Sponsored: Healthesystems

Better Care = Lower Costs

10 Best Practices in Medical Claim Management
By: | November 2, 2019

U.S. healthcare spending is expected to grow an average of 5.5% per year from 2018 – 2027, eventually accounting for almost 20% of the American GDP. In workers’ comp, healthcare spending continues to rise and is approaching 70% of total claims costs.

This is partly due to price inflation for medical services and products, but other factors are also having a big impact. For example:

  • Multiple comorbidities correlates to a 341% increase in total claims costs and a 285% increase in temporary total disability
  • Claims that are open for 180 days or more drive 80% – 90% of total claim costs and opioid use, comorbidities, and psychosocial issues are key reasons for longer claim duration.

These and other contributing factors are cited as top concerns by claims professionals and case managers who deal with these challenges every day. And they can positively impact these challenges to a significant degree with some best practices, such as:

  1. Conducting careful reviews of medical and pharmacy records to identify comorbidities early in the claims process

For the remaining 10 best practices, click here and read: Better Care = Lower Costs: 10 Best Practices in Medical Claim Management.

Healthesystems is a leading provider of Pharmacy Benefit Management (PBM) & Ancillary Benefits Management programs for the workers' compensation industry.

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