Workers' Compensation Services

Workers' Compensation patients' medical bills in 46 states are paid based on fee schedules published by each of the states, not on the billed amount listed on the claim from the provider. Some providers will accept an amount below the fee schedule as payment in full. Medical bills for Workers' Compensation patients in four Non-Fee-Schedule states are paid based on the billed charges or on discounts they agree to below those charges. HHC Group reprices Workers' Compensation claims to fee schedule and works with providers to reduce those bills further when applicable. We also work with providers to determine if their billed charges in non-fee schedule states are reasonable and customary. HHC Group reprices all Workers' Comp claims to the state fee schedule and will make any adjustments the provider agrees are proper. Then we return the claims for payment within 5 working days, unlike some companies that can take weeks to complete the process.

Fee Schedule States

Repricing Claims to Fee Schedule
To ensure accurate repricing of medical bills for Workers' Compensation patients in fee schedules states, we have developed our own Workers' Compensation repricing software. We have a dedicated Workers' Compensation Compliance Officer whose job it is to make sure that all updated fee schedules are loaded to our database and that they are fully tested to ensure repricing accuracy before the updates go into effect.

Reductions below fee schedule.
Some providers in fee schedule (FS) states will accept payments less that the fee schedule amount for the services they provide when they believe it is warranted. We secure these discounts with providers in two ways: first, through discussions with the provider; and second by accessing agreements the providers have with preferred provider organizations.

After the claims have been repriced to the FS, those of sufficient size are sent to our team of attorney case managers. This team works directly with the provider to determine if they should receive the fee schedule amount or if the FS amount makes more sense. Importantly, the providers supply signed confirmation that the amount agreed to is accepted as payment in full for their services.

The HHC Group Guarantee
We guarantee to reprice, come to agreements with provider for amounts below FS when it makes sense, and return the claims for payment within 5 working days.

Claims Negotiation – Discounting Through PPO Networks
Some providers in fee schedule states will accept payments less that the fee schedule amount for the services they provide. We secure these discounts with providers in two ways: first, through Claims Negotiation; and second by accessing agreements the providers have with preferred provider organizations.

After the claims have been repriced to the FS, those of sufficient size are sent to our team of attorney negotiators. This team works directly with the provider to get them to agree to accept an appropriate amount below the fee schedule for their services. Importantly, the providers supply signed confirmation that the negotiated amount is accepted as payment in full for their services.

Additionally, HHC has established relationships with major national, regional, and local preferred provider organization networks (PPOs). These networks have pre-negotiated rates below the fee schedule that participating providers will accept as payment for their services. For larger claims with discounts we double check with the network to confirm that the provider is currently contracted with them and that the discount taken is correct, minimizing the potential for any reversals.

The HHC Group Guarantee
We guarantee to reprice, secure the discounts below FS and return the claims for payment within 5 working days.

Workers' Comp patients' medical bills for the same services can vary by tens of thousands of dollars from one provider to the next even in the same market. In addition, many provider bills include errors, some of which impact the billed amount. That's why we offer our clients a wide range of products designed to ensure providers receive and payors pay a suitable amount for the provider's services.

Claims Negotiation
Upon receipt of your Workers' Comp medical claims in non-fee schedule states, our team of attorney case managers goes to work to resolve the case using our proven approach. Our team works directly with the providers – from hospitals to doctors' offices, to imaging centers. If the provider issues a bill, our team will work with them if we believe the bill contains errors or is out of line with reasonable charges for their services.

Using a proprietary database of pricing information – gathered over more than twenty five years of working with the provider or similar providers in the same market - published databases and their many years of negotiating experience, our skilled case managers work collaboratively with the provider to achieve a mutually acceptable resolution, one that results in our payors paying only an appropriate amount for the services their employees/members receive.

Importantly, the providers supply signed confirmation that the agreed to amount is acceptable as payment in full eliminating any balance billing or lost discounts.

PPO Discounts
HHC has established relationships with major national, regional, and local preferred provider networks (PPOs). When our clients submit the Workers' Compensation claims, we often reprice the claims to significantly lower rates to which providers in these networks have already agreed. For larger claims, we double check with the network to confirm that the provider is currently contracted and that the discount taken is correct minimizing the potential for reversals.

The HHC Group Guarantee
We guarantee to turn around bill adjustments in five days or less – always with a sign-off from the provider, so the price they agree stays firm.

Every Breed of Specialist for Every Type of Review
For claims that require an independent determination of medical necessity, causation, medical appropriateness, general acceptance, or ability to return to work, HHC offers independent Utilization Reviews. With a network of medical professionals in almost every medical specialty, we're ready for virtually any type of review that comes our way.

By Qualified Medical Professionals
We have assembled a team of highly-qualified, credentialed professionals including board-certified physicians, physical therapists, psychologists and other professionals, individually vetted using stringent guidelines to ensure their fitness for rendering decisions. As a result, our team includes some of the most respected medical professionals in their fields.

Timely Turnaround
Sometimes reviews need to be expedited due to a patient's treatment plan – such as when surgery is required or a high-cost drug is prescribed. For these types of urgent peer reviews, our reviewers are available 24/7, and we provide reviews with same day, one-day, two-day, or three-day turnaround.

Objective, Impartial, Unbiased
We provide utilization reviews in a variety of circumstances and for different types of clients. In all cases, we ensure an objective analysis of the patient's medical circumstances, such as:

• When a patient/plan member appeals the decision of his or her insurance company to access care or medication
• When a payer wants to ensure the most appropriate and cost-effective approach for a complex medical condition
• When a payor, such as a workers' compensation plan, wants to determine responsibility for coverage or when a patient can return to work

About Our Process
Our Medical Director and Unitization Review Nurse Supervisor (RN) oversee Utilization Reviews, and they apply a stringent quality assurance process. They ensure every report answers pertinent questions, that appropriate medical guidelines are referenced, and that the contents of the report are easily understandable – not only by trained medical professionals, but by a lay person.

HHC Group offers high quality Independent Medical Examinations (IMEs) for cases requiring an examination by a doctor or other licensed healthcare profession to help answer specific legal or administrative questions related to workers compensation or disability claims.

Performed By Qualified Medical Professionals
HHC utilizes only Board-Certified specialists who are experienced IME examiners. All have been in practice for at least 5 years and have been thoroughly vetted to ensure they will provide high quality, unbiased reports.

Our Proven Process
We've designed the process to make it as easy for our clients and their employees. You just fill out the 1-page HHC IME Authorization form, provide the medical records and questions to be answered and approve the charges prior to the exam. We confirm each appointment with the patient, client and physician by phone, letter, and email, and provide translators, transportation and even overnight accommodations should the need arise. We even call the patient 48 hours prior to the exam and to check on the day of the exam to make sure they arrived. Our Utilization Review Nurse and Medical Director review each report to ensure that all questions have been fully answered.

HHC Group offers administration for Functional Capacity Evaluations (FCEs) and Vocational Evaluations (VEs) used by physicians, case managers, and employers to transition injured workers from disability to function and employment. An FCE is a series of tests measuring physical strength, range of motion, stamina, and tolerance to functional activities, including lifting and carrying. FCEs and VEs together can be used to evaluate work tolerance, the necessity for work restrictions and earning capacity.

Our Proven Process
As with URs and IMEs, we use only qualified, vetted physicians and other professionals to conduct the evaluations. Again, all a client must do to order a FCE is fill out the Authorization form and approve the payment amount. We follow the same scheduling and notification process as for IMEs to ensure the evaluation takes place and the report is forwarded to the client on a timely basis.

Other Cost Containing Services
In addition to its Workers' Comp related products, HHC Group offers a full continuum of services to reduce the cost of your claims, including Medical Bill Review, Referenced-Based Pricing, and more. Click here to learn more.