In the Ohio Bureau of Workers’ Compensation (BWC) system every employer is required to work with a state-approved managed care organization (MCO) who manages the medical portion of your company’s workers’ comp claims. Fees for MCO services are paid by the BWC as part of your premium for each year. Acting as the liaison between injured workers, treatment providers, and employers, your MCO helps to evaluate the current and future medical needs of your injured workers, approve treatments, pay workers’ comp related medical bills, and provide rehabilitation referrals. Here are 5 things you should know about your MCO.
Return to work strategies
Lost time claims can have a significant impact on your workers’ compensation premiums. Your MCO should consistently strive to return injured workers to the job as soon as they are medically cleared. Not only do these efforts help save your company money, but they also set your employees up for post-injury success by reducing downtime.
Your MCO should approach every claim with the ultimate goal of returning your injured worker to active employment as soon as possible. Identifying temporary modified duty off-site work opportunities and transitional work assignments that allow your employee to return to productive activity helps them build additional skills. By staying engaged and connected to the workforce during the recovery, your workers claim is less likely to develop into a total disability claim.
Strong provider network
An MCO can also have a substantial influence on the medical costs by utilizing a medical provider network with rates negotiated lower than the current BWC fee schedule. Lower costs mean less impact on the employer’s experience and, in turn, controlled premium dollars.
While employees have a choice in deciding who their medical provider will be following a workplace injury, our MCO should identify specific providers in your area and facilitate meetings between the practice and your key staff members. By establishing relationships with medical care providers who specialize in workplace injuries, your MCO can help you develop an outcome-based approach to returning injured workers to full duty faster.
Drug utilization review
It’s an unfortunate reality that even prescription medications are often misprescribed by doctors or abused by patients during recovery from an injury. As a standard component of their claims management protocol, drug utilization review allows your MCO to identify potentially inappropriate medication prescriptions or excessive use that could lead to negative outcomes for your employee.
This proactive approach to claims management allows your MCO to ensure the health and safety of your injured worker, the safety of others they work with during return-to-work assignments, and helps control the cost of claims. With the prevalence of abuse of prescription pain killers (by both medical providers and patients), taking measures to identify and halt potential abuse before it gets out of hand can significantly improve outcomes for your workers.
Your company should have one point of contact at your MCO. Not only is having multiple contacts is confusing, but it can also result in mixed communication and balls being dropped. When you have one point of contact, your account manager can spend more time learning your preferences and ensuring that communication is always clear.
Your MCO should maintain an open line of communication with you and your injured employee as treatment progresses. While they keep you updated on any developments with the claim, you should also relay any new information about your employee or their incident to your MCO as well. Communication during a workers’ comp claim is a two-way street and both you and your MCO must be vigilant in sharing information.
Make an informed decision
The BWC created the MCO Report Card to make it easy for employers to evaluate the performance of every MCO in the state. The important role that they play in managing your employees’ injuries and the claims process demands that employers select an MCO partner that can provide the best service levels, including medical management quality, safe return-to-work strategies, and service timelines.
Each year, the BWC updates the Report Card based on assessments gathered during the prior calendar year. Instead of relying on word of mouth or being randomly assigned to one by the BWC, the MCO Report Card gives you the data you need to make an informed decision that will impact the quality of care your employees receive and the costs of your claims.
Know your partner
Your MCO serves both the best interest of your company and your employees. Having a partner in your corner that you trust to look out for the best interests of your employees while returning them to work quickly and keeping your workers’ compensation costs down is vital to the success of your business. A partner like Sheakley UniComp can guide you and your workers through the often confusing world of workers’ compensation, helping your employees return to work quickly and safely.
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