Claim-Coding Mistakes Found, Confirmed by Ohio Bureau of Workers’ Compensation

As many as 23,000 workers’ comp claims filed in 1999 were miscoded or lacked a code that helps determine the premiums paid by businesses. So found a study released Monday by the Ohio Bureau of Workers’ Compensation. The bureau plans to make changes to its computer and claims processing systems to reduce the error rate and to use the data collected to revise future base rates.

Base rates cannot be changed retroactively, meaning companies would only be reimbursed for overpayments or be charged for underpayments if they have inaccurately reported the payroll amounts for employees assigned to various codes. The codes, or manuals as they are referred to, are numbers assigned to about 615 different job descriptions.

They are the basis for determining the risk level of each job. The state calculates base premium rates using actual losses for injuries that occur among employees in each type of job. Base rates are the starting point in the system used to determine each company’s workers’ comp premium. Questions about miscoding were raised during the summer by bureau employees who noticed an unusual amount of mistakes.

The Bureau of Workers’ Compensation formed a special team that randomly selected 500 claims, finding 20 with incorrect codes, 30 without codes and 112 where the correct code could not be determined. Based on this information, the team projected that of the 273,522 claims filed in 1999 23,001 contained errors. The 8.4 percent error rate is significantly higher than the 5 to 7 percent national error rate reported by the National Council on Compensation Insurance, which devised the manual codes.

Topics Workers' Compensation Talent Ohio