40% of CA Utilization Review Providers Non-Compliant with New Law

I was stunned to read in a recent WorkCompCentral article (subscription required) that only 38 of the 63 firms currently providing workers’ compensation utilization review (UR) services in California are URAC accredited. Per California Senate Bill 1160, the deadline for mandatory accreditation was July 1, 2018. WorkCompCentral’s reported figures on July 9 mean that 40

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Upcoding Crackdown: Federal Efforts Fail to Benefit Private Insurers

For more than a decade, taxpayer-funded health care programs have seen a steady uptick in higher-paying billing codes. Office visits, outpatient services, and emergency room care have all been billed at progressively higher reimbursement codes, raising fees by billions of dollars. Many providers contend the shift is the result of sicker patients coupled with the

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The Road to Optimal Opioid Prescription Length

The Centers for Disease Control and Prevention (CDC) estimates that the total economic burden of prescription opioid misuse in the United States is $78.5 billion a year. Most of that burden is related to workplace costs, such as lost productivity, prolonged time on disability, and increased work disability claim costs. To help combat this crisis, organizations

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The Future is Now – Telemedicine in the Marketplace

For years, telemedicine has been touted as the next frontier in healthcare. Based on data from multiple health systems, the future has arrived. Some of the country’s largest and most prestigious health systems such as Kaiser Permanente, NewYork-Presbyterian, and Johns Hopkins now boast robust telemedicine programs. At Kaiser Permanente, virtual patient encounters now outnumber in-person

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The One Litmus Test for Indispensable Employees

It’s no secret executives value employees who are smart, driven and lifelong learners. However, sometimes organizations can get bogged down with too many key performance indicators (KPIs), copious desirable employee traits and overly complex review processes, so it’s nice to have a quick, “back-of-the-napkin” measure of employee value. According to businessman Mark Cuban, the secret

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Rest in Peace, Jamey Masingill

It has been a sad couple of days. Last Thursday, one of my favorite people in the industry and in life, Jamey Masingill, lost his battle with ALS (amyotrophic lateral sclerosis; also known as Lou Gehrig’s disease). Many of us at Rising and throughout the workers’ compensation community worked with Jamey over the years. Anyone

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Rest and Fewer Reps Hasten Learning

We all know the saying “Practice makes perfect.” According to Malcolm Gladwell’s Outliers, at least 10,000 hours is required to be a true expert. Many of us assume that aspiring experts must cram those hours into uninterrupted practice sessions and master one topic at a time before moving on. But the conventional wisdom of “blocking”

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