Automated Support of Medical Decision-Making in Workers' Compensation: Adjudication and Bill Payment Decisions

In: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2203906

Open Access

Abstract

Medically related decision-making in workers' compensation, especially in areas of patient eligibility for benefits and determination of exact medical and compensation benefits, differs significantly from similar decisions in clinical practice and acute care payment. A government-sponsored program has been developing guidelines and decision algorithms to aid in decision-making in these areas, focusing on occupational diseases. These decision algorithms are now being automated to support national implementation of the guidelines by Federal agencies and to encourage their adoption by the private sector.