Inside Workers’ Comp Blog

Uncovering the Hidden Treasure in Your Bill Review Program

Posted by David Dubrof on November 9, 2017

There’s a gold mine of data embedded in the bill review process, and if you are not mining and leveraging this treasure trove of information, you’re missing out on valuable opportunities to impact your bottom line.

That’s what David Dubrof, vice president at Genex, reports in an upcoming thought leadership piece, “Unleashing Powerful Insights Hidden in Your Bill Review Data.” David joins us today on Inside Workers’ Comp to give us more details on how companies can dig into this treasure trove of information.

Tom Kerr (TK): David, thanks for joining us today.

David Dubrof (DD): Tom, thanks for having me on the line.

TK: David, how are bill review companies unlocking workers’ comp data to improve customer results?

DD: Well, that's a good question. I think Genex and other bill review companies are leveraging data warehouses and analytical tools to really mine the data to create action plans, and not only on a retrospective basis, but prospective as well.

So, we can take the bill review data, the UR results, provider outcomes, and provide clients with a complete 360-degree view on how to optimize return to work. We've had situations where we've identified small sets of physicians that were not only prescribing outside of evidence‑based guidelines and, while they were about the same cost as other physicians available, their utilization was higher and had significantly lower return-to-work rates.

We, then, identified a similar set of physicians who, in the market, had better outcomes and created a panel of preferred physicians.

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TK: How does an integrated program involving bill review provide customers with deeper insight?

DD: It's not only deeper insights. They're proven metrics that show you will have a deeper savings result by having your UR and bill review programs integrated. Your adjusters will end up not approving certain medical treatment requests that were denied but, subsequently, taken at the claimant's choice.

And when you look at having the deeper insights and looking at which providers are following evidence‑based guidelines, which providers are getting claimants back to work, and which providers are following up, that is how you can give your client deeper insights on which providers they won't put up on their panels.

TK: Thanks, David, and we look forward to a more detailed focus on this topic in “Unleashing Powerful Insights Hidden in Your Bill Review Data.” We also encourage our listeners to stay tuned for upcoming Inside Workers’ Comp interviews and catch up on past podcasts on iTunes and Stitcher. Until then, thanks for listening.


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