Don’t Call Us “Consultants”
For many in our industry the word “consultant” leaves a bad taste in their mouth. For whatever reason, services were over-promised and under-delivered. To be polite: client expectations and consultant performance were out of alignment.
If the truth be known, anyone can call themselves a consultant and tout “50 years of experience” or some other equally meaningless claim. The real questions to ask revolve around results and consistency. What are the hard dollar (and percentage) savings you have consistently produced for clients? Are they still your clients?
Our new services might resemble some of the offerings of a consultant, but a better explanation of what we do is “claims oversight.” We never promise anything we can’t deliver. Our results and consistency are solid (ask us for details). And while our services are not really new, they may be new to you. We’ve been performing them for years for clients, but we just haven’t advertised them before.
Here are a few of the basic services we offer:
- Claims monitoring
- Clinic assessment
- Fraud & litigation control
- Quarterly claims updates
- Return-to-work program
- Unit stat claim reviews
But beyond these, we dig deeper by providing…
Workers’ Compensation Training
When we meet with clients, we review their current workers’ compensation program and determine their training needs. We meet with their administrative staffs to review current policies and procedures, then suggest improvements to their processes. We help identify improvements to claims reporting, medical direction, investigating an injury, mandatory timeframes, claims oversight, return-to-work, and any other areas of claims management that may need to be improved or developed. We meet with their supervisory staff to outline responsibilities and claim reporting procedures, as well as the importance of maintaining an effective workers’ compensation program.
Ongoing Claim Review
Access open claims on a weekly basis to ensure claims are moving toward conclusion and claim costs are being controlled. These services include review of claim notes, reserves, plans of action, and available records. Recommendations are outlined and communicated to the claims examiner and other stakeholders by telephone and/or email. An initial claim review report is generated at the 14 day mark and then subsequently each month.
Specific Task Assignments
Not every organization is the same. Some need help with specialized audits, while others might need a hand with closing projects. We understand that and tailor a program to your specific needs.
Below is a partial list of tasks we perform for clients:
- Closing projects
- Review of aged pending files for settlement
- In-person file reviews
- Special audits
- Return-to-work programs
- Medical review
- Oversight of litigation management
- Vendor management
Bill Review to Include First-Aid
We also accept first-aid bills received by clients from medical providers. We review them and apply allowable pricing per the California medical fee schedule. From there, our state certified bill review coders produce an Explanation of Benefits (EOB) which includes the provider, all procedure codes, the provider charge, and the fee schedule allowance along with the recommended payment. We also provide a monthly report outlining a summary of provider charges, total savings, and percentage of savings.
If you’d like to hear more (specific savings, case studies, etc.) about what and how we serve clients, contact Diane Harroun at firstname.lastname@example.org or Donna Quirk-Sorensen at email@example.com.