Managed Care

Is Your MCO Using Best Practices for Workers’ Comp?

Chelsea Bikner
MCO Best Practices
Reading time 4 Mins
Published on Jan 7
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Your Managed Care Organization (MCO) plays a key role not only in your workers’ compensation cost control strategy, but also in helping return your injured employees to work safely and quickly. Your MCO should be a reliable and trusted partner for your organization – delivering only the best service to you and your workers. By employing best practices, they can help you control the costs of medical care, thereby impacting your premium rates, and help your employees bounce back to regular employment faster following a workplace injury. Here are the best practices you should expect your MCO to employ in managing the claims of your injured workers.

 

Reporting

It’s imperative that you report any workplace injuries to your MCO as soon as possible after the incident. Early reporting allows them to quickly become involved with the claim and collect all the necessary information about the incident and begin evaluating the injury and overall situation. Early intervention by your MCO facilitates a more rapid medical management of your workers’ case, with an eye toward quicker return-to-work. These efforts can help minimize medical costs incurred in each claim.

Your MCO should work with you to put a plan in place before an accident occurs. Ensuring that personnel policies and procedures establish the parameters and steps for claim reporting helps to keep everyone on the same page and well-informed. Reducing unnecessary delays allows your injured employee to get the help they need sooner.

Early reporting also allows them to begin investigating the details behind the claim. They will talk to the injured worker to obtain information helpful to that investigation. This information will be kept on file and allows your MCO to develop a more complete picture of the incident and to make recommendations to reduce future incidents.

Referring

While employees have a choice in deciding who their medical provider will be following a workplace injury, your MCO should identify specific providers in your area and facilitate meetings between the practice and your key staff members. By establishing relationships with medical care providers who specialize in workplace injuries, your MCO can help you develop an outcome-based approach to returning injured workers to full duty faster.

Communication

Your MCO should maintain an open line of communication with you and your injured employee as treatment progresses. While your MCO keeps you updated on any developments with the claim, you should also relay any new information about your employee or their incident to your MCO as well. Communication during a workers’ comp claim is a two-way street and both you and your MCO must be vigilant in sharing information.

Return to work

Since the ultimate goal of case management is for your injured employee to return to work as quickly and safely as possible, your MCO should approach every claim with that outcome in mind. Understanding that some injuries are more severe or take longer to heal than others or that some employers don’t have viable alternative job duties for injured employees to perform, your MCO can even work with you to identify a temporary modified duty off-site assignment or transitional work assignment for your injured worker at a local nonprofit during their recovery. These positions allow your employee to stay engaged and connected to the workforce during their recovery while building additional tools that they can use if they are able to return to full capacity with you at a later date.

Best practices at work

Workplace injuries and the looming costs of associated claims can be scary for employers. When you work with an MCO that always uses best practices, you can be confident that your workers’ claims will be handled quickly and professionally. MCO partners, like Sheakley UniComp, have the experience and expertise needed to ensure that you and your injured workers get the best quality service during the claims process and always use best practices to assist your employees in their journey to return to work after a workplace injury.

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