MADISON, Conn.--()--The integration of workers’ compensation utilization management/review (UM/UR) systems with bill review and other medical management systems was a key issue detected by Health Strategy Associates’ (HSA) 2012 Survey of Workers’ Compensation Utilization Management/Review (UM/UR).
“Execs are one-and-a-half times more likely than front-liners to report their UM/UR systems are integrated. In fact, the one thing the front-line ‘wished’ their UM/UR vendor was doing was ‘system automation and integration.’ If UR determinations are not getting to bill review in time, unauthorized procedures are being reimbursed.”
Conducted on-line, the survey assessed two distinct groups: workers’ compensation executives tasked with overseeing UM/UR and the front-line staff responsible for day-to-day UM/UR processing.
“There’s a big gap between the perceptions of executives and front-line claims managers when it comes to the integration of UM/UR with other medical management systems,” said HSA Principal Joseph Paduda. “Execs are one-and-a-half times more likely than front-liners to report their UM/UR systems are integrated. In fact, the one thing the front-line ‘wished’ their UM/UR vendor was doing was ‘system automation and integration.’ If UR determinations are not getting to bill review in time, unauthorized procedures are being reimbursed.”
Other highlights are:
- UM/UR systems have been in place an average of five years;
- Majority of respondents use UM/UR to control medical costs and ensure appropriate treatment;
- All types of services are subjected to UM/UR from low-cost items, such as physical therapy, to high-priced surgeries;
- A decision to switch vendors would be based on service, results and outcomes and both groups feel it is fairly easy to change vendors;
- No vendor enjoys brand awareness; many were unknown to a substantial percentage of respondents.
The survey was sponsored by CID Management, a URAC-accredited utilization review company, providing utilization management, peer review and per-incident clinical management services to workers’ compensation payers. Paduda will present findings on Wed., Nov. 7, at 2 p.m. and 3:30 p.m. and Thursday, Nov. 8, at 10:30 a.m. at CID Management’s booth (1023) during the National Workers’ Compensation and Disability Conference at the Las Vegas Convention Center. Attendees may pick up copies of the report at the booth.
About Health Strategy Associates
HSA is a national consulting firm serving insurers, employers and health care providers. Led by Joseph Paduda www.healthstrategyassoc.com/paduda.html, who also writes www.ManagedCareMatters.com, the firm specializes in helping clients control health care costs in workers’ compensation and group health. HSA has also conducted surveys on workers’ compensation pharmacy management, bill review and claims systems.