Inside Workers’ Comp Blog

How Service Impacts Claim Costs

Posted by Tom Kerr on February 14, 2019

The speed, costs and reliability of diagnostic services can seriously impact the progression of a claim, especially if the exams are hampered by poor customer service. On today’s Inside Workers’ Comp, Bob Smith, CEO, of Priority Care Solutions, a division of Genex, explains why quality customer service is so important.

 
 

Tom Kerr (TK): Bob, you had mentioned to me that case management can help enhance diagnostic services, why is that?

Robert Smith (RS): Well, one of the ways it's going to help is by getting that in the pipeline right away to a group like us. We can make sure that the injured worker is scheduled in a timely manner and that we can get the reports back within four to eight hours from when the exam was completed at that facility. We can then get that information back to the case managers who then can then proceed with their client.

TK: What are some of the challenges diagnostic service programs face in ensuring they offer the best centers in their network?

RS: One thing involves the patients and where they live. The further you live from a major metropolitan area, it gets tougher and tougher because a lot of times you're being treated in hospitals, not a true, diagnostics facility, per se. And hospitals charge probably two-to-three times more than what is allowed in the workers’ comp arena.

TK: So how does a good diagnostic service program help manage costs?

RS: That's our goal: to make sure that we have a decent return for our clients. But, for the nurses who are managing the case, it's really the service aspect of getting the exam done very quickly, knowing that they are going to get it below fee schedule and be able to get reports back in a timely matter to their customer base. Because the longer you take to get treatment, that's dollars that are going out the door. So, from our standpoint, we know that as soon as we get that referral, we're on the clock.

I think by immediately scheduling the exam at the right facility and getting it done right as soon as possible, you avoid costly problems. Adjusters don't want delays. They don’t want to deal with phone calls from the clients or the patients themselves asking, "Hey, what's going on?" Delays can also cause problems that lead to getting the legal aspect into the game and that's what we try to avoid.

TK: It seems like it would be a pretty simple process to provide quality customer service, but so many companies struggle with it. Why is that?

RS: I think the problem is that everybody's gotten away from the personal aspect and instead go from the standpoint of thinking that, “well, we'll just take care of the request as we normally do and that's it.” Personalization is seen as not being an important aspect, other than making sure that the company took care of what was needed from a referral standpoint.

And I think when we go out and work with the clients, just like a Genex does with theirs, one of the things I know that Genex prides themselves on is the service aspect of knowing that we're going to communicate effectively.

And I think that's one of the flaws in the industry today is people don't really ask the questions to the client base: “What are your true needs? We don't have to stay down this lane. We can actually open up a few other lanes for you. Just let us know what are your particular needs and we'll take care of it.”

Again, I think it goes right back to the beginning of listening to the customer. “Let us know what are the things that you truly need and that you want.” And then we can actually incorporate that into our special instructions so that when our care coordinators get that phone call, or fax, or email, it comes right up on their system and shows the ways to handle the client’s needs.

And I also think the Genex nurses play a big part in it. They're the first upfront that meet the patient and have the nursing capability to handle his or her needs on the front end. A company like PCS, we use a similar approach because we still are part of the total program and we have to be just like a nurse would be from our end.

And so, being on the front end of that it really creates a great continuum of care not just the nurse and the doctor but also the patients themselves — just knowing that they're going to get treated immediately — and that also helps with return to work faster.

TK: Thanks, Bob. In our next Inside Workers’ Comp, we’ll look at ways you can mitigate your MSA burdens. Until then, thanks for listening.

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