By Judi Williams - Pro Active Case Management Services| Date: 03/01/2005A physician once said to me, “If a physician is smart, he will know that a Case Manager is his best friend.” What did this physician know and understand about case management? Case Management is a relatively new discipline in nursing and is now being recognized for its importance as a valuable tool in the worker’s... Read More
SummaryAfter you visit a provider, you may get a bill telling you how much you have to pay. Providers can include doctors, hospitals and others who give you healthcare. The amount you owe will depend on a number of things. Those may include whether you have insurance, as well as your type of plan and its cost-sharing requirements. They may also include whether you received... Read More
Reasons for peer reviewProcessQuality, relevance, and importanceDifferent methodsWhat do reviewers look for?FlawsPeer review is a quality control measure for medical research. It is a process in which professionals review each other’s work to make sure that it is accurate, relevant, and significant.Scientific researchers aim to improve medical knowledge and find better ways to treat disease. By... Read More
Posted by Joe Paduda on Thursday, January 6th, 2022 | CommentsOnce more I head out on a limb to prognosticate on the events and trends that will shape 2022.The soft market will continue.Carriers are still over-reserved, rates are still too high (see the opioid hangover), capital is still flowing into workers comp (gotta love that looooong tail), and employment growth may continue to be... Read More
Posted by Joe Paduda on Wednesday, September 8th, 2021 | CommentsLast week we pondered Mitchell’s future; as (perhaps) the largest WC entity outside the TPA space Mitchell/Genex/Coventry has an enviable position – albeit one that is by no means dominant.Today our attention turns to Paradigm, a company I’ve written about…a lot.I wrote this four years ago...I’ll admit to wavering... Read More
Med-Save Negotiations is not a prompt-pay discount. We review each bill to make sure that charges accurately reflect the procedure, facility usage, supply usage, and other factors. Our process incorporates physician-based and data analysis to identify and correct billing errors such as upcoding, unbundling, medically unlikely events and duplicate charges. The corrected bill is then analyzed for... Read More
Posted by Joe Paduda on Monday, August 2nd, 2021 | CommentsOkay, a LOT of interest among work comp service providers in rating/reviewing workers’ comp payers…so let’s find out what service providers want to know/share.I’ve got a few thoughts about key considerations…perhaps assessing payers based on:does the buyer really know what they want?rating payers on how they work with... Read More
One of the top issues in work comp pharmacy – heck in all pharmacy – is transparency.More than half of the 27 respondents to our latest Survey pf pharmacy management in workers’ comp want more transparency, while several others “need more transparency as I don’t feel comfortable not knowing if pricing is fair.”The question is – what exactly is “transparency?Is it the customer... Read More
by Bethan Moorcraft 06 Apr 2020Health reform in the United States has led to a significant increase in the number of employers that offer self-funded health benefit programs. As self-insured plans are generally free from state-governed insurance requirements, employers are able to provide more flexible and tailored coverage, which could result in cost savings. However, self-funding also comes... Read More
Posted by Joe Paduda on Thursday, June 3rd, 2021 | Comments I spend a lot of time in the weeds, digging intofacility reimbursement details,evaluating COVID infection rate studies,identifying new work comp scams,figuring out if WC claims will increase,railing at insurers and TPAs that aren’t doing what they should be,studying the impact of pharmacy on work comp claim reserves andall manner of... Read More