Tag Archives: Claims Journal

How to Power Down WC Medical Costs

It just makes sense. When an injured worker has an underlying medical condition, recovery is compromised in one way or another. The case will be more complex, and it is likely to have a longer duration, higher severity scores and cost more. A recent article published by Denise Johnson in Claims Journal describes how identifying comorbidities early can help control workers’ comp claim costs.

Johnson identifies common comorbidities to watch for, including obesity, diabetes, hypertension and depression. There are many more, too. For instance, a pregnant injured worker will require careful medical management. Pregnancy should be considered a comorbidity and followed closely. Other examples include HIV, hepatitis C, cardiac disease and chronic pulmonary disease. The important thing is to identify the comorbid conditions in claims so they are monitored carefully and referred to nurse case management early.

See also: 25 Axioms Of Medical Care In The Workers Compensation System  

Comorbid diagnoses can be found in the data—usually. Treating doctors can include the comorbid diagnosis in the list of diagnoses on the bill, but sometimes they do not. They might consider a general health problem irrelevant to a workers’ comp claim, while it might be critical.

Reviewing diagnoses in a claim by the date they were added can be revealing. A diagnosis of diabetes or obesity can appear weeks after the injury date and well into the treatment process. Moreover, when in the course of treatment a diagnosis appears can be enlightening and deserves attention.

Some comorbid diagnoses appear late in the data because they are newly discovered or the treating doctor becomes aware of them later. An example is discovering a diagnosis for a mental disorder in the data long after the actual injury.

A mental disorder diagnosis might result from delayed or unsuccessful recovery as the patient acts out in frustration. Or the late diagnosis might imply previously unrecognized psycho-social factors. Nevertheless, the data should be monitored continually to tag any diagnosis that creeps into the claim picture at any point.

When comorbid or any apparently unrelated diagnoses appear later in a claim, it could be a pre-emptive signal of poor response to treatment or even impending litigation. Monitoring the data continually to uncover new diagnoses is essential to avoid missing subtle issues.

Data can be made smarter by the form and mechanism in which it is presented to those managing the claim. The manner in which diagnostic data is portrayed for claims reps and medical managers can be not only informative, but actionable. An example is portraying all diagnoses by the date they were added to the claim in bills. Such views can disclose subtleties about what is occurring in the treatment process and inform those managing a claim of ensuing problems.

See also: Even More Tips For Building A Workers Compensation Medical Provider “A” Team  

Identifying comorbidities and other troublesome conditions in claims using predictive analytics and continuous data monitoring leads to early intervention and best results. For additional perspectives on this topic, please see, “Analytics-Informed Early Intervention Drives Best Outcomes.”

Simplifying Enrollment for Optional Products

Financial education is crucial when it comes to helping employees understand the roles that optional products such as disability, critical illness and accident insurance play in protecting their financial futures, but education isn’t enough.

Making it easy for employees to sign up is equally crucial, to increase enrollment. Insurers can increase the opt-in for optional products by streamlining the enrollment process with modern technology.

Let’s take a look at four ways use of technology can increase enrollment through greater efficiency and awareness.

  1. Provide quotes through the enrollment system. The fewer barriers to entry that employees have, the more likely they are to sign up for optional products. By having quote data sent through the enrollment system, you remove the necessity of employees having to enter data multiple times. They can get quotes and sign up for benefits through the same system. Providing instant quotes and more options for plan comparisons reassures employees they’re getting a good deal.
  1. Have a portal site for opt-in. With a specially designed user-friendly worksite portal, you can automate quoting, proposal generation and enrollment. When employers make enrollment mandatory and employees are required to log in to the portal site, employees are more likely to review the options available to them and sign up even if they initially intended to simply opt out. You can up-sell and cross-sell worksite marketing and optional individual products on the employee enrollment portal site. Employees can select what products they require and the payment method.
  1. Allow for digital signatures. Providing authenticated signatures on multiple paper documents can be frustrating for employees and employers. Digital signatures are the perfect tool for collecting authenticated signatures on multiple documents while saving time and reducing waste. The technology is pretty standard and straightforward once you’ve made the commitment to digital signatures.
  1. Ensure electronic data delivery for medical underwriting. In some cases, medical information is required for underwriting worksite products. This can be difficult and time-consuming to collect and dispense unless you allow electronic data delivery. Electronic data delivery also shortens the interval between underwriting and quote delivery, ensuring a better customer experience. Achieving electronic delivery requires integrating various systems and making sure they have seamless connections. It takes work, but isn’t a massive project.

Insurers that have invested heavily in legacy systems often resist change, but these systems cause problems that are costly and time-consuming to fix-and can cost insurers clients. (According to Claims Journal, 59% of senior executives surveyed in 2015 admitted that they had to spend “considerable amounts of time” dealing with IT issues in legacy systems.) If your legacy system won’t let you streamline enrollment, it’s time for a change.

No matter how you choose to increase awareness and participation in worksite optional products, make sure that you have the technological infrastructure in place to make enrollment fast, efficient and accurate. It makes a big difference.