By opting out of the
Texas Workers’ Compensation Act, Nonsubscribers lose certain “entitlements” available to all employers insured under
the Act, such as:
-
“managed
healthcare” services utilized by workers’ compensation insurance
carriers, like access to preferred provider organizations, medical
case management, hospital preadmission authorization and medical
bill audits.
However, Texas Healthcare
Foundation (“THF”) has successfully contracted with hundreds
of targeted occupational medical providers for appropriate “managed
healthcare” at substantial discounts off their billed charges. Unlike
in workers’ compensation, Nonsubscribers can direct their injured
employees to employer designated medical providers who cooperatively
render appropriate healthcare for fees comparable to the DWC MFG.
For Nonsubscribers, effective medical and disability claims management
(whether handled by the employer or THF) includes:
Commitment
from top management to provide a safe workplace, thereby reducing the frequency and severity of workplace injuries.
A selection of
cooperative medical providers
approved by the employer who administer appropriate healthcare focused on
getting the injured employee well and quickly back to productive work.
Early
intervention to immediately ascertain from the treating
physician the injured employee’s medical diagnosis, treatment
plan and ability to return to regular, normal duties while incorporating
“managed healthcare" as needed.
Immediate
investigation
of all injuries reported to determine causes and merits of the claim.
If justified, changes in safety procedures and/or equipment should be implemented
to prevent similar incidents in the future. Claims having litigation
potential should be immediately discussed with top management and/or
legal counsel.
When
appropriate, coordinate with the treating physician to prescribe
modified return to work for
the injured employee. Employers realize the greatest benefits
by minimizing costly time off pay and keeping the employee productive
at work.
Monitor
the work-injured employee’s medical treatment and return to work
progress until the employee can fully perform regular, normal duties.
Close, continuing communication
often helps THF detect problem claims that are “attitudinal” rather
than medically based.
Reprice
all medical bills
to THF's contractual agreements and/or fair and reasonable medical fee guidelines,
generating overall savings currently averaging an amazing 50%+ off billed charges!
|