7 tips for hiring a great LNC

Posted by on Nov 29, 2016 in Blog

I’ve worked with a lot of legal nurse consultants since launching MKC Medical Management in 1997. And, from experience, I know what qualities make for the best ones. This fall, I had the chance to dive deep into that topic as I wrote a piece about how to hire a great LNC. For more information, see my article in Attorney at Law Magazine. Here are seven tips for hiring a great LNC: Know what you want: Have specific goals in mind and make sure the LNC meets them. Find out if somebody else will review the final product before it’s sent to you. Ensure the LNC understands the case: The LNC must understand not only who is at fault, but the standard of care and any other relevant legal issues. Expect a translation of medical terms: If the reader has to use Google or a medical dictionary to get through the report, then the LNC has failed. Demand attention to detail: If the LNC repeatedly misspells words, gets dates wrongs and makes other mistakes, then you need to question whether she has what it takes to be a consultant. Make sure medical information is properly reported: The LNC’s analysis should demonstrate a knowledge of the disputed facts versus the undisputed facts, along with any expert opinions. Any information that speaks to your specific issue or questions should be included. Look for a basic understanding of biomechanics: Nurses are not biomechanical engineers, but they need to have an understanding of how an accident affects the body. Meet in person or by telephone:  An LNC must be able to think like the opposing counsel and determine why a provider did what they did. A lot of information about the nurse’s skills and expertise can be gleaned from talking through issues in person or by telephone. Not every registered nurse makes for a good LNC. It’s critical they understand both a claim’s legal nuances and are able to explain them clearly in writing. But, when you do land on a great one, they can help you build your case – and...

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Tips, Trends & Findings

Posted by on Nov 15, 2016 in Blog

 Here are studies, reports and stories that caught our eye in the last month. Medical marijuana and the workplace: An article in WC Workers’ Compensation magazine covers the clinical and legislative significance of medical marijuana. As more states approve the use of medical marijuana, employers must consider how to handle claims when medical marijuana is prescribed for work-related injuries and policies related to work duties for those using  medical marijuana, the article says. Liability Medicare Set-Asides on the horizon: An article in Claims Management says that the Centers for Medicare and Medicaid Services could review Liability Medicare Set-Asides. The article updates the latest movement on the issue and recommends current best practices for liability claims with Medicare beneficiaries. New study on Alzheimer’s disease: In a report from JAMA Psychiatry, higher brain amyloid burden, an early indicator of Alzheimer’s disease, was associated with more frequent feelings of isolation, being left out and lacking companionship. These feelings could be associated with early brain changes in preclinical Alzheimer’s disease before the onset of mild cognitive impairment. Help for those healing: As many as 70 percent of patients with cancer report increased anxiety, depression, fatigue and a poorer quality of life after chemotherapy. A study in the Journal of Clinical Oncology found improvements when patients took part in a web-based cognitive rehabilitation program. Kids at risk: An analysis in JAMA Pediatrics found that pediatric hospitalizations for opioid poisonings increased almost two-fold from 1997 to 2012. Older adolescents had the highest hospitalization rates, but the largest percentage increase was among toddlers and preschoolers. Public health interventions, policy initiatives and consumer-product regulations are required to curb children’s exposure and misuse of the...

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Baseline Reports: How ER records can help you build your case

Posted by on Nov 8, 2016 in Blog

Emergency room visits are on the rise. One study from the American College of Emergency Physicians found that 28 percent of ER doctors polled have reported a spike in the number of cases since the Affordable Care Act took effect. Another 47 percent have seen at least a slight increase. The costs are on the upswing too, especially for personal injury claims, as  hospitals attempt to recoup money thanks to changes in the health care system and other factors. In fact, charges can vary wildly – from $4 to care for a sprained ankle to $24,000, according to one study. There is no associated fee schedule with property and casualty claims. This, by default, allows providers to set their own fees with the expectation of full reimbursement. Still, the ER is the first place many go for medical care. And those ER records provide a critical, but complex window into a patient’s health and injuries, establishing a medical baseline at the time of the incident. To the untrained eye, the codes, test results and billing practices can be a confusing garble of medical terms and figures. But, when insurance claims are analyzed by MEDICAL consultants they provide vital clues into a patient’s actual injuries, the inciting event and billing practices. Did the injured person actually suffer serious injuries or is there some inconsistencies in their reporting? Are the provider charges verifiable with the medical record? Were the ordered and completed test indicated for the injuries and reported conditions? In my mind, appropriate care is appropriate care regardless of payer source.  Unfortunately, this is not always true. In ERs, doctors practice “defensive medicine” to avoid malpractice claims, which can drive up health care costs. Liability claims also are the only kind of claim to not have an applicable fee schedule. Other types, such as workers’ compensation, Medicare and private insurance claims, pay out at a specific level. With liability, there are no specific allowed fees for a test or procedure. The ER records are where you analyze and begin to build your case. An accurate reading and understanding will provide the objective findings to understand how the injured person fared after that slip and fall or car accident, and contrast those findings against subjective complaints and reported history. If you’re analyzing them, here’s what you need to know: Basic ER documentation: Be sure you have all of the paperwork. In the ER, that includes the RN triage sheet, the ER physician documentation, diagnostics studies and testing, bedside nursing notes, consultation reports, order sheets and consent.  Look at what was ordered?  Is it consistent with the working diagnosis? Was the physician confirming a suspicion or ruling something out. These details matter...

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‘Turning the Tide’ on Opioid Abuse

Posted by on Nov 1, 2016 in Blog

How doctors, patients, employers and insurers can help By Kari Williamson, RN, LNCC, CCM For decades, doctors prescribed opioids to fix their patient’s chronic pain. In reality, for some, opioids just made their lives worse, leading to addiction, escalating drug use and even death. The numbers behind what’s being called an “epidemic,” which I wrote about in this month’s edition of Property Casualty 360, are stark. Opioids were involved in the deaths of more than 60 percent of people who died from a drug overdose in 2014, a year when more people died from overdoses than ever before, according to the Centers for Disease Control and Prevention. Since 1999, the number of overdose deaths from opioids has nearly quadrupled, says the American Society of Addiction Medicine. To address the issue, the Obama administration in March announced the federal government’s first coordinated plan for reducing the burden of chronic pain. And, this summer, the U.S. Surgeon General Vivek H. Murthy sent a letter to every doctor in the country, asking them to “turn the tide” on the opioid crisis. “Many of us were even taught — incorrectly — that opioids are not addictive when prescribed for legitimate pain,” Dr. Murthy wrote. “The results have been devastating.” Doctors are taking a new look at how how they can curb opioid use – and abuse. No longer using opioids as a regular course of action; strictly limiting the number of pills and refills; searching for other therapies and medications; and checking with their state’s prescription drug management program database all are proven ways to limit opioid prescriptions. But the hard work to defeat this epidemic doesn’t fall only on them. Patients must be aware of the dangers of opioids; always take the lowest dose; and be ready to try alternative therapies to manage their pain. Employers should seek out an expanded drug testing panel; ask insurers and providers to look out for warning signs that a patient is abusing opioids; and create a safe zone where employees can ask for help. Insurers must make sure case managers follow patients throughout treatment and their use of any opioids; insist on periodic, random drug screenings; and look out for warning signs. I shared many more tips for doctors, patients, employers and insurers in my article in this month’s edition of Property Casualty 360. The opioid epidemic is serious – destroying lives, families and communities. But, together, we can turn this tide...

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