Debunking the myths about Colorado’s system

by Bob Mook, CMS contributing writer

Colorado’s workers’ compensation system is considered a model for other states because of its comprehensive and frequently updated guidelines, accessibility and a fee structure that pays more than Medicare and private insurers.

Yet despite many benefits, a recent survey among Colorado Medical Society members revealed a number of misperceptions from providers who don’t participate in the system.

Conducted by Kupersmit Research, the survey showed a vast majority of non-participating physicians believe the system inflicts a heavy administrative burden on participants and pays too little for workers’ compensation services. The survey showed that 77% of CMS members who don’t participate in workers’ compensation are not open to doing so.

To change those perceptions, Colorado’s Division of Workers’ Compensation is encouraging health care professionals throughout the state to consider an accreditation program intended to help providers better understand the system, enabling them to help patients recover from work-related injuries while getting fairly compensated for their efforts.

“We’re educating providers on what the workers’ comp system is really like,” said Dan Sung, manager of medical policy for Colorado’s Division of Workers’ Compensation. “Our programs are truly great and the investment of time and money is nominal when compared to the benefits of learning how to effectively navigate the system.”

The division offers two types of accreditation courses to help providers better understand the system: A one-day (Level One) course gives a basic overview of the system and its administrative criteria and a two-day (Level Two) course offers an emphasis on medical impairment rating. Costs for accreditation range from $200 to $400, with re-certification required every three years.

A Level Two course will be available Oct. 10-11 and the next Level One course will be conducted in May 2015. Ideally, the division would like to offer more classes so that more health care professionals understand the system and are fairly reimbursed for their services, Sung said.

“Getting accreditation shows insurers and employers that you understand the system, so you are more likely to be chosen by employers as an authorized provider and thus reimbursement may be more efficient,” said Kathryn L. Mueller, MD, MPH, FACOEM.

Mueller is the medical director of the Division of Workers’ Compensation and a professor of the Department of Physiatry and the School of Public Health at the University of Colorado Anschutz Medical Campus. She was recently named among the 50 most influential people in workers’ compensation by SEAK Inc., a training and professional-development organization representing individuals in the workers’ compensation arena.

While Mueller acknowledges that there are key differences in how workers’ compensation services are reimbursed compared to “regular health care,” she maintains that Colorado’s system offers strong support services to help providers fill out and submit the required paperwork and give clarification when needed.

“Billing systems are always challenging,” Sung said. “But we’ve put in a medical billing dispute-resolution process to make sure that payers and providers can resolve their disputes as quickly as possible.”

Compared to other states, Colorado’s workers’ compensation system is quite user-friendly, said Edward Leary, MD, medical director of Pinnacol Assurance, Colorado’s largest workers’ compensation insurer representing more than 55,000 employers in the state. All employers in Colorado are required by law to carry workers’ compensation insurance.

Established more than 100 years ago, Leary says Pinnacol has laid much of the groundwork for workers’ compensation throughout the country. Pinnacol works closely with policyholders and health care providers to help staff navigate through paperwork associated with workers’ injuries.

Leary said there are misconceptions on how much paperwork is required from practice managers dealing with workers’ compensation patients.

“Once we have one of our provider relations specialists interacting with these administrators, many of these misconceptions go away,” he said, adding that Colorado’s workers compensation system has done much to ease the administrative burden for physicians so they can focus on patients and draw revenue from treating them.

“It’s an unknown fact that workers’ compensation and occupational medicine can be very profitable practice for medical providers,” Leary said.

Compared with other states, Colorado’s workers’ compensation guidelines are “very easy to understand,” said David Hansen, Pinnacol’s SelectNet network operations lead.

“Physicians are given a lot of leeway to treat injured workers. They don’t have to pick up the phone and ask for authorizations every step of the way,” Hansen said. “Some states micromanage every step and make it very difficult.”

In addition to favorable compensation levels, Leary points out that physicians play a critical role in patients’ lives and the state’s economy by participating in the system.

“They are caring for these people at a very important juncture in their lives – particularly in terms of their ability to provide for their families,” Leary said. “It’s also an important service to the companies of Colorado who rely on a system that cares for their injured workers and brings them back to work.”

Categories: Communications, Colorado Medicine, Initiatives, Workers' Comp and Personal Injury