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Transitional Work: Programs, Bonuses and Making Them Work for Your Business
Transitional Work is a topic that’s often misunderstood (therefore not utilized) by Ohio employers, because there are a few different angles on it. Many don’t realize that there’s the official program through BWC, but there are also bonuses available to companies with their own Transitional Work Program (TWP). Ohio BWC’s Transitional Workplace Grant is designed to help employers (who don’t already have a similar program in place) set up the policy itself and develop detailed job descriptions. These can make it much easier for the employer to accommodate restrictions given by the provider, or a light duty offer from the employer’s TPA. The finished job descriptions will include information such as how much an employee in that role would need to push, pull or lift (including weight limits), how much of the shift is spent sitting or standing, and any other physical demands. The grant funds each employer receives will depend on the company’s size and can range from $2900 to $6300 total. So, what if you already have your own TWP in place? Great! You’re a step ahead. Regardless of how your TWP came to fruition, there’s also the possibility of benefitting from the Transitional Work Bonus. As long as your policy isn’t enrolled in Group Retro and the program is utilized on qualifying claims (and a few particulars are met), you may be able to receive as much as 10% of premiums back as part of this program. If you hav
Ohio BWC's MCO Report Card: What Does It All Mean?
Every year, Ohio BWC releases the MCO Report Card, scoring MCOs in six categories. During MCO Open Enrollment every two years, the Report Card plays an important role in employers’ decision making. However, not everyone understands what all of these benchmarks mean, or they’re thrown off by how the numbers are represented. Most scores are represented in a horizontal bar chart with a vertical line representing the “statewide average” in that category. While the numbers may appear far apart visually, they may be very close in value. Here’s a great example, pulled from the 2023 Report Card’s Provider Bill Accuracy. One would assume these figures are at least a few percentage points apart, right? Not so fast! They’re less than 1% apart. The graphic makes it seem like the MCO to the left is really dropping the ball, when in reality they’re only 0.59% behind their competitor to the right. Be sure you’re looking at the actual numbers, not just visuals. It’s just as important to know what each category means, and why some of these benchmarks matter more to BWC than employers. The first two categories aren’t scores, but give you an idea of market share for each MCO. Page 2 shows the number of employers represented by each MCO, and how many active claims they were managing at the time the snapshot was taken. Page 3 showcases each MCO’s book of businesses across 12 industries. Eve
MCO and TPA Responsibilities
Workers' compensation, especially in Ohio, comes with so many acronyms that it can be overwhelming to determine who is responsible for what. Our team put together a helpful graphic to help cover the larger parts of the picture without getting into the weeds. We hope you find it helpful! Feel free to contact us with any additional questions on these
Vocational Rehab in Ohio BWC Claims
What is vocational rehab and who is it for? More commonly called “voc rehab,” this is a set of services offered to an eligible injured worker (IW) who, due to an industrial injury or occupational disease, needs assistance to return to work, retain employment, or obtain new employment. Not all claimants will be eligible. BWC determines eligibility for Voc Rehab (VR) services based on these criteria. TPAs or employers can contact their MCO’s VR Program Coordinator with eligibility questions. Does the injured worker return to work for the original employer (where the injury occurred) or look for work elsewhere? Either option is possible. The VR case manager performs an initial assessment and file review, then makes a recommendation. An important part of the initial assessment is referred to as determination of the “return-to-work hierarchy.” This is typically followed by approval from your MCO’s Voc Rehab Program Coordinator. The VR case managers are responsible for systematically going through the four levels of the hierarchy & ruling options out based on info obtained at the onset of the case, and throughout the process until the hierarchy level is reached that fits the IW’s situation. The research-supported priority outcomes for return to work minimizes disruption in the IW’s life & ensures the most cost-effective, efficient, and permanent re-employment for that IW. The hierarchy in desce
Modified Duty Off-Site Programs
Understanding Modified Duty Offsite Work - What is it, and who is it for? Employers in industries without fixed worksites, like trucking and construction, have been taking advantage of modified duty offsite (MDOS) work for several years - but it can be a good fit for employers of all industries. If an employee is injured at work, their treating physician may provide restrictions detailing what they can and cannot do. Even when the restrictions seem easy to work around, some businesses are still unable to accommodate them because of the manual nature of their industry. With no option for light or restricted duty, the injured worker (IW) is placed on Temporary Total Disability (TTD), meaning that either the employer or Ohio BWC is providing compensation for their lost wages. This raises claim costs, which can raise Ohio BWC premiums as a result. MDOS can make a positive impact for everyone involved by providing the IW an opportunity to perform duties for a non-profit until they’re able to return to full duty with their employer. Maintaining a daily schedule and physical activity while recovering from a workplace injury are key factors in an employee’s return to work plan. What is the purpose/advantage of a modified duty offsite (MDOS) work offer? MDOS facilitates meaningful work for the injured worker through MDOS. Many IWs that have been provided this option have said that working for charity just “feels good.” It removes a significant barri
How to Choose the Right MCO
Every two years, Ohio employers in the state fund (paying premiums to Ohio BWC) are permitted to choose the MCO (managed care organization) they'll work with for the next two years, and maybe far beyond that. Not every employer has had an interaction with their MCO, so let's start with the basics. What is an MCO? MCOs are contracted through Ohio BWC to manage the medical aspect of employee work-related injury claims. They are paid by Ohio BWC with a portion of employer-paid premiums. What should an employer look for when selecting an MCO? A utilization review department that is separate from the case management department is key. This helps an MCO maintain impartiality and make objective decisions when responding to treatment requests by doctors to determine their appropriateness in the context of a claim. An MCO needs a comprehensive fee-auditing department to determine what claims are appropriate to pay. A company should feel confident that their MCO’s process is thorough enough to avoid unnecessary charges. Companies benefit from MCOs that have a relationship with a provider network. This enables it to take advantage of discounts below the BWC’s fee schedule. Lower medical costs equate to lower workers’ compensation premium payments. Customized reporting is an added perk, as such reports can contain incredibly valuable information - like how to target and engineer out certain injury types with better safety or ergonomic programs. An emplo
Spooner MAI URAC Accredited
URAC's case management accreditation standards require companies to establish the policies, procedures, and structure needed for optimal case management
Spooner MAI Pharmacy Reports
Our best practice of providing access to "pharmacy reports" helps lower workers' compensation costs by ensuring prescription requests are medicinally appropriate for each
Spooner MAI Web Access
Spooner MAI's best practice of "web access" helps to lower the costs of workers' compensation by ensuring that employers have access to all of the information that they need in a timely manner. All of our best practices help to ensure that every treatment and payment is medically appropriate for each
Spooner MAI Customized Claim Reports
Spooner MAI’s best practice of “customized claim reports” helps lower workers’ compensation costs by ensuring that every treatment and payment is medically appropriate for each
