsistency in where these fees are located in the payouts.

There are many different combinations of charges by Workers Compensation bill review companies.

A few of them are:

  • Header Fee – a flat per-bill set-up fee
  • Line Charge – a flat fee for each line processed on the bill
  • % of Savings – my least favorite way for employers to be charged. The employer pays a % of savings – no matter what they are – back to the bill review company. If you are being charged this way, you may require an immediate bill review by an outside consultant company such as J&L
  • Network Fee – If you access the bill review company’s providers, your company must pay a % of the savings back to the bill review company. For example, a total initial savings could be 15% of the post-fee-scheduled bill.
Picture Drug Deal Workers Comp Bill Review Charges

Many other agreements can be reached on fees Workers Comp medical bill processing. The one area that I mentioned previously in this post is where the charges for bill review are located. You may have to look hard to find them. The charges will not be on the loss run. If you look back into my previous posts, you will see where I heavily recommend online claims access. That is a great way to see how you are being charged for bill review and other charges. You may find some unpleasant surprises.

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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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