ACE Group has announced the launch of ESIS Medicare Impact, an important addition to ESIS' leading edge approach to claims management, ESIS Impact.
ESIS Medicare Impact capitalizes on ESIS’ existing compliance processes and expertise, which provide for proactive claim management in accordance with the Centers for Medicare and Medicaid Services (CMS) Medicare Set-Aside (MSA) compliance guidelines.
ESIS Medicare Impact is unique in the industry and furthers ESIS’ longstanding commitment to MSA compliance. ESIS Medicare Impact is designed to ensure that the approach to Medicare Set-Aside allocations on workers compensation claims will be appropriate, cost effective and fully integrated with the MSA settlement process.
"We are pleased to expand upon our highly successful claims management approaches by addressing this emerging need for better coordination with CMS," said David Patterson, Division President of ESIS, Inc. "Our continual investment in programs and services that fully meet the complex and evolving needs of our clients means they continue to have a high level of control over their loss costs on each claim and on their risk management program overall."
"ESIS Medicare Impact is a comprehensive approach where ESIS clinicians and Medicare specialists employ ESIS’ risk scoring predictive modeling and data analysis to identify claims that have the potential to incur high costs and generates appropriate actions at critical junctures throughout the life of a claim," said Nancy DiVincenzo, Vice President, ESIS Claims.
The process begins with a comprehensive analysis that contemplates an employer’s total population of Medicare-eligible claims in the aggregate to identify trends and prioritize intervention efforts.
Next, ESIS clinical team members apply a consultative approach on individual claims to proactively identify the potential for high costs associated with an injured employee’s therapy regimen.
Once identified, steps can be taken to optimize treatment and mitigate the costs of these therapies before they become part of the MSA. Ongoing attention through the life of each claim includes specialty-matched physician peer reviews and ESIS nurse progress monitoring to help ensure best possible clinical outcomes while lowering costs.
"ESIS clients understand the goals of CMS and their efforts to ensure taxpayers’ assets are protected – and they are committed to compliance with the MSA submittal and approval guidelines," added Ms. DiVincenzo. "At ESIS, we are dedicated to continuing our tradition of assisting our clients in meeting their compliance obligations while protecting their interests and those of their injured employees for the life of the claim."