January 2012

Provider News

This is a monthly roundup of L&I news for medical providers. To subscribe by email, join our Medical Provider News email list.

You can also read previous Provider News editions.

In the Provider News for January 2012:

A message from L&I Director Judy Schurke: New Stay at Work program launches - Should encourage light-duty

Greetings, valued health care providers:

Many of you are familiar with research in occupational medicine showing improved health outcomes and reduced disability rates among injured workers who stay salaried, active, and connected to their workplace before they are fully recovered.

I'm happy to announce that today we're launching a new program called Stay at Work. The Stay at Work program pays wage and expense reimbursements to employers who can find light-duty or transitional jobs for injured workers who are ready for activity you've approved.

For you, there won't be any change in paperwork. But you may have more employers asking you to review light-duty job descriptions. And, it will be more important than ever to complete the "restrictions" section of the Activity Prescription Form.

This step, approved by the 2011 Legislature, is an historic one for us at L&I. It will be a powerful tool we can all use in our effort to make your approved work activity a part of patient recovery.

We hope you will take on this challenge with us. You can have a positive effect on your patient's future by supporting early return to work and by evaluating employers' job descriptions to ensure they meet your patients' physical restrictions.

I also want you to know that I appreciate, as always, your willingness to take on the additional responsibilities workers comp insurance can entail, especially when a patient requires time off work to recover.

Thank you.

Judy Schurke, Director

Provider network rules for participation are now finalized

L&I has reached an important milestone in the development of our workers' compensation medical network - the Provider Network rules have been finalized and filed.
In response to comments about the proposed language, the department made some changes in the rules. No significant new issues emerged from the comments, a tribute to the thoroughness of the Provider Network Advisory Group. The revisions include clarifications and editorial changes. You can review the rule and other information at these links:

Two clarifications may be of particular interest:

  • We added "based on cause or quality of care issues" to the minimum requirements related to termination from public health programs. Terminations from public programs that are not explicitly designated as for cause would be reviewed, but would not cause an automatic denial.
  • We clarified that denying a provider's application and removing a provider from the network have the same appeal rights as all other department actions under RCW 51.52.

When the rules become effective on February 3, L&I will begin credentialing providers for the network. Network application processes are being finalized and will be announced soon. We want all great providers to enroll and it's an open network - we will accept all qualified providers who meet network requirements. The network will launch on January 1, 2013.

Write to us at ProviderFeedback@Lni.wa.gov or call 360-902-5140.

Four COHEs begin pilot of new occupational-health best practices for backs

Research shows that injured workers take longer to heal than the national averages for the same injuries sustained during non-occupationally-related activities, especially for mechanical back pain and back strains. To improve outcomes for back injuries, four Centers of Occupational Health and Education (COHE) clinics began a new pilot project on October 1. The pilot focuses on identifying patients at risk for developing long-term disability and intervening with activation modalities such as graded exercises in the first few weeks of treatment.

The activation modalities are part of a new set of occupational-health best practices developed by L&I in conjunction with UW researchers and with the support of experienced private-sector providers. Based on a survey of published studies, the UW researchers identified 20 potential quality indicators for treating back injuries. A focus group of Washington State providers from multiple specialties reviewed them based on their clinical knowledge and years of experience treating injured workers.

15 quality indicators were selected as the most likely to prevent long-term disability in occupational back injuries. These indicators are the basis for the occupational health best practices being tested over the next 4 years. They can be grouped as follows:

  • Activation (5) - Assessing expectations and pain; designing a care plan that includes graded activities
  • Opioids (4) - Conservative, evidence-based opioid prescribing practices
  • Surgical (5) - Closer coordination between primary attending physician and surgeon
  • Community-based support - Development of long-term collaborative resources for chronic pain patients

Interested in helping L&I develop best practices?
Over the next four years, we will need providers to help us design and to participate in additional pilots. The next pilot is scheduled to begin in November 2012. If you are interested in participating, contact Carole Horrell, Emerging Best Practices Manager, at Carole.Horrell@Lni.wa.gov or 360-902-5080.

A new study documents that investing in occupational health "best practices" improves outcomes for injured workers

A recent study found that injured workers treated by health-care providers operating under best practices used in the Centers for Occupational Health and Education had 19.7% fewer disability days than other injured workers receiving treatment, and a reduction in total disability and medical costs of $510 per claim. Workers suffering from back strain had a reduction in disability days of 29.5%.

The study was published in the December issue of Medical Care, the American Public Health Association's journal. Dr. Gary Franklin, L&I medical director, was a researcher on the study.

FileFast online claim filing is expanding to Eastern Washington

FileFast online claim filing is now available in Eastern Washington and will expand to Central Washington in April. L&I launched the new system in June in Northwest Washington and quickly became popular with many providers' offices. It will be marketed across the rest of the state later this year.

Medical providers and workers can file State Fund-insured accident reports on the L&I website at Lni.wa.gov/FileFast. Workers who don't have access to a computer or who need an interpreter can file by phone instead at 1-877-561-FILE (3453).

Workers can still file using the old-style paper report as in the past, but incomplete information and mistakes often slow down claim processing.

How online claim filing benefits health-care providers:

  • Immediate confirmation of filing
  • More space to provide medical information
  • Faster authorization for treatment and prescription refills
  • Reduces mistakes common on the paper form
  • L&I offers an additional $10 for online filing (use billing code 1040M)

Structured Settlement: A new option for injured workers

Your workers' compensation patients over age 55 now have a new option for resolving their claims. An eligible patient may enter into a structured settlement with L&I and their employer that creates a customized solution for meeting their work or retirement goals. In most cases, settlement will include claim closure. L&I is not involved in structured settlements with self-insured employers.

While a settlement is being developed, L&I or the self-insured employer will continue to manage the claim and pay all appropriate benefits. You should continue your normal billing practices and direct all claim-benefit questions to the assigned claim manager. If the settlement includes claim closure, for State Fund claims L&I will issue the closing order and give a copy to the claim's attending physician.
To be eligible for a structured settlement, your patient must:

  • Be age 55 or older (age 52 or older beginning January 1, 2015 and age 50 or older beginning January 1, 2016)
  • Have an allowed claim in Washington that is not under protest or appeal
  • Wait at least 180 days after submitting their injury claim to their employer

For more information, visit www.Settlement.Lni.wa.gov or call the L&I Structured Settlement Unit at 360-902-6101. The Settlement Unit can update you on the status of potential settlements.

Need an interpreter? Use telephonic interpreting for fast access

With telephonic interpreting, you can get an interpreter on the phone in 30 to 60 seconds. The services are paid for by L&I and two private vendors offer 24-hour access to over 180 languages. Not having to depend on the availability of onsite interpreters allows you to be more responsive to your patients' needs, especially patients with unique languages. No appointment is needed. No pre-authorization is required for interpretation services when treating an injured worker.

We encourage you to try out these services. Learn how to contact a telephonic interpreter at Finding an Interpreter.

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