Bill Review In Workers Comp

One of the most controversial areas in Workers Comp from what we have observed is when the carrier or TPA charges an employer to do their Workers Compensation bill review. We have seen overcharging for things such as:

• Price per bill or per line
• PPO Network Access Fee
• % of Savings - this one is abused the most
• Physicians Discount Fee
• Hospital Bill Negotiation Fee
• Many others using different and catchy names

This is one area that if you feel that you do not understand, it is best to call in an expert. We discovered in 1998 a bill review and PPO company that was overcharging a public employer $680,000 per year in just bill review fees. The public employer signed off on the review contract, so there was no $ to be recovered.

There are now "boutique" PPO and bill review companies that are independent of insurance carriers and TPA's. They are really catching on in California with their recent Workers Comp law changes. These boutique PPO companies work directly with the employers, usually Self Insureds or Large Deductible programs.

These bill review fees may be billed off-claim, which makes them very hard to track.

Next Up - PBM's - are they worth the fees?