Research
Medical Dispute Resolution: Utilization Review and Independent Medical Review
Medical dispute resolution is a vital component of all healthcare delivery systems. This study examines the key linkages between utilization review (UR) and independent medical review (IMR).
California WC Medical and Indemnity Benefit Payment Trends, AY 2002-2012
CWCI's latest study tracks the Calif WC medical and indemnity benefit growth trends from AY 2002 – 2012
Medical & Indemnity Benefit Trends, AY 2002 – 2014
Initial data on AY 2014 lost-time claims indicate that average medical payments at 3 and 6 months post injury declined following implementation of SB 863, though the 12- and 24-month data on claims from prior years still show average losses trending up, led by ongoing increases in payments for prescription drugs and DME.
Changes in WC Physician Reporting Under the RBRVS Fee Schedule: Initial Results
The average amount paid for all California WC physician reports fell 37% from $26.13 in the 1st quarter of 2013 to $16.53 in the 1st quarter of 2014 as the state began to transition to the new RBRVS Fee Schedule, but that decline was due to changes in the underlying E&M services in the schedule and not a decrease in the fee schedule amounts assigned to report codes.
California WC Claims Administrator UR Audit Results: 2009 – 2013
A review of DWCs 2009-2013 UR audit results show claims administrators had an average performance rating of more than 97% over the 5-year period.
IMR Outcomes in California Workers Comp
A CWCI analysis of 2014 IMR decisions suggests that the medical dispute resolution process mandated by SB 863 is working to assure that treatment provided to California injured workers meet evidence-based medicine standards and is providing a needed check against unnecessary and potentially harmful tests, surgeries, drugs and procedures.
