Medical Implications in Reserve Setting

Posted by on May 26, 2011 in Blog, Claims Tools, Reserve Setting, WC, Workers Compensation

How much is my case worth? No matter what side you are on, the question “How much is the case worth?” is the all important one!  Accurate reserve setting takes into account multiple factors including: venue, job/earning ability, the specific injury; current and future medical expenses, treatment, diagnosis, prognosis, permanent loss/damage and specific claimant information. The goal of this process is to not to over or under reserve a claim, but to find the truest amount, and do it as quickly as possible. Many of the factors involved are medically driven.  As a LNC/ NCM, I am often asked to help with analyzing medical information/records on a claim to assist with reserve setting. The clearer the medical information, the more accurate the reserve will be. Unfortunately, sometimes the medical details can get lost in the overall process. Here are a few ways a LNC/NCM can assist with initial reserve setting and/or periodic reserve assessment: Help determine damages sustained by the injured party. same day pay advances Medical record review for analysis and comment of current medical information and proposed treatments. If appropriate, communication with the client to obtain information about injuries, medical care, personal specifics, and complaints. Onsite medical assessments to gather medical information from the medical providers and client Life care plans Task assignment for real time analysis of medical information. Attorney, client or adjuster education on disease process, condition, healing parameters and/or recovery timeframes. Field or telephonic case management Sometimes getting a clear understanding of the medical aspects of a claim can be challenging. However, with the help of a LNC, NCM, physician and other medical providers, an accurate analysis of the available medical information can be obtained and analyzed. Remember a small amount of accurate medical information can make a BIG difference in dollar expenditures!...

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Knowing Your Provider

Posted by on May 12, 2011 in AALNC, Blog, Case Management, Legal Nurse Consultant, LNC, WC, Workers Compensation

As a LNC/NCM I am often asked to help identify physicians to assist/work on a file/case OR help navigate the provider-client-payor waters. This is especially true in the Workers Compensation arena. Most recently this topic was discussed at length in a LinkedIn discussion group. Several excellent points were made. Noted in the discussion group: Does a provider have experience in your desired service? Be aware of reimbursement issues. Learn the State Rules and Regulations concerning WC. Check out the State website for details and reporting guidelines. Check out guidelines such as ODG, or MD Guidelines to verify that the client is tracking along with their recovery or rehab. ACOEM (American College of Occupational and Environmental Medicine) provides a guide to help assess outcomes. Some of the more basic ones that I utilize are: bad credit instant approval loanspayday loan online direct lender no credit check Check with other adjusters and attorneys for their experiences with the provider. Local NCM/LNC are very knowledgeable about the physicians in the area and can give solid insight as they often deal with the providers on a first hand basis. An employers will also know which doctors are easy to work with, take a certain type of case, etc. especially providers that will provide front line care such as family practice, occupational medicine, etc. If possible ALWAYS pre-screen the physicians. Learn how they report, communicate, how they interact with a NCM/attorney/insurance company, etc. Try and learn the “particulars” of the office staff. Periodically re-assess the physician and support staff. People change within a practice; physicians get busier and become unable to communicate as well; practice philosophies, and goals change. Seek feedback from the employers as to how their provider choices are or are not performing. Ongoing assessment of the physician(s) should be done. Help to educate the payor, employer, and provider on what to expect in regards to reporting, State regulations, employer RTW philosophies, etc. Does a physician embrace modify duty? We sometimes forget that the medical arena is consumer based. Knowing how your provider is performing is critical to successful...

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