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5 ways an MCO can help when workplace injuries occur

When your business experiences a workers’ comp claim, having the right Managed Care Organization (MCO) in place to approve treatment, pay medical bills and facilitate the employee’s return to work can make all the difference.

Does your MCO have the expertise to ensure your employees return to work healthy and productive as quickly as possible? Below are five areas in which the right MCO can help in the event of an injury:

1. Post injury management

How you initially react to an employee injury is key. Following an organized game plan fosters trust and cooperation, while a chaotic atmosphere can lead the injured employee elsewhere for direction. You should be prepared to address these three things immediately after an injury:

  1. Initial medical treatment – Know the available options in the area. Have contact information to call ahead and make sure the employee has safe transportation.

  2. Quick and thorough documentation of the injury – Be prepared to assist in completing an injury report. Facilitate filing a clearly legitimate claim through your MCO. This will help prevent delays and keep everyone focused on recovery and return‐to‐work.

  3. Discuss early return‐to‐work and transitional work options – Establish an expectation for a quick recovery and safe return‐to‐work. Be prepared to make adjustments to facilitate that return.

2. Negotiate for early return‐to‐work

The employee’s injury could lead to time off work, but this can be negotiated if you demonstrate a safe work environment that facilitates recovery. Working through your MCO to address transitional work options can lessen exposure to costly lost‐ time claims.

3. Oversight of medical treatment

Medical treatment for a workers’ comp injury must be approved as appropriate and cost‐effective by your MCO. The right MCO engages physicians on treatment decisions and advocates for quality treatment that facilitates early and safe return‐to‐ work. You should also be involved in this process so you have an understanding of the necessity and value of treatment for your injured employee.

4. Review of prescription medications

Problems with prescription medication abuse are well documented. Excessive medications increase the cost of a claim, and certain medications can also extend lost time simply due to their side effects. The right MCO will review the prescribed medications and recommend non‐narcotic alternatives that may eliminate side effects and benefit both your employee and your business.

5. Scrutiny of medical bills

Medical bills must be scrutinized to ensure accurate payment only for injury‐related treatments. There are often opportunities for significant reductions through the use of universal codes and “bundling” services for efficiency. Leveraging resources from the right MCO can help you minimize costs and preserve premium savings.