The Medical Provider Network and care clinic you choose for your employees gives you control over the outcome of workers’ compensation claims. Choosing the right Medical Provider Network, or MPN, gives you as the business owner the opportunity to select the level of care your employees will receive if and when an on-the-job injury occurs. The MPN and clinic will be approved by Division of Workers’ Compensation if they are qualified.
It’s important to be aware of the networks of which the clinics you are considering belong. Select one that is a member of the insurance carrier’s Medical Provider Network. Otherwise, you could lose control of the workers’ compensation claims process. Provide all your employees with the required MPN paperwork so that you know what to expect if an employee is injured.
Remember when working with your clinic and MPN, you are the customer! By understanding what you need for your employees, you can make sure the clinic addresses your expectations of first aid, pre-employment physicals, drug testing, and your Early Return to Work Program.
As their customer, you deserve top-quality service. Demand immediate communication and assistance from your provider when requesting recommended treatments and prognosis for work related injuries and illnesses. If the clinic is not willing to meet your demands, ERM Insurance recommends you start interviewing others who will take your needs into top consideration.
ERM Insurance brokers recommend two documents to assess if a clinic is right for you: Level 1 Clinic Basic Selection Criteria Questionnaire and the Level 2 Clinic Advanced Selection Criteria Questionnaire.
Bring your needs to the attention of the Medical Provider Network and clinic by conducting the questionnaires orally, or leave the documents with clinic staff to return to you at a later date. Terms to Know When Communicating with Medical Providers will be an indispensable asset for you to facilitate your discussions.
As their names imply, the two documents assess the clinics on their level of experience and integrity. The Level 1 Questionnaire gives insight into how a clinic will respond to basic occupational health practices. The Level 2 Questionnaire is more in-depth, and will reflect whether or not the clinic has developed advanced occupational health expertise. The clinic you find suitable should most definitely satisfy all level 1 requirements. It may not meet all level 2 requirements, so understand what qualities are most important to you.
A clinic that qualifies as “good” will be interested in your company’s vision for occupational health delivery, and will share your concern for the importance of getting employees back to work. The clinic should be interested in touring your facility and learning about the nature of your business. This will help them understand the types of injuries that occur most frequently on site, to better jointly determine with you the work restrictions that apply to injured employees returning to their jobs. The Medical Provider Network clinic should be quite aware of your business practices day by day to better lower the risk and manage workers’ compensation claims appropriately.
When negotiating with a clinic, make clear your focus communicates what’s in the best interest of your business. Don’t focus on gaining a deeply discounted fee schedule. Instead, remind them that your company will facilitate regular business with the clinic, should they uphold the agreed commitment and high quality of care requirements.
It can be difficult for business owners to ascertain what makes up qualified providers. To assist you in this process, you may want to briefly review the Clinic Performance Agreement and the Employer Performance Agreement with medical clinic staff. These agreements, further explained in the next implementation step, may need modifications per your agreement, but a clinic’s willingness to consider them is an important indicator of a productive future relationship.
Once you have conducted your evaluation of the clinics and selected which best suits your needs as a business owner, it’s crucial to execute clinic and employer performance agreements that will define the mutual expectations.
These non-binding agreements provide guidelines to all parties reminding the objectives of the relationship. You may need to negotiate the finer details, but the general purpose and statements within the agreement should be acceptable for defining the majority of practices.
For the clinic, the agreement includes performance expectations for:
- prompt diagnosis
- determination of causation
- analysis of the degree of impairment
- designation of appropriate work restrictions
- notification of all stakeholders
Most clinics will not resist these conditions.
As the employer, the agreement with the Medical Provider Networks and clinics states, among other things, that you will refer and transport all injured employees to the clinic. You will honor any work restrictions designated by the physicians, and provide all necessary information (such as the results of drug screenings, incident reports, etc.) in a timely manner for the better of your workers’ compensation.
The brokers at ERM Insurance have your best interests in mind, and highly recommend following these parameters for finding the best Medical Provider Network and clinics. Our holistic risk management program and advice seeks to lower the overall cost of risk within your business, to make your budget and the wellness of your company better off. Discuss how to find the right Medical Provider Network and clinic for your business with one of our knowledgeable brokers today at (949) 222-0444.