OMCA Earns URAC Reaccreditation in Workers’ Compensation Utilization Management

August 3rd, 2023

OMCA is proud to announce that it has earned URAC reaccreditation for Workers’ Compensation Utilization Management. URAC is the independent leader in promoting health care quality by setting high standards for clinical practice, consumer protections, performance measurement, operations infrastructure, and risk management. By achieving this status, OMCA has demonstrated its commitment to quality care, enhanced processes, patient safety, and improved outcomes.

“Appropriateness and efficiency are words to live by in meeting new value-based goals for population health. OMCA’s URAC accreditation shows an ability to abide by the gold standard when it comes to performing Workers’ Compensation Utilization Management functions,” said URAC President and CEO Shawn Griffin, MD. “URAC’s utilization management accreditation standards promote an evidence-based and reasonable review of services that respect both patients and providers.”

URAC accreditation helps us do better for our clients.

Call us. We can do better.

Rosalie Faris, RN, BSN, CCM, COHN-S

President & Chief Operating Officer

rosalie.faris@omca.biz | (502) 495-5040

OMCA.biz | MediReview.biz

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Supreme Court Opinion Impacts UR

June 17th, 2022

On June 16, 2022, the Supreme Court of Kentucky rendered an opinion, soon to be published, in the case of Tracy Scott Toler (appellant) v. Oldham County Fiscal Court, Hon. Jonathan R. Weatherby, Administrative Law Judge, and Workers’ Compensation Board (appellees), 2021-SC-0356-WC.

In layman’s terms, the Supreme Court of Kentucky has concluded that a physician who is not licensed in the Commonwealth of Kentucky is not a “physician” as defined by KRS 342.0011(32) (“‘Physician’ means physicians and surgeons, psychologists, optometrists, dentists, podiatrists, and osteopathic and chiropractic practitioners acting within the scope of their license issued by the Commonwealth”), and therefore a written report or oral testimony by a physician who is not licensed in Kentucky is inadmissible as evidence.

Accordingly, Utilization Review (UR) and/or Peer Review (PR) referrals for Kentucky workers’ compensation claims must be performed by Kentucky-licensed physicians in order for those reports to be admissible as evidence.

OMCA has a comprehensive panel of Kentucky-licensed physician reviewers and has instigated protocols to ensure that our clients’ UR and/or PR requests are referred to the appropriate physician holding an active medical license issued by the Commonwealth of Kentucky.

We can help you comply with the latest opinions and guidelines. This is brand new, there will be much commentary on it, and we will keep you apprised as things develop.

Call us. We can do better.

William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

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“I Know Nothing!” ~Sergeant Schultz

August 25th, 2021

Remember Sergeant Schultz from the late ‘60s comedy Hogan’s Heroes? He was an incompetent officer and comic foil in the German Army at an unlikely spot — a POW camp — during WWII. One might think he had been revived in the persona of Richard Sackler, President of Purdue Pharma, makers of OxyContin.

In a recent deposition for one of the many lawsuits Purdue has faced, Sackler said his family, the major owners of Purdue, bears no responsibility for the opioid crisis in which his drug played the starring role. Were this tragedy an actual sitcom, I guess the drug would win the Emmy for Best Actor, and Sacker would take home the Best Supporting Actor prize.

It’s difficult to discuss Sackler. His product, expertly marketed, caused thousands of deaths, lifetime disabilities, broken families, and human misery on a scale difficult to comprehend. Maybe that’s the same with Sackler. Maybe he cannot comprehend the absolute destruction expertly delivered by his star product. Maybe it’s too much to face.

He accepted the Emmy anyway.

Call us. We can all do better.

William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

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Laws Loom Large

July 28th, 2021

Laws loom large. Get ready for the next pandemic.

“Expanded Presumption Laws Loom” is the headline of a recent Business Insurance article by Louise Esola. She explores the potential impact from the 16 states that have introduced legislation allowing injured workers diagnosed with certain communicable diseases to file workers’ comp claims “presuming” they contracted the illness in the workplace.

In this analysis, Mark Walls from Safety National Casualty Corp comments, “This is an unprecedented expansion of workers’ compensation into an area that is not appropriate.”

This expanded presumption trend is in response to the COVID-19 pandemic but raises the following questions for the future of the insurance industry:

What happens with the next community spread?

How do you quantify unknown risks?

Is it fair to take “occupation” out of the formula and just accept the disease?

If you want to do better, then learn the looming laws.

Call us. We can do better.

William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

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Psych Claims and Lord Voldemort

June 22nd, 2021

Until Harry Potter came along, the wizards in J.K. Rowling’s world never uttered the name of Lord Voldemort for fear of the consequences. They called him “He Who Must Not Be Named.”

When I embarked on my career in the workers’ comp world, oh so many years ago, “psych claim” was the phrase that must not be named. We drew a red line that ignored the fact that mental issues, although not directly related to the accepted physical injury, may impact duration, recovery and ultimate cost.

Louise Esola, writing in Business Insurance, introduces the reader to a couple of terms as follows:

Catastrophizing – for the injured worker, “thinking that the worst had happened and that he would only get worse;”

Biopsychosocial model – “referring to mental elements that can weigh heavily on the trajectory of a claim despite not being part of a compensable, physical injury.”

Dr. Marcos Iglesias, the medical director of Travelers Insurance, explains that the mental component of an injured worker’s claim may not be the insured’s problem, “but if you want to help the claim along, it might make sense to help the individual in the problems they are having.”

Doing better requires speaking the word.

Our nurse case managers do better by naming the early indicators of potential psychosocial issues that may affect outcomes and costs, and providing options to the claims team.

Call us. We can do better.

William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

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It Ain’t Over Till It’s Over

June 14th, 2021

“It ain’t over till it’s over.” Most people attribute that quote to hall of fame catcher and my personal all time favorite baseball player, Yogi Berra. Purists may debate whether he actually uttered those exact works, but it certainly seems like a Berra-ism to me.

When it comes to COVID-19 and workers’ compensation, ODG by MCG is warning us not to take our eye off the ball with their white paper The Impact of COVID-19 Comorbidities on Return to Work. Although the worst of the pandemic may be in our rear-view mirror, ODG has summarized the latest research on comorbidities and return to work, and best practices for early intervention to improve outcomes and lower costs.

Almost one-third of the study participants experienced long-haul symptoms and a quality of life decline. Approximately 8% had issues with lifting heavy objects and standing/walking for long periods.

The key RTW issues after a COVID-19 infection include the following evaluations:

State of the worker vs. physical job demands;

Safety issues;

Use of impairing medications;

Personal protective equipment;

Risks to coworkers;

Rehabilitation and PT needs.

And those are even more critical with certain comorbidities.

As usual, doing better requires early intervention, evidence-based treatment plans, and a holistic approach to case management.

Call us. We can do better.

William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

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“Great, kid! Don’t get cocky!”

May 21st, 2021

“Great, kid! Don’t get cocky!”

~Han Solo, Star Wars: Episode IV – A New Hope

The NCCI just released their State of the Line Report which highlights the strength of the workers’ compensation system in 2020. Although job losses and pandemic-shrinking payroll caused a 10% drop in written premiums, reserves and loss ratios remained strong.

This white paper is filled with informative graphs and charts including the following system-wide COVID-19 related data.

COVID-19 Loss Summary

$260 million in total losses

45,000 claims

75% of claims are lost-time

$6,000 average claims severity

Excluding COVID-19 Claims

Claim frequency declined 7%

Indemnity severity increased 3%

Average cost of lost-time medical basically unchanged

Looking beyond the favorable statistics, the experts express concerns about the future, including:

Will premiums recover?

How will long-haul COVID claimants recover?

What are potential mental health exposures from the pandemic?

Is ever-expanding presumption legislation the new normal?

So, the industry is okay, but doing better requires all of us to not get cocky.

Call us. We can do better.

William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

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The New Normal is Not Just a Cliché

April 28th, 2021

I’m linking to a National Council on Compensation Insurance (NCCI) article by Jeff Eddinger and Damian England titled Perspectives on Managing Risks During (and After) a Pandemic. This is not a scientific research paper; rather it is a summary of opinions and future expectations from NCCI interviews with industry professionals.

The main pandemic-related takeaways are as follows:

Shielding workers from an “invisible risk” is the new norm;

Risks from high workplace physical proximity in food service, healthcare, retail and education are the most challenging;

Innovative employee communication of exposures and quarantines inspire worker confidence;

Work-at-home injuries will require new technology and approaches from carriers/payors.

Doing better requires adapting to the new normal.

Call us. We can do better.

William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

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“Gotcha Covered,” Said the Doctor

April 21st, 2021

It’s been a while since I reported on physician fraud and abuse as it related to opioid dispensing. But this article from WorkCompWire about a West Coast doctor is just too egregious not to highlight.

Evidently this physician’s license authorized him to write Schedule II though V controlled substances. Unfortunately for him, the monitoring system identified him as a “high prescriber”. Fast forward to undercover law enforcement posing as new patients requesting hydrocodone and oxycodone for “vague pain complaints,” and this is what the Feds found:

Limited or no patient physician examinations;

An initial physical exam in one situation of only 8 seconds;

Prescriptions written to pay back friends with pills, to give away to employees as incentives, and to replace pills lost at a concert.

The provider’s current charges could land him in prison for 20 years.

Herein lies a good example of why your workers’ comp network matters if you want to do better.

Call us. We can do better.

William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

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I’m Not Psychic, But…

March 30th, 2021

The National Council on Compensation Insurance (NCCI) constantly monitors legislative activity and provides workers’ compensation stakeholders with an early heads-up on trends and changes. I’m linking to an article by Laura Kersey that provides an overview of what to watch for in 2021, including:

Over 700 state/federal bills along with 161 workers’ comp regulations are moving through the system;

20 states have possible COVID-19 related presumption legislation on the agenda;

There are 40 bills that impact workers’ comp for mental health related injuries including post-traumatic stress disorder;

35 states plus D.C. have legalized medical marijuana, with more to come.

Doing better requires being better informed and anticipating change.

Call us. We can do better.

William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

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