Insights
Clinical Oversight Reduces Claim Costs by Recommending Discharge Over Added PT
To control escalating therapy costs, a managed care organization implemented a system of regular reviews for additional physical therapy (PT) authorization requests. They sought a clinical partner with PT expertise to provide informed recommendations on whether to discharge patients or approve continued therapy.
Workers' Compensation Pharmacy Legislative and Regulatory End of Year Recap
6 MIN READ
New regulations, proposed legislation, and notable judicial developments made 2024 a significant year for workers' compensation pharmacy programs. For pharmacy benefit management (PBM) roles, staying on top of these changes is critical for compliance and operational efficiency. Here is a recap of some of the major developments in workers' compensation pharmacy we’re watching as we move into 2025.
Managing the Seismic Shift from Inpatient to Outpatient Physical Medicine Services
Learn how shifting rehabilitative care to outpatient services earlier in recovery impacts physical medicine networks and return-to-work outcomes in our insightful conversation with Kim Radcliffe of Enlyte.
Ask The Pharmacist: Preventing Tetanus in Workers’ Compensation
2 MIN READ
Tetanus is a serious infectious disease that can result from workplace injuries. Caused by spores of the bacterium Clostridium tetani, tetanus is often associated with rusty nails but these spores are found in many environments, including soil, dust and animal feces. All it takes for infection is a small cut, puncture wound, or scrape—common injuries in many workplaces.
Field Case Manager Delivers Early Full Duty Release
2 MIN READ
A successful recovery takes collaboration, consistency, and care. Discover how our swift action and focus on compliance helped a heavy equipment operator return to full duty 14 weeks faster than guidelines recommend, saving $12,000+ in indemnity and medical costs.
AuditPro Corrected Inflated Medical Billing
2 MIN READ
A client encountered billing challenges with an outpatient ASC bill concerning a procedure that involved removing a bony growth or "osteophyte." The billing problem arose when fluoroscopy, an imaging technique used during the procedure, was incorrectly billed separately instead of being included in the overall procedure cost. This error by the surgery center led to billing challenges that required correction since the fluoroscopy should not have been charged as an additional service.
From Machine Operator to Medical Assistant
2 MIN READ
Discover the inspiring transformation of a machine operator to a medical assistant after a workplace injury. Learn how Genex’s vocational services, career counseling, and a customized rehabilitation plan helped rebuild a career.