Archives for April 2014

Workers Compensation Action Network (WCAN) – Great California Chart

April 29, 2014 By JL Risk Management Consultants

Workers Compensation Action Network

Workers Compensation Action Network (WCAN) produced another great graphic on the Workers Comp situation in California. Click here for the chart. Why do I try to point out most of the happenings on WC in CA? This is a WC system that is becoming prohibitively expensive for employers.Some of the same variables are present or growing in other states’ Workers Comp systems can be seen in California presently.The most startling number was the 41% medical cost increases in such a short time (2007- 2008 and 2011-2012). SB 863 may shorten the continuation on some of the increases.

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As pointed out often in these articles, California seems to be on the cutting edge quite often for any workers comp developments. What happens in CA may soon be coming to your state.

The trends that occur in CA seems to flow out into other states’ WC systems. That is why I try to point out any significant developments that occur in CA..

Sitting behind a desk and thinking that your Workers Comp related job will always be the same is just not going to work in today’s insurance and legal environment.

©J&L Risk Management Inc Copyright Notice

Loss Runs Most Important Time To Have Them Updated

April 24, 2014 By JL Risk Management Consultants

Updated Claims Loss Runs Are Critical To Cost Savings

Your WC loss runs should be up to date at all times. Online access is key as carriers and TPA’s will usually allow ad-hoc reports for analyzing loss data.

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January 1 is the most popular renewal date for Workers Comp policierenees even though January 1 should be avoided for policy renewal dates.

Most policies with a January 1, 2015 renewal date have a very important date occurring in the near future. Generally, on June 30th at the close of business, the applicable Total Incurred figures will be pegged by NCCI or your state’s rating bureau.

In this case, June 30th, is the Unit Statistical reporting date. Your company’s E-Mod/X-Mod will usually be calculated in the next 90 – 120 days using the June 30th figures.

If your loss runs are not up-to-date, how will you know whether or not the Total Incurred figures are correct on your Workers Compensation files? If your company has a January 1st renewal date, you will usually have 67 days from today to negotiate any reserve figures with your insurance carrier.

As I have said often, do not just call up the claims department or your agent and say the reserves (Total Incurred – Paid) are too high. This will only negatively affect the working relationship you have established with your Workers Comp claims adjusters. You need to be specific.

The key is knowing which claims have truly been over-reserved. Selecting the proper claims to question may lower your next years’ E-Mod/X-Mod. Selecting the wrong ones can be costly.

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Independent Medical Exams (IME) – Great Article On Basics

April 22, 2014 By JL Risk Management Consultants

Independent Medical Exams (IME)

Workers Comp Independent Medical Exams (IME’s) can be a great risk management technique when used properly. IME’s are worth the time and cost in certain circumstances.

Picture Of Medical Personnel Independent Medical Exams In Hospital

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The final diagnosis and medical opinion by the IME physician may often agree with the current medical treatment and future treatment plan. However, knowing that the injured employee is receiving the proper medical care is of the utmost importance.

This is a great basic article on the mechanics of the IME process. If you are not familiar with the process, I do recommend reading the articles on the first two links in this article.

One possible way to reduce the need for IME’s is to have the proper medical treatment network from the day the claim is reported until its conclusion. Controlling the medical is one of the Five Keys to Reducing Your Workers Comp Costs. The treatment network will usually consist of:

General Practitioner/Walk-in-clinic – original treating physician
Orthopedist/Orthopedic Surgeon
Pharmacy
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Physical/Occupational Therapy
Dental – may not be used that often, but still need to have one in place
Optometrist/Ophthalmologist – may not be used that often, but still need to have one in place
Hospital
Ambulatory Surgery Centers
Radiological – especially MRI’s
This is not an exhaustive list

Some states require the employer to have a panel of physicians for the employee to choose from when receiving treatment for their injuries. Other states allow the employee to have the choice. The number of states that allow employee choice has been shrinking over the last few years.

Most Third Party Administrators (TPA’s) and carriers will usually have a medical treatment network in place that will save even more on the cost of medical treatment.

The bottom line is the treating physician may be seen by the WC Board or Industrial Commission as the only impartial witness in the claims process.

©J&L Risk Management Inc Copyright Notice

Workers Comp Action Network – California SB 863 – Great Infographic

April 21, 2014 By JL Risk Management Consultants

Workers Comp Action Network Produces Great SB 863 Infographic

The Workers Comp Action Network produces great summary charts for California work comp analysis. They have once again made the complicated much simpler with their great work.

Graphic Of Computer Screen Workers Comp Action Network With Analysis

WCAN (Workers Comp Action Network) has created the best explanation of the implementation and cost of California’s SB 863. You can find the infographic here. (Requires PDF reader).WCAN’s position is that if not all of SB 863 is after implementation the costs may end up outweighing the benefits. Nine of the 14 areas of SB 863 have been implemented overall. Three of the nine are on track for cost: savings. Those areas are:

Lien filing fees
Ambulatory Service Center fees
Spinal Hardware pass-through payments

There are three areas where costs have increased post SB 863:

Workload has tripled for IMR’s (Independent Medical Reviews)
Litigation
Permanent disability filings have increased 5% after SB 863 vs. the 1% forecast

It is highly recommended that you download the infographic. The infographic is the simplest analysis of SB 863 that I have seen to date. The link to the infograph has been provided at the top of this article. Upgrades to WordPress now allow the graphics/charts to be included in some of the articles.

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CMS Self Administered Toolkit for WCMSA’s – Confusing Section

April 17, 2014 By JL Risk Management Consultants

CMS Self Administered Toolkit

This article is a continuation of the CMS Self Administered Toolkit. The CMS (see yesterday’s J&L Blog article) has done a good job in attempting to provide injured employees with a guide if they decide to self-administer their WCMSA’s (Workers Compensation Medical Set Asides). Most of the CMS Self Administered Toolkit seemed helpful until this section.

hiv.gov

One blogger has suggested that the guide was not user-friendly. I was going to disagree until I read this section. One confusing area is trying to instruct the providers on how to bill for the charges.

What happens if the provider does not agree? Are they under any obligation to bill at the rate requested by the patient?

How can an RX provider be required to pay AWP as described below?

The letters to use are not that great to instruct a provider how to bill for services.

Section 5: What to Tell Your Health Care Providers

Before you get treatment for your WC injury, you must advise your health care
providers about your WCMSA.

Your health care providers should bill you directly, and you should pay them out
of your WCMSA account, IF:

Picture Of Calculator and Financial Bill CMS Self Administered Toolkit On Table

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• The treatment or prescription is for the WC injury, AND
• The treatment or prescription is something Medicare would cover.

How should my health care providers calculate the bill?

You will need to know whether the WCMSA was set up based on full actual charges (the actual cost of the item or service). If so, health care providers may bill you according to full actual charges.

On the other hand, if the WCMSA was funded based on a state (or federal) WC fee schedule (rates negotiated between WC and health care providers’ groups), the health care providers may bill you
based on those fee schedule rates.

Any prescription medications should be billed based on the Red Book Average Wholesale Price (AWP). Your provider will have access to this resource.

Mid Adult Doctor CMS Self Administered Toolkit Explain

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Tell your health care providers how your WCMSA was set up so they can bill you for your WC injury treatments using the correct pricing method. Note: Regardless of how you are billed by your health care provider, your WCMSA funds should be used to pay for your treatments. Sample letters for this purpose are included in the Letters and Examples section of this Toolkit.

If your health care providers mistakenly bill Medicare for your WC-injury-related treatment, remind them to bill you directly so you can pay them from your WCMSA account. Your health care provider is responsible for refunding any payments received from Medicare for bills related to treatment of the WC injury.
What if my health care provider is also treating me for other problems?

If your health care provider is also treating you for conditions not related to your WC injury, be very certain that you do not pay for such treatments using your WCMSA account. Use other insurance, including Medicare or your own funds. If you are not certain whether a treatment is related to your WC injury, ask your health care provider.

Should the provider make basically a WC adjuster-type decision?

©J&L Risk Management Inc Copyright Notice

CMS Issues WCMSA Self Administration Toolkit For Injured Employees

April 16, 2014 By JL Risk Management Consultants

WCMSA Self Administration Toolkit Good idea

A WCMSA self-administration toolkit for injured employees was a desperately needed item. Last week, the Centers for Medicaid and Medicare Services (CMS) created a page with quite an amount of documentation for Workers Comp Medicare/Medicaid Set Asides (WCMSA).

Picture Of Woman With Arm Injured WCMSA Self Administration Toolkit With Plastercast

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The page is for injured employees that wish to Self-Administer their MSA account. The CMS provided a laundry list of documents for claimants that did not wish to have an outside service handle their MSA account. Click here for the page. The PDF file for the toolkit is here.

The CMS does a great job of explaining the WCMSA process. The amount of tracking and materials may be too burdensome for some of the injured employees. CMS performed well for giving it a try. The Table of Contents of the guide is below. The page numbers were intentionally left off the Table.

There are a few interesting yet troubling areas in the guide. Those will be included in tomorrow’s article.

Table of Contents

Section 1: Introduction
Section 2: Setting Up the WCMSA Bank Account
Section 3: How Your WCMSA is Funded
Section 4: Using the Account

What medical and prescription expenses can I pay for from this account?
Can I use the account to pay for anything else?

Section 5: What to Tell Your Health Care Providers

How should my health care providers calculate the bill?
What if my health care provider is also treating me for other problems?

Section 6: Reviewing and Paying Your Bills
Section 7: Keeping Records
Section 8: Annual Attestation

Final depletion of funds

Section 9: Reporting Changes

Medicare entitlement status

Section 10: Inheritance
Section 11: Topics Unique to Structured WCMSA Accounts

What if I do not use all the funds in a year?
What happens if my funds run out before the next deposit?

Section 12: Where to Get Help
Section 13: Letters and Examples

Letters for your health care providers: Medical providers
Letters for your health care providers: Pharmacy providers
Lump-sum annual attestation and expenditure letter
Lump-sum annual attestation and expenditure letter: Exhausted lump-sum account
Structured account attestation and expenditure letter: Annual attestation
Structured account attestation and expenditure letter: Temporary exhaustion
Structured account attestation and expenditure letter: Permanent exhaustion
Transaction Record Sample

Section 14: Glossary

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Best Workers Compensation Apps on Google Play Store Are

April 15, 2014 By JL Risk Management Consultants

The Three Best Workers Compensation Apps

Last week, I wrote two articles on any Workers Compensation apps that were in the Google Play store. As promised, I have tried a few out to see if any actually worked and if any would be helpful.

Wikimedia commons – Google

The one that actually looked to be a timesaver and worked well was Sedgwick’s ViaOne Express. Even though there have been connections and leave reporting issues, it is one of the better ones on the Play store. The app received 3.5 stars out of 5. Even though the score could have been better, it is slim pickings on the Play store website for WC apps.

Online claims access is always critical in controlling Workers Comp costs. The ability to have the injured employee update their return to work date is a nice feature. If there are better apps that are not on Google Play, the provider can always upload it to the Play store. A description of the Sedgwick app is below.

Description

Beneficiaries Workers Compensation Apps in Danang

Wikimedia commons – USAID Vietnam

Sedgwick viaOne express mobile gives our clients’ employees instant access to view the status of their workers’ compensation, disability and FMLA/leave claims and cases managed by Sedgwick, as well as the ability to submit any questions they may have regarding claims, forms, benefit plans and more. Claimants can even update the claims examiner regarding their anticipated return-to-work date.

Self-registration – If you are not yet registered on the web, you can self-register by providing a valid claim/absence number or employee ID, along with key demographic information.

Claim and case summary – View a list of your recent workers’ compensation, disability, and FMLA/leave claims and cases (open or closed within the last 24 months).

Claim and case details – Click on the claim number to view additional information concerning each claim or case.

Payment history – View a payment history log for workers’ compensation and disability claims that are scheduled or have been issued in the last 60 days.

Submit a request or inquiry – Use a secure online form to submit any of your requests. For example, submit a new return-to-work date or need for extension; indicate your next medical appointment or your plan to submit new medical information, or send a general question to be addressed by your claims examiner or leave specialist.

Claim status notification preferences – Now available for employees of select workers’ compensation clients, app users can opt in to receive notifications related to their cases and claims.

Contact technical support – Access viaOne express mobile support representatives.

Contact claim support – Simply click to call a Sedgwick claims representative focused on providing live support to answer your claim or case questions.

©J&L Risk Management Inc Copyright Notice

Android Apps for Workers Compensation Looking Further

April 9, 2014 By JL Risk Management Consultants

Android Apps for WC – A Further Look Online

I decided to carry the Android apps for the Workers Compensation examination from yesterday further and look at each one. Please note that I did not access most of the apps themselves. Many of the apps were combined when they were from the same provider.

Picture Of Cellphone With Android Apps On Table

Wikimedia commons – Intel Free Press

The rest of the 177 Android apps from yesterday were mainly plaintiff attorney-based or were unrelated to Workers Comp such as anime. I did not include the provider’s name unless it was necessary to describe the app. You may use the link from yesterday to see a list of the apps. When I accessed the apps early this morning using the same search term, the results were slightly different than yesterday. There are many apps for WC that are not in the Android marketplace for some reason. I did not mention those apps. I will be covering the best three out of the list next week.

Experience Mod app – did not work
State of Mississippi Annual WC Conference – good app
Digital Permanent Disability Calculator – cost $ to use
Oregon TPA – Risk Management Library – purports to provide invoices, schedules, documents, risk management library, publications as PDF documents
National PBM provider – good RX app
National occupational med clinic – good app that allows injured employees, adjusters, and employers to have access to records
Wikimedia commons – Google
National Third Party Administrator – app allows full access to claims information, my favorite if it works properly
National Workers’ Compensation and Disability Conference® & Expo app – for attendees. I have used this app previously and it performed well
California Occupational Code lookup app, single impairment calculator, combined and full impairment calculator – all paid apps
Nevada TTD/PPD Calculator – simple table search and calculator
Texas lifetime, temporary, and supplemental benefits calculator
Workplace safety app
North Carolina single impairment calculator
North Carolina WC Statutes
Florida Temporary Partial benefits calculator
National PBM provider
Risk & Insurance Magazine – I read their emailed version

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Workers Compensation Apps Google Play Store Has 177 – Few Helpful

April 8, 2014 By JL Risk Management Consultants

Google Play Store Has 177 Workers Compensation Apps

I have owned a Google Nexus 4 phone for approximately one year. There are so many apps to choose from for most of what I need that the experience is similar to car-shopping. While I was in the Google Play store (never liked that name) I thought I would perform a search for Android Workers Compensation apps.

Wikimedia commons – Google

There are 177 apps on the results screen. Many are from plaintiff attorneys from across the nation. I am going to trudge through the apps to see if any are that helpful. If anyone reading this article knows of a great app for Workers Comp, please feel free to post a reply, or email me.

I will provide updates as I eliminate any of the 177 that do not belong there. I see that are a few anime apps that are beyond me why they would show up in the search results.

My first one that I thought would be interesting was an app on Experience Mods (E-Mods/X-Mods). It did not work whatsoever. I had to remove it from my phone.

BTW- the most useful overall apps I have found are:

The Weather Channel
Amazon Kindle
Audible
Avast! Mobile Security
SwiftKey
Android Assistant
QuickOffice
Google Maps
Google Chrome

Hopefully, there will soon be more providers of Workers Compensation apps in the near future.

2019 Update – I have received a few emails with explanations on why not as man apps show up in the Play Store searches. Website-based apps became more popular in 2018 – 2019. The need to provide an app shrank over the last two years.

Smartphones became powerful enough to not require an app to provide the necessary information online. Most phone can handled Microsoft Edge, Firefox, and Chrome without having to resort to an app. In other words, smartphones replaced computers with the handling of online workers compensation apps.

©J&L Risk Management Inc Copyright Notice

Determining Future Medical Exposure – Life Care Plans + Cost Projections

April 2, 2014 By JL Risk Management Consultants

Determining Future Medical Exposure Presentation

Determining future medical exposure was the next presentation. Presenters – Alisa Cornetto and Carmen Bullard, Concierge Medical and Risk Consultants

Picture Of Baby Determining Future Medical Exposure Wearing Doctor Dress

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Hire someone certified due to Daubert rules and also that have proper credentials

Review CV’s of life care planners and other consultants

Definition of Chronic Pain – daily pain that has lasted six months to on year after the original pain incident

15% – 20% of the population has chronic pain

Cost of Chronic pain (annually):

2003 – $25 billion
Present – exceeds $40 billion

Pain:

25% of all sick days = $50 million
80% of all physician visits

Definition of A Life Care Plan:

A life care plan is a dynamic document based upon published standards of practice, comprehensive assessment, data analysis and research which provides an organized concise plan for current and future needs with associated costs, for individuals who have experienced catastrophic injury or have chronic care needs

Goals

Provide health education to the interested parties, when appropriate.
Develop accurate and timely costs information

Functions

Collect data that is systematic, comprehensive, and accurate

Research

Use reliable sources
Sources that are readily available to the client

Considers

Duration of care
Replacement frequency
Appropriate use by client
Care is reasonably available

MSA Analyis and Life Care Plan are two very different things

Life Care Plan needs to be collaborative

Medical Cost Projections are not the same as Life Care Plan

No governing body for Medical Cost Projections

Goal is the patient

Chronic Pain 101 Evidence Based Medicine – Dr. William Nemeth

April 2, 2014 By JL Risk Management Consultants

Chronic Pain 101 Evidence Based Medicine

Chronic Pain 101 was the next topic at the conference.

Dr. Nemeth ([email protected]) with RestoreFx was the prior Medical Director for the TDI – State of Texas. He is from Austin, TX. He is going to talk about medication misuse.

Picture Of Man With Chronic Pain 101 Black And White Picture

Wikimedia – Simon James

Definitions

Abuse – Addiction is a brain disease with loss of control, compulsive use, craving, and consequences.
Tolerance – the state of physical adaption in which exposure to a drug induces changes that result in decreases of drug effect over time
Hyperalgesia- a state of hypersensitivity following the withdrawal or of opioids or in chronic addiction
Pseudoaddiction – drug seeking due to the undertreatment of chronic pain

Pain

Acute
Chronic
Nocieceptive
Neuropathic

Chronic Pain Syndrome

Copers – tolerate the pain
Chronic pain syndrome

Screening

Up to 56% of Pain Clinic patients
Alcohol/Drug/Use
Family History of Addiction
Behavioral indicators
Urine Drug Screening
Smoking
Medical Indicators

TAKEAWAY – CHRONIC PAIN – ADDICTION IS A BRAIN DISEASE

Dr. Suzanne Novak – Board Certified Anesthesiologist, PhD Outcomes research and pharmacoeconomics, Professor in pharmacotherapy, at University of Texas, lead author ODG Treatment Guidelines

She is the wife of the prior speaker – Dr. Nemeth

Medicines Chronic Pain 101 Vector Graphic

Wikimedia – Pöllö

ODG- National Guidelines- prescribing guidelines that are now accepted in the 13 states.

Evidence Based Medicine (EBM) is here to stay

There are obviously limitations to the use of EBM

Handling a Complex Case Main Focus

Evidence based
Effective
Safe
Cost-effective in most cases

Paying for something that is not work-related

Diabetes
Hepatitis
Autoimmune disease
Numerous other conditions

Part of the problem missed

Injections
Other care – e.g. urine drug screens
Compounded drugs
Causality
Underlying comorbidity

Why to do the review and uses of info

Treatment plan issues
Settlement//MSA
Have a plan
Get a team
Who will first contact provider?
Type of info
Options to offer

State of Washington – Labor and Industry has a daily morphine equivalency calculator – used to see the amount of morphine can be equated to a daily amount of narcotics. There is also a Benzodiazepine equivalency calculator.

Injections

Interventional techniques increased by 228% – 2000 to 2011
Medicare expenditures increased by 240% – 2000 to 2008
Office of Inspector General (DHHS) significant proportion of facet joint and ESI’s were not medically necessary.
A single facet joint injection is recommended
If 50% or more pain relief for 6 weeks from the single facet injection, proceed to other blocks
Series of three injections is antiquated

Urine Drug Testing

A Point of Care screen is recommended before initiating chronic opioid therapy
Risk assessment should be made on a schedule determined by patient abuse risk factor
Random collection is encouraged
Quantitative testing is not recommended

Tina Fey May Have Had Workers Comp Coverage After All

April 1, 2014 By JL Risk Management Consultants

Correction on Tina Fey Article

Even Tina Fey has to have Workers Comp coverage. A recent article in the Insurance Journal indicates that Tina Fey may have had continuous coverage. I found an article last weekend which said she owed $79,000.

Wikipedia – Evan-Amos

However, the newest article did not say that WC coverage was found for a period from November 2012 to November 2013.

The New York Comp Board said that it was a clerical error. I have rarely seen a WC Board admit to the press that a clerical error was made after fining a company for no WC insurance.

I rarely do previous article retractions of any type. However, I did not want to accuse anyone of not having WC coverage if , in fact, they did have a policy in effect.

Even Tina Fey is not above the law when it comes to having WC coverage in place to cover any on the job accidents. Many states such as North Carolina have been lax in enforcing the laws and rules which require WC coverage for employers.

The actress and writer could have been in hot water if one of her employees was injured on the job with no WC benefits.

Archives for April 2014

NCCI Study on Effect of Fee Schedules

Workers Compensation Action Network

Updated Claims Loss Runs Are Critical To Cost Savings

Independent Medical Exams (IME)

Workers Comp Action Network Produces Great SB 863 Infographic

CMS Self Administered Toolkit

WCMSA Self Administration Toolkit Good idea

The Three Best Workers Compensation Apps

Android Apps for WC – A Further Look Online

Google Play Store Has 177 Workers Compensation Apps

Determining Future Medical Exposure Presentation

Chronic Pain 101 Evidence Based Medicine

Correction on Tina Fey Article