If you are injured on the job, you may have a lot of questions regarding your medical care and the organization that manages your requests for medical treatment. One of the biggest questions injured workers in Ohio have is “What does MCO stand for?”
In the context of workers’ compensation in Ohio, MCOs are crucial in handling medical claims and facilitating communication between injured workers, employers, and healthcare providers. Below, we’ll go into more detail about what MCOs are and what they do for injured workers in Ohio.
If you have suffered from a workplace injury in Ohio, contact Cincinnati workers’ comp attorney Mark L. Newman today at (513) 533-2009 or reach out online today to schedule a consultation regarding your claim.
What Does MCO Stand For?
MCO stands for Managed Care Organization. When injured workers file workers’ compensation claims in Ohio, MCOs are responsible for coordinating medical care and ensuring they receive appropriate and timely treatment.
What is a Managed Care Organization?
A managed care organization is an organization that coordinates and manages medical services to enhance care quality and control costs. When a workplace injury occurs in Ohio, MCOs oversee medical claims, arrange necessary medical appointments, and maintain communication between injured workers, healthcare providers, and employers.
They also monitor the treatment progress to ensure it adheres to established guidelines and protocols under Ohio workers’ compensation law. As a result, MCOs help control medical costs, reduce downtime, and improve overall outcomes for injured employees in Ohio.
MCOs vs. Insurance Companies
Because the Ohio workers’ compensation system is run by the state, all employers must obtain workers’ comp coverage through the Ohio Bureau of Workers’ Compensation (BWC) rather than through private insurance companies. However, some large employers may apply to become self-insured.
The difference between insurance companies and MCOs lies in their roles and responsibilities. Insurance companies primarily handle the financial aspects of a claim, while MCOs focus on the medical aspects of the claim, ensuring that injured workers receive proper medical care and coordinating their treatment plans.
Here’s a more comprehensive overview:
- Managed Care Organization (MCO):
- Care Management: Actively manages and coordinates healthcare services.
- Provider Networks: Requires members to use a small network of providers.
- Payment Model: MCOs are paid by the BWC from the employer’s workers’ compensation premiums.
- Insurance Company:
- Care Management: Provides financial coverage and reimbursement for medical expenses without direct management of care.
- Provider Networks: Offers more flexibility in choosing providers.
- Payment Model: Paid directly by self-insured employers.
MCOs in Ohio
Ohio employers are required to select one of the state-approved Managed Care Organizations (MCOs) to manage their workers’ compensation claims. These employers must choose an MCO partner from the BWC’s list of approved providers during their initial workers’ compensation policy setup or during the open enrollment period.
If you are interested in learning more, you can find the MCO assigned to your employer through the employer/MCO look-up on the Ohio Bureau of Workers’ Compensation website.
The Role of Managed Care Organizations When Filing a Workers’ Compensation Claim
When an injured worker files a workers’ comp claim in Ohio, MCOs take on an important role in managing various aspects of the process. Key duties and responsibilities include:
- Initial Medical Management: Coordinating the initial medical care for workplace injuries and ensuring timely and appropriate medical treatment is provided to address the injury.
- Case Management: Assigning case managers to oversee the medical portion of the workers’ claim, including medical treatment and recovery, and monitoring their progress to facilitate communication between healthcare providers, employers, and the injured worker.
- Provider Network Management: Maintaining a network of approved medical providers to ensure quality care and coordinating rehabilitation referrals to specialists within the network as needed.
- Authorization of Treatment: Reviewing and approving medical treatment plans and procedures as well as authorizing future medical care that is necessary and appropriate for the type of workplace injury.
- Medical Bill Processing: Processing medical bills, making sure they are paid, and ensuring that billing complies with the state’s fee schedule and guidelines to manage claim costs effectively.
- Return-to-Work Programs: Developing and implementing return-to-work strategies to facilitate the transition of the injured employee back to their job. They may also work with employers to modify duties or identify suitable alternative work if necessary.
- Compliance and Reporting: Ensuring compliance with BWC’s regulations and guidelines while providing regular reports and updates on the injured worker’s status.
- Education and Training: Educating employers and employees about workplace safety and injury prevention as well as providing resources and training to support coordinated efforts.
What’s an MCO Report Card?
An MCO Report Card is a performance evaluation tool used by the Ohio BWC to assess and compare the effectiveness of MCOs. It provides ratings based on various data, such as medical management quality, cost management, and return-to-work outcomes, helping employers make informed decisions when selecting an MCO for managing workers’ compensation claims.
For Experienced Workers’ Compensation Assistance in Cincinnati, OH, Call Attorney Mark L. Newman Today
Handling a workers’ compensation claim can be overwhelming, and trying to keep up with the ins and outs of the system and the role of certain organizations like MCOs can be confusing. Luckily, Ohio workers’ compensation lawyer Mark L. Newman is here to help you through the process, providing personalized legal assistance to ensure you receive the benefits you deserve.
With years of experience handling workers’ compensation cases in and around Cincinnati, OH, Attorney Mark L. Newman has the knowledge and skills to effectively advocate for your rights and guide you through the entire claims process. Whether you’re dealing with denied claims, delayed benefits, or disputes with Managed Care Organizations (MCOs), Attorney Mark L. Newman offers comprehensive support to address all aspects of your case.
Call (513) 533-2009 or reach out online to schedule a consultation with Attorney Newman regarding your workers’ comp case today.
