The fees an employer’s TPA or insurance company charge for bill review have always been one of my sore spots when we do reserve and/or claims handling reviews for employers. This is an area that seems to be the most confusing and misunderstood in the Workers Comp claims process. It is a good idea check these fees very closely when looking at your loss runs. However, are the bill review charges under Medical or Expense? There is a great amount of inconsistency on where these fees are located in the payouts.
There are many different combinations of charges by Workers Compensation bill review companies. A few of them are:
- Header Fee – a flat per bill set-up fee
- Line Charge – a flat fee for each line processed on the bill
- % of Savings – my least favorite way for employers to be charged. The employer pays a % of savings – no matter what they are – back to the bill review company. If you are being charged this way, you may require an immediate bill review by an outside consultant company such as J&L
- Network Fee – If you access the bill review company’s providers, your company must pay a % of the savings back to the bill review company. For example, a total initial savings may be 15% of the post fee-scheduled bill.
There are many other agreements that can be reached on fees Workers Comp medical bill processing. The one are that I mentioned previously in this post is where the charges for bill review are located. You may have to look hard to find them. The charges will not be on the loss run. If you look back into my previous posts, you will see where I heavily recommend online claims access. That is a great way to see how you are being charged for bill review and other charges. You may find some unpleasant surprises.
Article provided by James J Moore, AIC, MBA, ChFC, ARM. All articles are original content. Check out the full website at www.cutcompcosts.com.