Genex: Uncovering Hidden Data in the Workers’ Comp Bill Review Process

December 12, 2017

While several factors define a sophisticated bill review vendor, data analysis and reporting capabilities are becoming increasingly important in selecting the right vendor, according to a recent report released by Genex, a workers’ comp case management company.

The white paper outlining several ways to uncover hidden data in a carrier’s workers’ comp bill review process.

According to David Dubrof, vice president of National Sales and Jim Harris, vice president of Analytics & Reporting, for Genex, finetuning analytics and a good bill review vendor are the keys to unlocking this valuable information.

When a quality partnership is established, both say benefits include employee health and safety improvements as well as a reduction in costs and outcomes.

First, they recommend being wary of inflated savings, a result of data spinning by certain bill review companies. According to the report, “they overstate savings to hold onto current customers or to gain unsuspecting new ones.”

Discounts obtained on duplicated billings are sometimes reflected as double the savings, they wrote.

Dubrof and Harris point to the value in ensuring a bill review partner offers self-service to pre-configured reporting capabilities. They state, “Online self-service reporting capabilities not only combat any misleading practices, like the one outlined above, but they also provide convenient, direct, anytime access. You can log in to analyze performance based on your own designated criteria on an ad hoc basis.”

A good bill review service will ensure a benchmark is established at the beginning of the partnership in order to measure the program’s progress. Data-driven bill review allows the management of targeted measurements decided by the carrier and can identify “high-cost, high-injury areas”, according to the report.

Once a partnership with a quality bill review service is established, carriers, TPAs and others can expect to benefit from the data derived from multi-year, historical data. The authors state, “Using this information, you can develop an action plan to determine where and how costs can be reduced, how utilization can be improved and how to ensure you’re using the best providers. You may want to compare this performance against peers and industry benchmarks to identify more areas for improvement.”

The report outlines how advanced analytics utilized by a data-driven bill review firm can further delineate areas of potential concern, such as:

  • Medical spend by category
  • Jurisdictional analysis
  • Examining details
  • Spend by body part

Partnering with a quality bill review vendor will allow for optimization of provider networks and doctors.

According to the report, a quality bill review provider will offer value-added services, like case management and utilization review. The obvious benefits of having these services provided by one vendor are obvious and underscored by the additional data they can provide.

Identifying patterns and future outcomes is key to any bill review program, the report noted.

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