Coventry’s workers comp business appears to be going through some interesting changes, especially in case management.
Jun
6
Insight, analysis & opinion from Joe Paduda
Category: Workers Comp
Jun
6
I think I’m starting to figure this out.
Workers comp managed care firm CorVel is once again on the acquisition trail. Schaffer Companies, a Baltimore TPA, was acquired by CorVel with the deal announced yesterday. This deal follows by several months the company’s purchase of California TPA Hazelrigg, a deal that had many in the industry doing a collective head scratch.
Jun
4
A reader posted a very insightful comment on my post regarding hospital overypayments in workers comp.
Her point? “overpayments to hospitals and other providers whom participate in PPO’s are not necessarily accidental or unintentional.”
She is right, and the explanation should give any PA workers comp payer or employer pause.
It is well worth a read.
Jun
1
Texas just released workers comp medical payment data for 2005 and 2006. There’s some really great stuff here.
May
30
I finally cracked the latest Health Affairs, and immediately found myself engrossed in Gerald Anderson’s piece on hospital pricing trends (paid subscription required for entire article).
While the article is focused on self-pay patients, the implications for workers comp payers are striking. And this isn’t some academic exercise, we’re talking serious money.
Continue reading Hospital overpayments in workers comp – part 2
May
29
Obese people. 85% of those injured at a major manufacturer were overweight or obese.
May
23
Here in no particular order are a few items of interest from the world of workers comp managed care.
May
23
The US health care system is a mess – it is a convoluted and ridiculous web of cross-subsidies and cost-shifting and billing practices that serves to tax some to pay for care delivered to others. And for some payers, it is grossly unfair.
One of those “some” would be workers comp insurers and employers. Some state reimbursement requirements are unfair at best, forcing WC payers to pay way too much for hospital care. That’s bad enough, but what’s worse is when WC payers ignore favorable regs, and reimburse more than they should.
Continue reading Why are comp carriers overpaying hospitals?
May
22
Pharmacy and Therapeutics committees have been around for ages in the provider community – they are the “link between medicine and pharmacy”. In the managed care world, P&T committees take on a somewhat different role, establishing formularies, reviewing medical device reimbursement (at some health plans), contributing to coverage determinations and benefit design.
Mostly, they provide the health plan or insurer with an expert opinion on most things pharmacy-related. Without a P&T Committee, these decisions often are left to a medical director, or worse, claims adjuster (in the P&C world), individuals who are not equiped to make educated decisions about pharmaceuticals.
May
16
In a lesson for all those tempted to leverage their positions in the workers comp industry for ill purpose, I once again give you Tom Noe The latest? Rats as big as cats are scampering to safety, afraid they’ll be infected by his unsavory kind. (that’s not exactly what the article says, but as it does not indicate a direction of travel, and rats are great survivors, I made a guess…)
For humans, it’s better news. Convicted money launderer and swindler Noe is safely ensconced in solitary confinement in a Federal jail in Atlanta, where he is awaitnig transfer to another prison in Florida.