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Confessions of a Work Comp Payer

Confessions of a Work Comp Payer

Having worked for years on both sides of the Provider/Payer spectrum, it has always surprised me how little each side knows about the other when it comes to the medical billing and payment, especially with hospital bills. Usually when I speak with colleagues in the Insurance industry they have lots of opinions about hospitals and […]

Professional Bill Review: The “Hidden” Work Comp Fee Schedule

Professional Bill Review: The “Hidden” Work Comp Fee Schedule

  Throughout my career as a managed care professional in the workers’ compensation industry, I have had the privilege of working with insurance carriers, third party administrators, bill review companies and medical providers alike. I have seen many innovative and successful payment mechanisms bring speed and efficiency to an administratively bloated and vastly outdated work […]

The Top 4 Workers’ Comp Questions and the Iraqi Bread Maker

The Top 4 Workers’ Comp Questions and the Iraqi Bread Maker

Top Gun and Black Hawk Down – who’s seen them? One a fictional adventure of a rebel pilot and his loyal best friend and navigator. The other, a raw, tense and jarringly accurate portrayal of modern war. Together, these two movies inspired what I thought would be a career in the military. Fast forward to […]

The $547,775 Error I Found in a Work Comp PPO Contract

The $547,775 Error I Found in a Work Comp PPO Contract

Most hospitals that I encounter have at least a few Preferred Provider Organization (PPO) Network contracts that include workers’ compensation. Some have dozens. These contracts range from super simple 1-page Letters of Agreement, to massively complex multi-line managed care agreements. Hospitals typically devote staff to developing and managing these contracts, but just as is true […]