CASE MANAGEMENT
VOCATIONAL/RTW
PREAUTHORIZATION
PEER REVIEW
MEDICAL BILL REVIEW
LIFE CARE PLANNING
CONSULTING

YTD MEDICAL BILL REVIEW SAVINGS

SUMMARY OF RULE 30
COST CONTAINMENT
PROVISIONS

Utilization Review is required
The Arkansas Workers' Compensation Commission requires carriers and self-insured entities to have a Utilization Review (UR) program certified by the Arkansas Board of Health (AR §20-9-901).
(View a summary of Arkansas regulations pertaining to bill review.)

Systemedic's medical bill review services
Medical bill review is a primary cost containment resource in Arkansas workers' comp which Systemedic can maximize for its customers. Our bill review service, in conjunction with USAble, has delivered substantial savings off total billed charges for our customers.

PPO Discounts
Systemedic is a service partner with USAble Corporation, the MCO of choice of over 15,000 Arkansas employers, comprising 74% of the state's work force. Through USAble's True Blue PPO, discounts are available with or without an MCO contract (the MCO contract in Arkansas gives the option of employee steerage to selected hospitals and physicians within the PPO).

Added value
After our computerized repricing of medical bills is completed, our nurse and pharmacist specialists perform a final review of every bill, recovering extra savings from those items requiring human experience and judgment to discover. This extra step generates an average 8–10% in additional savings off our customers' total billed amount. (View more information about our bill review savings.)

Our experienced nurses and pharmacist review workers' comp medical bills for the following:

• Relatedness to work injury

• Accuracy

• Appropriate type and level of services billed

• Repricing to the current Rule 30 relative value fee schedule or to USAble True Blue PPO, whichever is less

For additional information or a free consultation, contact:
Doney Williams, Manager, PD
Phone: 501-227-5553 or 800-822-2680 (ext. 136)
Fax: 501-227-6954

Summary of Arkansas regulations pertaining to medical bill review
Arkansas Workers' Compensation Commission Rule 30, Medical Cost Containment Program, establishes and requires:

• Schedules of maximum fees (based on the national RBRVS) to be paid to health care providers, i.e. hospitals, physicians, pharmacists, physical therapists, etc.

• Procedures to pay the lesser of (1) providers usual charge, or (2) workers' comp fee schedule, or (3) the MCO/PPO contracted price, where applicable.

• Carriers and self-insured employers to have a utilization review (UR) program certified by the Arkansas Board of Health (whether operated by the payer or an entity in their behalf) in accordance with the Arkansas Code Ann. §20-9-901, which shall:

• Perform ongoing UR of medical bills to identify over-utilization of services and improper billing.

• Determine the accuracy of coding and recode/re-price as appropriate

• Carriers and self-insureds to provide the Medical Cost Containment Division the name, address and license number of the entity responsible for conducting the carrier's UR program.