Contact Relationship Management: What does your LNC business want to be when it grows up?

Posted by on Feb 27, 2016 in AALNC, Best Practices, Kari Williamson, Legal Nurse Consultant, Legal Nurse Consulting, MK Consulting, Services

By Kari Williamson, BS, RN, LNCC, CCM MKC Medical Management I recently saw a post by a fellow LNC, inquiring: “How do I best manage leads, names, clients, contacts, supportive colleagues, and others while I grow my business?” What’s a LNC to do? There are many Contact Relationship Management (CRM) platforms which boast a variety of functions—in addition to the ol’ tried and true Excel spreadsheet. Some CRMs are very expensive, while others more reasonable. Excel is on most everyone’s computer, is very versatile and can be effective. So how do you choose what would work best for you? What systems work the best? Does a more expensive tool really give you better results? Click over to the AALNC Presidents Blog to see the full blog...

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Top 5 Traits of a Great LNC

Posted by on Jan 18, 2016 in AALNC, Best Practices, Kari Williamson, Legal Nurse Consultant, Legal Nurse Consulting, LNC

By Kari Williamson, BS, RN, LNCC, CCM MKC Medical Management What a difference 18 years makes. I was a rarity way back in 1997, when I became a Legal Nurse Consultant and it was still a fairly new specialty practice. Hardly anyone knew what an LNC was, much less what to do with us. Nowadays, you can hardly swing a stethoscope without hitting one, and attorneys and claim representatives better realize the value of using a skilled LNC to evaluate a claim or review complex medical records. What makes an LNC great and how do you know? And, if you are a LNC, how do you know if you are providing maximum value to your client? Click over to the AALNC Presidents Blog to see the full blog...

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Biomechanics: A way to better understand mechanisms of injury and how the M.O.I. measures up with a claimant’s stated injury

Posted by on Mar 8, 2015 in AALNC, Best Practices, Legal Nurse Consultant, Legal Nurse Consulting, LNC, Medical Conditions/Terminology Blog Series, RN

By Danny Marshall, RN, EMT-P, CLNC What is biomechanics? It is a scientific discipline which applies principles studied in mechanics to the understanding of living organisms. So, what does this mean to the LNC? As a LNC we are challenged to determine if a claimant’s reported injury or injuries can be the result of the mechanism of injury he/she has reported. As a new LNC I have learned this is easier said than done. I am thankful for the LNC who has helped me edit the reports I have completed, she told me to study biomechanics. Studying biomechanics has helped me to better understand the relationship between the M.O.I and the claimant’s reported injuries much better. For example disk herniations are uncommon in front and side impact cars crashes that are severe enough to cause other serious spinal injuries. In laboratory testing, pure compression, torsion and flexion do not result in disk herniation. Only a combination of lateral bending, hyperflexion, and severe compression can cause a herniation. This is usually the result of heavy lifting, but rarely occurs anywhere in the spine during automobile accidents. In rear end collisions the neck is most likely to sustain injury and the thoracic and lumbar spine is less likely due to protection by the seat and restraints. Proper placement of the head rest would be an important piece of information to obtain because it can reduce the chance of whiplash injury to the neck. So a study in biomechanics and how it relates to the body when an injury occurs can be most beneficial to a LNC who is trying to see if the claimant’s reported injury or injuries are a result of the reported M.O.I. or related to another...

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Separating Chronic Spinal Injuries From Acute Injuries

Posted by on Apr 7, 2014 in Best Practices, Blog, Legal Nurse Consulting, LNC, Medical Conditions/Terminology Blog Series

Technical Terms Make the Difference When a legal nurse consultant reviews a file, one of the objectives is to identify and separate chronic from acute. This is critical in order to help the claims representative have a clear and precise understanding of what is and is not related to the injury in question. So, when reviewing medical records dealing with a back-injury claim, it’s important look closely for words the radiologist uses to describe the spine.  For example: Desiccation Joint space narrowing Bone spurs/osteophytes Scoliosis Vertebral endplate bone marrow alterations Osteochondrosis Modic changes Sclerotic Sclerosis Disc degeneration Spondylosis Schmorl’s node Facet joint hypertrophy Spondylolisthesis Synovial cysts Congenital stenosis Acquired stenosis Ligamentum flavum thickening Fissures Multi-level disc bulging, and Annular tears When any of these appear in the radiology records, they could  indicate long-standing spine pathology.  Remember:  MRI imaging has made it possible for the radiologist to take a closer look at the structures within the spine; therefore, the records reveal a lot more about the condition of the spine, provided the reviewer knows the technical jargon. The radiologist will rarely ever use the word chronic.  Therefore, the reviewer has to be familiar with those words which are indicate a chronic condition.  Having a solid understanding of the terms used to separate chronic verses acute is invaluable when determining what radiological abnormalities are directly related to an alleged injury. Debra West is a Registered Nurse and Legal Nurse Consultant with MKC Medical Management, Inc. Contact Debra at debra@mkcmedicalmanagement.com or at...

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Fraud in the Healthcare System

Posted by on Feb 23, 2014 in Best Practices, Blog, Health Care, Legal Nurse Consultant, Legal Nurse Consulting, Litigation Tools

Better Education and Technical Know-how Can Combat the High Cost of Fraud The FBI estimates that healthcare fraud costs the country an estimated $80 billion a year!  It’s the Number One factor responsible for the country’s astronomical increases in healthcare costs. Fraud defined The National Health Care Anti-Fraud Association says that healthcare fraud is “an intentional deception or misrepresentation that the individual or entity makes knowing that the misrepresentation could result in some unauthorized benefit to the individual or the entity or to some other party.” Fraud and abuse can come in many forms.  It can include acts (and inaction) committed by providers as well as patients.  Providers may, for example… Bill for services not provided Duplicate submission of claim for same service, Misrepresent the service provided, and Bill for a covered service when the service provided was actually not covered Plan Members may abuse the system by… Doctor shopping Filing for reimbursement on services or medications not received or performed Falsification of information or injury Forging or selling prescription drugs, and Using transportation benefit for non-medical related business Why is healthcare today so vulnerable to fraud?  One reason is that medicine has become much more complex, and the doctor-patient relationship has changed.  For instance, a patient nowadays might be under the care of multiple providers, and each provider might not have a clear picture of the patient’s plan of care. Another reason the system is vulnerable to fraud relates to constant changes in billing and coverage.  Terms and conditions of reimbursement often change, too, and they’re highly technical and arcane.  Moreover, the urge – whether cultural or economic – for quick fixes creates opportunities for fraud. What’s being done about it? Various public and private-sector anti-fraud organizations have formed.  Through education and working with lawmakers and regulators, they’ve made progress preventing fraud and reducing its cost to the system.  The legal nurse consultant is another resource to which many fraud investigators have turned for the technical knowledge and experience it often takes to spot a fraudulent medical claim. Jordan Ilderton, RN, BSN is a Legal Nurse Consultant with MKC Medical Management.  Contact Jordan at...

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Need to really understand a claim?

Posted by on Feb 5, 2014 in Best Practices, Blog, Case Management, Claims Tools, Legal Nurse Consultant, Legal Nurse Consulting

Need to really understand a claim? Then understand the Mechanism of Injury Understanding and accurately interpreting the Mechanism of Injury are essential to determining if an injury is directly related to an event or accident. Making sense of the facts Insurance claims typically assert that someone with an injury fell in a certain direction and extended their arms to break the fall. In the case of motor vehicle accidents, claims usually detail the placement of an individual in the vehicle, whether they were restrained, the point of impact, speed, and so on. An individual in a car with a rear-end collision, for example, will potentially have much different injuries than someone who is hit from the side at a high rate of speed. These pieces of factual context are used to understand injuries and the legitimate basis for claims. Related or unrelated? Claims often include treatment for injuries related to an accident which are entwined with non-injury diseases or conditions. In addition, medical providers often identify and treat solely on the injury description provided by the patient – whether related to an injury or not. In order to untangle what is not directly related to the injury, there has to be a clear understanding of the injury details and Mechanism of Injury. Appropriately trained and experienced medical providers can separate related and unrelated parts of a claim and reduce the overall claim exposure. That’s because they understand Mechanism of Injury and its physical effects. The bottom line Injuries can be caused by a single event or can have multiple factors, and the presence of risk factors can make the individual more prone to injury. Once the Mechanism of Injury has been clearly identified, attention should focus on potential causes (e.g., internal/external risk factors, pre-existing conditions). The ultimate goal is to ensure appropriate treatment only for injuries directly related to an event. This can help produce cost savings and reduce claims exposure. Debra West is a Registered Nurse and Legal Nurse Consultant with MKC Medical Management, Inc. Contact Debra at debra@mkcmedicalmanagement.com or at...

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