EK Perspectives

  UR Beyond Expectations   Utilization Review in Workers' Compensation   What comes to mind when you hear the words “Workers’ Compensation Utilization Review?” Unfair, delay in medical care, unnecessary fees to the claims administrator, non-integration with Bill Review, the “Dark Side,” or maybe all of the above?   Six years ago Health Strategy Associates (HSA) completed the first survey of Utilization Review (UR)…

  SESSION SUMMARY: The Art of Non-Submission (Medicare Set-Asides and Non-CMS Submissions) Public Agency Risk Management Association (PARMA) 45th Conference & Expo - FEBRUARY 2019   Panelists: JAKE REASON, Vice President of Medicare Set-Aside Services at EK Health Services, Inc. NEGAR MATIAN, Managing Attorney at Matian Law Group DeANNA SORIA, Risk Manager at City of Huntington Beach   Panelists discussed…

  Navigating the complexities of chronic pain and opioid addiction is an ever-present challenge for those in the workers’ compensation industry. A few anticonvulsant drugs are commonly seen in treatment plans for some pain conditions.  A recent study by the California Workers Compensation Research Institute reported the 2nd most common non-exempt drug undergoing UR in first four months of 2018 was gabapentin at 12.6%…

  SESSION SUMMARY: Exploring the Impact of SB 1160 (and new Formulary and MTUS Guidelines) California Coalition on Workers' Compensation (CCWC) 16th Annual Conference - JULY 2018   Panelists: Doug Benner, MD. Chief Medical Officer of EK Health Services, Inc. Roman Kownacki, MD, MPH, FACOEM. Chief of KaiserPermanente On-the-Job Rajiv Das, MD. Medical Director for Safeway Inc., VONS and Albertsons Alex Swedlow. President,…

  Across the country, there are millions of nurses united by a deep desire to care for others in their greatest times of need. They are the compassionate faces and the healing hands that work tirelessly to ensure that each patient receives safe, quality care. They are leaders, they are communicators and professionals,…

This week is National Nurses Week, so before we celebrate our fantastic nurse case managers, we thought you might like to learn a bit more about our Case Management team and all that they do for injured workers, and for EK Health as a whole.  Where It All Began Eunhee started as a home health nurse and developed a specialty in medical case management.  She founded…

  Drug formularies have become one of the biggest trends in worker's compensation over the last few years. A drug formulary or preferred drug list, is a continually updated list of prescription drugs supported by current evidence-based medicine and it is overseen by a body of clinical experts. The main purpose of the formulary is to promote the use of safe and effective medications, in addition to controlling costs.   Formularies…

One of the most effective tools for assisting your workers’ compensation claims team continues to be intervention by a Nurse Case Manager. Nurses assigned, on targeted cases, can be instrumental in cost containment. They serve as an advocate for the injured worker, assist in ensuring optimal care, and decrease disability days. Strong, healthy, case management programs that bring value require work on the front end to…

  Utilization Review (UR) and Bill Review (BR) are two key components in the managed care industry that must work together effectively if a program is truly going to flourish. For years so many organizations struggle connecting these two areas effectively. Have you had situations before in the industry where a service or procedure was denied from the UR department but for some reason the bill still ended up being paid…

Governor Jerry Brown Signed Senate Bill 1160, which primarily affects Utilization Review (UR) and liens. Changes will become effective on or after January 1, 2018. Medical treatment for injured workers may bypass formal UR for the initial 30 days of a claim with emergency treatment services, treatment related to an accepted body part(s), treatment rendered by a physician within the claims administrator’s Medical Provider…

  As part and parcel of the overall MSA process there is an item called Conditional Payments. When the Medicare Secondary Payer Act went into effect 1980, there was language in the Act which provided repayment to Medicare anytime a payment was made for treatment relating to an injury where another party was responsible. The idea being that any time there’s a work comp claim, a liability claim, or a group health policy…

    California Governor Signs Senate Bill 1160 Aimed at Reforming Utilization Review and Liens Waiting to the last day that he could sign or veto legislation, Governor Jerry Brown signed important workers' compensation legislation. SB 1160 had been initiated by the Department of Industrial Relations in coordination with various workers' compensation stakeholder groups. The measure passed with overwhelming support by…

        JUNE 2016     EK Health Featured in Forbes Magazine     Eunhee Kim is a home health nurse who built two companies that are transforming managed care in the workers' compensation industry. Now she's turning up on the pages of Forbes…

  Tennessee Approves New Treatment Guidelines and Prescription Closed Formulary Tennessee Attorney General, Herbert H. Slatery III has approved new treatment guidelines and a closed drug formulary proposed by the Tennessee Bureau of Workers' Compensation. The rule is scheduled to take effect on February 28, 2016. Treatment Guidelines:Tennessee Bureau of Workers' Compensation adopted the current version of the Official…

  We don't just promise it, we deliver! Bill Review Turnaround   While every jurisdiction has aggressive turnaround time standards, when measuring against the most strict turn -around time standard of 15 days for California electronic bills, EK Health's results definitely exceed expectations.Being able to deliver turn around times at least 2x faster has allowed…

A new year can bring a number of changes that may challenges us, but it also provides us with new opportunities for growth and success. Even though we are already hard at work in 2015, we want to take this opportunity to share with you our achievements, future goals and our appreciation as we reflect on a successful 2014.At EK Health, everything that we do as a company is guided by our Vision, Mission and Values. The…

With the enactment of the SB 863 Independent Medical Review (IMR) process, the legislature wanted to have medical determinations made by medical professionals and not workers' compensation judges or the litigation process. The challenge has been to make this paradigm shift smoothly so that injured workers receive quality reasonable and necessary medical care based on the MTUS guidelines.On October 6, 2014 the WCAB en…

by Douglas Benner, M.D.Chief Medical Officer, EK Health Services, Inc.   An interesting article in the May 2014 JOEM highlights a still significant issue in workers’ compensation: dispensing of medication out of physician offices. The results confirmed similar findings in a study in CA by CWCI in 2013. This Illinois study1 reviewed 6,824 comp claims with Accident Fund of Illinois for the years 2007 to 2012. When physicians…

by Douglas Benner, M.D.Chief Medical Officer, EK Health Services, Inc.   Reminder: When making medical treatment requests, it is essential to explain WHY a particular treatment is requested. This will help the Claims Administrator approve the request at their level, or facilitate approval by a UR organization if the request is elevated to them for review. For medications, it is useful to document the indication or…

by Eunhee Kim RN MSNCEO, EK Health Services, Inc. Our Workers compensation industry is seeing experienced well-seasoned nurses and claims adjusters leaving their positions either through retirement and relocation. Sadly, there has been not a lot of sustained effort and investment in educating and encouraging the new generation workforce to our industry. In workers’ compensation where the environment is always evolving,…

by Steve KlineGeneral Counsel, EK Health Services, Inc. On May 21, 2014, the DWC approved the EK Health Services, Inc. application for the EK Health Select MPN. Prior to the passage of SB 863, only insurance companies and employers could create a Medical Provider Network in California. With the 2012 reform legislation, entities that provide network services became eligible to own and create an MPN. We are proud that…

by Steve Kline, Esq.Legal CounselEK Health Services®, Inc. Close to 95% of the California reform, SB 863, will go in to effect on July 1, 2013—less than 30 days away.  The remaining items, mainly concerning Medical Provider Networks, will become effective on January 1, 2014. In one area of the system, specifically, the Independent Medical Review (IMR), the community has had some experience since the beginning of the…

by Gloria Farley, RN, BSN, COHN-S Ergonomic Service SupervisorEK Health Services®, Inc.  Does office work promote sedentary lifestyles? - It doesn't have to! The increasing rate of obesity in America is typically associate with our sedentary lifestyles—defined as not physically active.  Individuals sit, on average, for 14 hours and 39 minutes per day, mostly at work.  When not sitting, individuals are also considered…

With summer upon us, many of you may be hitting the garden with new fervor planting bright beautiful flowers, fruits & veggies. Here are some "ergonomic" tips to keep you "feeling" your best as you garden. Always use gloves and use a pad for your knees when kneeling Gloves provide padding and to prevent cuts and scrapes Gloves should be form-fitting—thin gloves are preferred; too much padding will decrease hand…