utilization review News

The Power of Streamlined IT Investment: Simplifying Claims Technology Implementation

In the past decade or so, the world has undergone tremendous technological transformation. For example, in 2008, only 139 million smartphones were sold, compared to 1.56 billion in 2018, according to Statista. In that same year, Uber didn’t exist yet …

7 Technology Features to Look For In a Medical Management Software Platform

As medical costs continue to rise, workers’ compensation payors are looking for methods to identify expenses that can be controlled and ways to handle claims more efficiently. According to a Lockton white paper, medical expenses are now averaging well over …

The Art of Creating a Physician Peer Review Panel, Part I

Creating a physician peer review panel is like solving a puzzle – it comes together only after reviewing the landscape, discerning what is important, and identifying what resources are available. As in most industries, a problem or opportunity in the …

California High Court Decision Limits Workers Right to Sue

The California Supreme Court on Thursday sided with employers in a fight over the right of workers to sue over treatment for injuries that occur on the job. Workers receiving medical care through the workers’ compensation insurance of their employer …

Cost Control and the Role of Precertification and Utilization Review in Workers’ Comp

Medical expenses, now averaging well over 60 percent of average claims costs, according to a 2014 Lockton whitepaper, represent a significant impact on an employer’s workers’ compensation total cost of risk. This trend isn’t going away soon, as this average …

California Workers’ Comp IMR Volume Fell Slightly in 2017, Outcomes Held Steady

New data on the Independent Medical Review (IMR) process used to resolve California workers’ comp medical disputes show that IMR volume dipped for the first time ever in 2017, but the outcomes were unchanged as IMR physicians again upheld 91.2 …

Oft Criticized Utilization Review in Workers’ Comp Not Just About Savings

While critics say utilization review (UR) in workers’ compensation claims is nothing more than a cost savings mechanism, an industry expert outlined its benefits recently. During a multimedia series, Inside Workers’ Comp, Todd Andrew of Genex, a medical managed care …

Early Lower Back MRIs May Lead to Longer, Costly and Unneeded Treatment

Inappropriate early use of Magnetic Resonance Imaging (MRI) to diagnose work-related lower back pain correlates with higher medical costs, unnecessary and ineffective procedures and prolonged disability, according to research conducted by the Liberty Mutual Research Institute for Safety. The most …