Subject: Workers’ Compensation Case Management
Welcome to the quarterly series of eBriefings that will provide you an overview of resource information available in, “A Guide to Successful Workers’ Compensation Case Management”.
Overview
In the workers’ compensation system, the professional case manager assesses the needs of individuals who have job-related illnesses, injuries, or impairments. Medical conditions may range from minor injuries or illnesses that require a minimum of medical intervention to more severe, even catastrophic conditions. Usually, a case manager is involved when the medical condition or other physical impairment impacts the individual’s ability to perform the duties and functions of his or her job. The more serious and complex the condition is, the greater the need for care coordination by a professional case manager.
Did you Know
- The Workers’ Compensation Insurance Industry leads in the field of offering case management services as a benefit to improving medical care delivery and cost containment as part of the claims management package in most states.
- The team approach recognizes an effective means to improve efficiency within the healthcare system. The Institute of Medicine, in its groundbreaking report, ‘Crossing the Quality Chasm,” emphasized the creation of patient-centered care teams, with greater cooperation and collaboration among healthcare teams being essential to overcome the fragmentation that has riddled the system when professionals operate in silos, focusing only on their individual roles in care delivery. (Institute of Medicine, 2010).
- Case Managers are expected to invoice services for actual time spent on each claim activity in increments of one-tenth of an hour by rounding up time to the nearest one-tenth of an hour.
- The benefit of case management interventions have been recognized over several decades. These interventions date back to World War II when case managers coordinated care for wounded soldiers. The practice of facilitating required medical services and coordinating care is the paramount role and function of the workers’ compensation case manager, which leads to major cost savings on each claim served.
The next eBriefing will focus on answering everyday practice questions posed by case managers.
