2018-09-19 Merit Appeals Board Minutes

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Merit Appeals Board September 19, 2018 So, what we identified the areas that are the most time-consuming—and the bill paying and the reconciliation of bills and payments to the physicians has been identified as the key component. So, what I—part of our re-org. is doing is, we’re removing that component from the case managers and we’re going to—that’s why we’re bringing in the clerks. The clerks are going to be, primarily, responsible for inputting data as it relates to each of the cases. So, they’re going to be data entry. They’re going to input the billing, they’re going to ensure that the payments are made through the County, and they’re being incorporated in our case management system. They going be the boots on the ground. But the overall supervision is still going back to the case managers. So, if something is missing, something is not there, this going be incumbent on the case managers who supposed to be looking at the cases on a regular basis as to why it wasn’t. So, right now, there’s too much pointing the fingers—“Oh, that wasn’t me. That was somebody else”—or something. So, I want to put—I’m transitioning to making sure that the people who are tasked with managing the cases, ensuring documentation is proper, correct, accurate—they’re there. They have time to do that. And then, we’ll get the data entry coming in from our clerical positions. We’ll see how it works. MS. NAMAHOE: Sorry, just a clarification. You’re saying that you don’t use a TPA to handle the billing and the claims? MR. BRILHANTE: We’re only allow—right now, we’re only authorized to use TPA for Police, and Parks and Rec. Those are the two highest—the departments with the two highest work comp claims. MS. NAMAHOE: So, the question in that I’m asking him is if—so, if Joe employee, the County parks guy, falls off the coconut tree—when he goes to the doctor for his knee injury and his back injury—the checks are actually—the doctor is billing the County directly. And the County employee and the Work Comp Division is actually adjusting the claims, saying these are the eligible charges— MR. BRILHANTE: (Inaudible) the reserves. MS. NAMAHOE: —confirming it, and draw and cashing the checks? MR. BRILHANTE: Yes. MS. NAMAHOE: Versus a TPA for only these 2 departments? MR. BRILHANTE: Police, and Parks and Rec. MS. NAMAHOE: Police and—oh, excuse me. Okay, Police, and Parks and Rec.— MR. BRILHANTE: Correct. Page 15