MedRisk, Inc., a provider of specialty managed care services to the workers’ compensation industry, has introduced CERTExpertSM, a pre-certification service for physical therapy.
Designed to address the escalating cost of physical medicine, which currently reportedly represents between 20 and 30 percent of total workers’ compensation medical expenses, CERTExpert controls over-utilization through the use of new treatment guidelines and peer-to-peer communication.
“Traditional PT pre-certification services merely authorize a number of approved visits,” said Shelley Boyce, CEO of MedRisk, which has operated a PT specialty network for more than 10 years. “CERTExpert goes beyond visit approval to give the treating clinician a detailed roadmap for achieving the best outcome for each patient.”
Clinicians at CERTExpert communicate with the treating therapist at key intervals and provide a week-by-week menu of treatments. The menu highlights the most effective treatments, those considered potentially effective, and those found to be ineffective for the condition. The latest research and supporting literature for each treatment recommendation is immediately available.
The expert-based, literature-supported guidelines were developed by Expert Clinical Benchmarks® (ECB), LLC, the academic and research arm of MedRisk. Working closely with a panel of international physical medicine experts, ECB defined optimum treatment protocols for all types of musculoskeletal injuries. These protocols were then outcomes tested against the industry’s largest data base of managed workers’ compensation physical medicine claims and adjusted to reflect current best practices and regional variations.
CERTExpert identifies the most appropriate and effective care, controls provider over-utilization, encourages progressive treatment, and achieves consistent and defensible results. The peer-managed service is clinician oriented and reportedly non-adversarial.
CERTExpert can be used in conjunction with other managed care programs and services for prospective, concurrent and retrospective reviews. It is available to insurance carriers, self-insured employers, third-party administrators and managed care organizations.
For more information, visit www.medrisknet.com.
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