Which is a common mechanism for controlling costs in workers’ compensation programs?

• A. Requiring pre-approval for all non-emergency treatments
• B. Limiting total number of visits or weeks allowed per diagnosis; case managers monitor rehab
• C. Providing unlimited visits with no caps
• D. Reimbursing only based on bill rate, with no case management

Answer: (B)

A common way to control costs in workers’ compensation programs is to use case management alongside utilization management that limits rehab services. By setting a cap on the total number of rehab visits or weeks allowed for a diagnosis and having a case manager actively monitor the rehabilitation process, the program keeps care aligned with return-to-work goals while preventing excessive spending. The case manager coordinates services, reviews progress, and adjusts plans as needed, which helps ensure that resources are used efficiently and that care remains appropriate.

Other approaches can be less effective for cost control. Requiring pre-approval for all non-emergency treatments is a gatekeeping step that slows care and isn’t as direct a budget-control mechanism as caps with active monitoring. Providing unlimited visits with no caps tends to drive up costs without necessarily improving outcomes. Reimbursing solely based on bill rates with no case management removes oversight and can lead to unnecessary or duplicative services.