Differences in Medical Care and Workers Compensation Bill Review

By Dave H Hutton

The goal of any medical service review process is to ensure that everyone is satisfied. Bill review is a service provided by a third party that acts as an intermediary between the worker, the employer, and the insurance company to ensure that the needs of all of those involved are being met. These types of services can be used for anything medically related to ensure accuracy of charges. The key is that the information provided by the review provider is personalized to meet your specific needs.

Workers compensation insurance is a benefit provided to an employee who is hurt on the job. With workers comp, the employee will receive the care they need to recover from an injury or work-related illness. It is not designed as total wage replacement and eventually the employee is expected to return to work. Between the employee, employer and insurance company, keeping everyone satisfied is difficult. The care provided has to at least be adequate but not excessive so bill review is a great tool that can be utilized to ensure that everyone is satisfied.

Medical procedures and follow-ups with a medical provider can add up quickly and it's easy to get carried away. Medical bill review is used as a tool that indicates the approximate return to work date for the employee as well as highlights anything that the insurer or business may deem unnecessary for recovery. In terms of cost containment and accurate medical care, these types of analysis are extremely useful for workers compensation.

Medical service bill review in general differs from worker's compensation because it encompasses all medical bills, not just those incurred in relation to an on-the-job injury. For instance, if an employee goes to an out-of-network physician because they got hurt on vacation, the reviewer will catch the discrepancy and notify the concerned parties that this medical visit will be more expensive. It has nothing to do with being hurt on the job but since medical insurance is carried through an employer, management software or a review company is still utilized.

All of the aspects of medical bill reviews can be used generally for medical care or for workers compensation more specifically. The benefit of personalized review through a specialized provider is the customization of the information. Workers compensation requires return to work estimates whereas general medical reviews are utilized to highlight medical care discrepancies like using an out-of-network physician. No matter what the system is used for, it's a great way to ensure personal service and rigorous cost containment.