The MedRisk Blog
While injured workers can make up a small fraction of a physical therapy practice’s patient base in comparison to group health, most PTs would agree that workers’ compensation cases come out on top when it comes to administrative load. Workers’ comp insurance companies, third-party administrators and employers each have their own workflows and documentation requirements that must be met. On top of this, keeping in touch with busy adjusters and case managers throughout treatment can add to the time dedicated to workers’ comp cases.
As a leading provider of managed physical medicine for the workers’ compensation industry, MedRisk has studied the path to recovery for injured workers and implemented solutions to make that route as direct as possible for patients, payers, employers, adjusters and providers alike. Here are five ways we streamline processes for providers in our network, from referral to reimbursement.
MedRisk helps accelerate the time to treatment by verifying authorization prior to scheduling patients with in-network providers. We serve 90% of the top workers’ comp payers and Fortune 500 companies and have electronic arrangements in place that make verification simple. This means that rather than injured workers coming in for treatment without a scrip or perhaps even without knowledge of who their insurance carrier is, you have assurance that patients referred to you from MedRisk have been verified for treatment in advance of scheduling. No chasing down approvals or dealing with concerns about payment authorization – our providers know that when a MedRisk patient walks in the door, they are dealing with a compensable claim.
For providers outside the MedRisk network, even treating a handful of workers’ comp patients a week can involve a significant administrative burden for office staff. MedRisk simplifies these processes by serving as a single point of contact for our referrals. Adjuster and Nurse Case Manager requests for progress notes and details come directly to us. We consolidate and manage these requests so that you are getting one or two calls from a dedicated MedRisk rep rather than five to ten calls from multiple claims professionals. In addition, providers submit their bills to us, and we electronically submit them to the appropriate payer – accommodating each separate payer workflow. That means your in-network provider office staff doesn’t have to keep track of – or worry about – complying with the many different payer requirements per employer, per jurisdiction.
Patients referred by MedRisk receive a phone consultation with one of our US-based, on-staff licensed PTs prior to their first visit. The goal: to help set patient expectations for treatment at one of our in-network clinics. We help prepare injured workers for what’s next by describing what to expect, answering any questions they may have and emphasizing the importance of patient compliance for safe return to work. We have found that this initial interaction can go a long way in allaying fear and anxiety, reducing no-shows and helping to keep patients accountable and engaged once appointments with their treating PT begin.
Should the patient not show the level of progress expected in the original treatment plan, PTs treating workers’ comp patients typically need to track down the injured worker’s busy adjuster and make the case for an extended treatment plan. Our on-staff PTs help facilitate these authorizations. On the off-chance that your request for additional visits exceeds evidence-based guidelines, our on-staff PTs review the case details, touching base with the treating provider, to learn more. MedRisk on-staff PTs then provide a third-party clinical opinion to the adjuster and nurse case manager. While the decision is always in the hands of the adjuster, in-network providers know that they can speak peer-to-peer about the clinical need for additional visits and that they have a MedRisk clinician in their corner.
The MedRisk brand is one known for its dedication, quality and commitment to patient care. This reputation has been earned not only through the services we provide as a managed care organization but also the expertise and work of our provider network. Our regional sales managers visit claims offices regularly to build relationships and gain referrals for our local in-network providers. We interact with employers and payers at tradeshows, where attendees can learn more about the unique advantages of treating with our network providers. And we are always looking for ways to promote the inspiring work of our network providers, including Provider Spotlights on the MedRisk website, case studies, e-newsletter coverage and other online and offline content.
In comparison to the typical group health patient, injured workers have unique needs. Clinically, these patients sometimes have psychosocial barriers that delay prompt return-to-work or particular functions that must be regained before safely returning to the job. As much as possible, MedRisk shoulders the administrative load of these cases so that instead of paperwork and phone calls, our providers’ sole focus can be ensuring an effective and timely return to health and meaningful work for these patients.
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