How a Workers' Comp Medical Review Program Benefits Your Business

Medical expenses constitute a significant part of workers’ compensation costs and can escalate rapidly, potentially raising your insurance premiums by affecting your experience modification rate (E-mod). Implementing a medical bill review process can help control these expenses, reduce your premiums, and offer additional advantages for your business. Here are five reasons to ensure your workers’ compensation insurer has a medical bill review program.  
 

1. Cost Control

   A comprehensive medical bill review process identifies discrepancies, such as duplicate charges, errors or incorrect coding, or services that do not align with the injury or treatment plan. A bill review program also ensures billed charges reflect discounts your insurer has negotiated with health care providers.  The savings can be significant: at Acuity Insurance, medical bill reviews reduce fees by 60% on average.

2. Ensures Compliance with Workers' Compensation Laws 

   Each state has its own workers’ compensation regulations, including fee schedules that dictate how much can be charged for specific medical treatments and services. Medical bill review helps ensure all bills submitted by healthcare providers comply with these fee schedules and other legal requirements.  

3. Faster Claim Resolution 

   A detailed medical bill review helps streamline the claims process by identifying discrepancies early and providing a more efficient experience for both employers and employees. 

4. Enhances Budgeting and Forecasting 

   Medical bill review allows more accurate forecasting of workers' compensation expenses. It can also provide insight to help you implement cost-saving strategies to reduce the overall financial impact of workplace injuries. 

5. Reduces Fraud 

   Medical fraud is a significant concern in the workers' compensation industry. Fraudulent billing can occur in various ways, from inflating treatment costs to submitting charges for fictional services. Medical bill review helps detect and prevent fraud by carefully auditing all medical invoices before payment.  

Medical bill review is critical for businesses looking to control costs and improve workers' compensation claims management efficiency. It offers key benefits such as cost savings, improved billing accuracy, faster claim resolution, reduced fraud, and enhanced budgeting. When looking for a work comp insurer, be sure they have a strong medical bill review program.