Podcast

The PAID Act is Coming to Medicare—Are You Ready?

…   In December 2020, an act was signed into law, which will change the way some reporting entities coordinate Medicare … the Provide Accurate Information Directly Act and it was enacted back on Dec. 11, 2020. It’s an act that is a means to help nongroup health plans such as workers’ compensation, insurance … may not know, Section 111 is the Mandatory Insurer Reporting. So, carriers and insurers have an obligation to report all of their open claims to Medicare so that Medicare can coordinate …
Podcast

Selecting the Right MSA and Regs to Know for 2025

… : So, most people who request an MSA request what we deem to be a standard MSA. And so, for us, a standard MSA is on we prepare that aligns with what CMS deems necessary if they’re going to be reviewing an MSA. A standard MSA contains two years’ worth of medical records that have been reviewed by … log, a pharmacy log and, if there’s any court orders, denials that are reducing a condition or an injury on the claim.  We want to have all that information. So, typically when people send us …
Article

Out-of-Network Dispensing Channels and Their Unique Challenges

… controls aren't in place. Our out-of-network pharmacy spend and utilization continues to be an area of focus for comp for that reason, especially because by the time the payer or the … Yeah. Physician dispensing as most of us probably listening in has long been an area of concern for workers' compensation first, because it may circumvent some of those … for dermatological agents were paid to physician dispensers than to pharmacies. So certainly an area we want to be monitoring and be mindful of. …
Article

2020 in Hindsight: Clinical Trends and Predictions

… Countless treatments have been studied (and are still being studied) to determine if there is an effective treatment for COVID-19. While studies and vaccines are still in progress, some drugs … list of those covered under a presumption law, the COVID-19 pandemic will likely leave an enduring mark on our industry. Listen to our experts’ predictions on how COVID-19 is changing … 18% since the beginning of stay-at-home orders compared to the same period pre-stay-at-home. An analysis from the White House drug policy office reported that drug fatalities increased more …
Article

StateWatch: Early Spring 2018

… for short-term (no more than 14 days) management of acute pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate. According to the … worker obesity , whether it’s from elevated employee medical costs, more absences from work or an increase in workplace injuries. ACOEM is recommending employers take steps to reduce or … opioids, that a risk assessment was performed and the employee gave informed consent for an opioid prescription. It would also require doctors to provide a treatment plan explaining the …
Article

StateWatch: Early Spring 2018

… for short-term (no more than 14 days) management of acute pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate. According to the … worker obesity , whether it’s from elevated employee medical costs, more absences from work or an increase in workplace injuries. ACOEM is recommending employers take steps to reduce or … opioids, that a risk assessment was performed and the employee gave informed consent for an opioid prescription. It would also require doctors to provide a treatment plan explaining the …
Article

StateWatch: Winter 2018

… MSA professionals began noticing a few months ago, can add hundreds of thousands of dollars to an MSA. And some say the use of Lyrica for treating low back pain and radiculopathy is … comp MSA reference guide , CMS spells out when it is appropriate to include medications in an MSA, such as when a drug has been approved by the FDA for an injured worker’s condition. The … family and medical leave benefits are absent about 893 million days due to illness and incur an estimated 527 million lost work days due to impaired performance, according to the report. The …
Article

StateWatch: Winter 2018

… MSA professionals began noticing a few months ago, can add hundreds of thousands of dollars to an MSA. And some say the use of Lyrica for treating low back pain and radiculopathy is … comp MSA reference guide , CMS spells out when it is appropriate to include medications in an MSA, such as when a drug has been approved by the FDA for an injured worker’s condition. The … family and medical leave benefits are absent about 893 million days due to illness and incur an estimated 527 million lost work days due to impaired performance, according to the report. The …
Podcast

2022 Midterm Elections – Takeaways That Will Impact Comp and Auto in 2023

… and all the votes have been counted. We invited those regulatory experts back to give us an update. Joining me today is Michele Hibbert, Mitchell’s senior VP of regulatory compliance … the governor will get more done on her agenda. Property and casualty is probably not at the top of the list. There are other concerns internally in the state of Michigan, but we will … seem to be the most vocal about it, and I think that was part of the problem. You’re seeing an erosion of the luster of Trump amongst the electorate. If you look across the country, …
Podcast

New Trends in Opioids and Pain Management

… So, looking at our aggregate trends among our top five opioid medications by cost, across, both retail and mail order channels, as well as our … we’re continuing to really focus in on the opioid class. The oxycodone products holding the top spots overall for cost are OxyContin, which is a controlled‑release or long‑acting version of … among opioids that might make it a good clinical choice for patients who are candidates for an opioid with some nerve‑related pain component. It is a dual action analgesic, similar to the …
Article

Functional Capacity Evaluation (FCE) Frequently Asked Questions

… What is a Functional Capacity Evaluation (FCE)? An FCE is a comprehensive assessment used to determine an individual's physical abilities and limitations. This standardized testing process is … work-related tasks and activities through a series of tests and observations. The results of an FCE are used to determine the patient’s ability to return to work and may offer suggested work … The results of an FCE are compared to the specific physical demands of the person's job or potential alternative …
Article

IME: A Tool for Effective Claim Management

… Determining the Best Treatment Plan with an IME … For most injuries, there is a standard treatment workflow and recovery timeline. This includes an initial medical visit, ordering any appropriate diagnostic studies, obtaining a diagnosis, outlining an initial treatment plan, and projecting a time frame for the injured person to return to work, … Early intervention is key in preventing an injury from becoming a long-term disability. Research confirms that employees who do not …
News Release

Oklahoma House Committee Advances Workers' Compensation Reform Legislation

… changes to the vocational rehabilitation section of the Act Adds a provision allowing an administrative law judge to require an employer to provide detoxification treatment for employees prescribed opioids or other … National Drug Code (NDC) of the manufacturer's product Adds a provision during the pendency of an appeal by an employer to require the employer or its insurer to continue payment for …
News Release

Hawaii Legislature Sends Opioid Limits Bill to Governor

… and abuse of opioid medications in Hawaii's workers' compensation system. The legislature is an important step forward, but hopefully not an end point of Hawaii's effort to combat opioids in the Aloha State. The following is a summary … care provider authorized to prescribe opioids should have in place policies that require an informed consent process between the physician and a qualifying injured employee when opioids …
Article

Managing Medical Records is Key to Improving Third Party Claim Settlements

… typically unorganized, inaccurately coded and seemingly stacked a mile high. It can feel like an insurmountable challenge to organize, digitize and understand every detail of the medical … first organizing, capturing the data and properly coding documents can make it difficult for an adjuster to efficiently reach the most accurate settlement. High quality data capture is essential in order to achieve the most accurate and complete analysis of medical treatment. An end-to-end third party solution can help organize and surface key details efficiently and …
Article

ABCs of the ADAAA: Are You Compliant?

… — employees have the ability to request accommodation. It became a big battle about what is an appropriate diagnosis in order to make an accommodation, and Congress came back in 2008 and decided to make the strategy a little … act requires. But what we can do is help them with the aspect called the interactive, where an employee will request an accommodation because of a perceived need. It could be a …
Article

After a Difficult Couple of Years, Making Workers’ Comp ‘Easy’ is Good for Everyone

… workers. One way to remove barriers from the process of getting people back on the job after an injury is through greater use of technology. Robust technological tools can help payers, … flexibility with their network design and the opportunity to do this themselves is seen as an added perk. Nomination tools serve all participants: Payers can nominate clinicians they work … data and outcomes metrics to help determine which providers would be right for inclusion in an outcomes-based network (OBN), for example. The technology that now underpins these networks …
White Paper

Insight to the Power of 2

… Seasoned claims professionals don’t need an algorithm to tell them that an injured worker who is obese or has diabetes might need an extra hand in recovery. Understanding the implications and potential effects of a comorbid …
Case Study

Motoring Toward Recovery

… An automotive manufacturer employee was test driving a car off the assembly line when the brakes … consistent with infection, she contacted his physician who directed the injured employee go to an emergency room. Ratzow then followed the couple in her car after the man refused an ambulance. He was diagnosed with an infected metal plate which required a repeat craniotomy be … Ratzlow worked very closely with all parties to facilitate an appropriate return to work for the injured employee. She incorporated her training as a …
News Release

West Virginia Governor Signs Opioid Reduction Act

… compensation. Highlights of the Act include: A non-opioid directive form that can be signed by an individual and contains an advanced directive to a health practitioner that the individual shall not be given or prescribed an opioid. Requires the prescriber to inform the patient of the quantity of the opioid being …
Article

Specialty Solutions Spotlight: When to Use Functional Capacity Evaluations (FCE) in Workers’ Compensation Claims

… What is an FCE and why does it matter in workers’ compensation? Complex claims often come with … Capacity Evaluation (FCE) can bring clarity, but only if used with purpose. Done right, an FCE helps move claims forward. Used too early or without clear direction, it can stall progress or increase costs. Understanding the Role of an FCE An FCE is a standardized, objective evaluation of an injured employee’s physical …
Article

Utilizing Nurse Case Managers for Workers Compensation Claims

… focus back to their most important goal: making people healthy again. Behind every claim is an injured worker seeking to get better. If a nurse case manager is engaged in a workers’ … build trust with the injured worker to ultimately support a timely recovery. In order to be an advocate in an injured worker’s journey to recovery, a nurse case manager will facilitate their medical needs … return after a year. Based off these numbers, the observation turns out to be: the longer an injured worker is out of commission, the more likely it is that they don’t return to work at …
Case Study

2021 Field Heart of Case Management Award Winners

… and ankle. She was sent to the local hospital’s emergency room where her foot was treated by an orthopedist. Marisela Chavero, RN, a bilingual case manager at Genex, was assigned to the case … bed in extreme pain, in a small, rat-infested apartment without heat. Chavero immediately made an appointment with the foot specialist to consult with him and examine the foot. She soon … the situation was dire, Chavero used her connections to transfer the injured employee to an urgent care facility to be seen by an orthopedist at a leading hospital in Houston. Here, the …
Article

How Employers and Insurers Can Create The Most Effective Return to Work Programs

… work arrangements that accommodate any restrictions or limitations that may interfere with an injured worker’s return to work. In pursuit of building out an effective return-to-work program, it would greatly help employers and carriers to keep in mind … The Employer's Role in Building an Effective Return-to-Work Program … who keep the lines of communication open with the injured worker post-injury are playing an important role in keeping the worker engaged. Injured workers tend to withdraw from their …
News Release

New Presumption Laws Signed: California and New Jersey

… rebuttable presumption for “essential employees” who contract the coronavirus during the time an executive order declaring a public health emergency, and any subsequent extension by the Governor, remains in effect. The definition of an essential employee includes employees in the public or private sector working in public safety … essential. The bill says that claims paid under the act shall not be considered in determining an employer's experience modification or otherwise impact premium costs. On the west coast, …
News Release

Missouri, Washington and West Virginia Adopt Emergency Changes

… Pursuant to the Governor's Executive Order declaring an emergency, the Missouri Board of Pharmacy has issued an order allowing for the emergency dispensing of medications. The order allows pharmacies to dispense an emergency supply of medication to a patient if the pharmacy that originally filled the … The Washington State Pharmacy Quality Assurance Commission has adopted an emergency rule regarding emergency fills of expired prescriptions. The rule “allows a …
Blog

Expertise and a Strong Specialty Network are Critical in Helping Injured Workers Recover from Opioid Use Disorder

… regimen or rely solely on diligent medical management. Instead, the various players orbiting an injured worker in treatment must act in concert to establish the most solid foothold that … have repeatable protocols, and have a multidisciplinary team in place. The team would include an experienced intake coordinator and someone with expertise in behavioral health. Having this … this work falls to experienced case managers, who often have good working relationships with top providers in a given network. That strength in the clinical realm can be matched with …
Article

10 Tips Every Estimator Should Be Following

… Today more than ever, the importance of creating an outstanding blueprint for automotive repair is an integral part of Proper and Safe repairs. Creating a roadmap of how the vehicle is going to be … 1. Have an SOP For the Estimating Process: … on today’s automobiles and the technology associated with them. Anyone who endeavors to repair an automobile should know how the system really functions before they can repair it. The same …