The Business Process Re-engineering project kicked off in August 0f 2013. Internal Board working teams and input from external stakeholders provided an honest evaluation of the system as it is today. The analysis served as in put in the development of the To Be recommendations. With the support of external stakeholder over 100 recommendations were developed. Three overarching themes or categories emerged, they are: Redefine the role of the Board in the system protecting the rights of injured workers and employers, management and availability if quality medical care and technology.
The Board chose to select three of the initiatives that would offer the best balance among a number of priorities, could be accomplished within a relatively short period of time and resolve some long standing, or pressing problems at the Board.
A great deal of work has been accomplished to get to the BPR Implementation phase. The first setsets of initiatives that will be implemented as part of the BPR implementation are:
- Medical Portal & Reporting Portal - A portal is a central place for making different types of information accessible to an audience. Stakeholders will be able to view the information based upon their role in the workers’ compensation system. We envision a Medical Portal that would be able to facilitate resolution of issues concerning Request for Treatment Authorizations, Requests for Variance from the Medical Treatment Guidelines, optional prior approval. We envision medical reports and bills being submitted electronically. Parties would have the ability to know and see exactly what stage in the process they were at.
- Payor Compliance - Building on the foundation of the Board's eClaims project where the Board began to receive accident and payment data electronically, the Board will begin to work with the payor community to increase performance. In support of this initiative the Board has established a Monitoring Unit. This unit will collaborate with the payor community and establish performance standards. Performance standards for timely first payment of indemnity benefits, timely payment of medical bills, timely submission of First Report of Injury and Subsequent Reports of Injury along with other key performance metrics will be evaluated
- Quality Medical Care Initiatives - The Board's proposal is to adopt a resource based relative value scale based fee schedule. This methodology used by Medicare will allow the Board to update the fee schedule on an annual basis. In addition, the Board's proposal is to adopt most of the Medicare billing and ground rules.