Keeping workers compensation costs under control, Part 1

Posted by on Jun 12, 2014 in Blog, Case Management, Claims Tools, Legal Nurse Consulting

Strategies when English-as-a-Second-Language creates obstacles By Joyce Salyers, BSN, RN, LNC, CCM No hablo Ingles. не говорю по-английски. 난 영어 못해요. No matter what the language, “I don’t speak English” probably translates into higher costs and more time necessary to resolve your workers compensation claims. Awareness of these factors and savvy strategies to manage them will help you contain your costs.  Here are a couple of issues involving your non-English speaking IW and ways to translate them into a successful RTW: Interpretation.  Communication between the IW and the medical providers is key to a successful RTW.  But this process slows and falters when the IW is not fluent in English.Solutions?  The use of a certified medical interpreter at all medical appointments can help relay subjective information from the IW to the provider and ensure adequate understanding of all care instructions from the provider to the IW.  Working with an interpreter slows an appointment and requires patience because everything must be said twice, but there is no shortcutting this process to ensure adequate understanding in the medical information exchange. Transportation and Housing.  Non-English speaking workers are often in the US as part of a seasonal work crew with no access to independent individual transportation.  Their employer might provide transportation to medical appointments, but if the crew moves on to another location, then medical transportation must be arranged for appointments, picking up prescriptions and the like.  The same is true for housing.  The IW may lose the assistance and companionship of fellow workers who relocate to follow the work while they stay behind to receive medical care.  Buttoning a shirt or preparing a meal isn’t so simple with a broken arm and no one around to help.Solutions?  A reliable medical transportation company, ideally with a bilingual dispatcher, will ease transportation challenges.  Sitter or home health aide services may be necessary for basic assistance with ADLs when the IW has no local family or friends.  Housing the IW close to the medical providers keeps transportation costs in check.  The use of community resources such as churches and same language social groups help to fill in the gap of emotional support when the IW is far from home. A language barrier need not be a barrier to successful and timely resolution of your claim.  With attention to a few details, you will know that a prompt “Return to work, without restrictions” is possible to hear…in any language. Joyce Salyers, BSN, RN, LNC, CCM, is a Legal Nurse Consultant with MKC Medical Management.  Contact Joyce at and...

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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 or at...

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ER Documentation Review Tips

Posted by on Aug 2, 2012 in Blog, Claims Tools, ER Documentation, Litigation Tools, Medical Records

Review ER Records from Multiple Angles Reviewing emergency room documentation can be challenging.  Gathering and assimilating the appropriate information from ER reports represents a crucial step in evaluating a case, relatedness and specific injury issues. Learn your basic ER documentation and how it all fits together! Follow these tips. loans for bad credit instant decisiononline cash loan lenders A patient’s medical history can disclose pertinent details regarding his current/prior condition. Review medical authorization forms personally signed by the patient.  These can offer critical insight into the case and provide access to the patient’s past medical records without violating HIPAA regulations. Review ER records against other physician’s notes, prior surgeries/tests and EMS records, to determine whether the complaint relates to past symptoms or issues. You can learn a great deal about a patient’s medical state based on the physician’s notes.   Also be aware that new findings/complaints can develop after ER discharge and all the more reason why a close review of the initial ER record is important and follow up on the records is important. Do ordered tests match completed tests?What was specifically ordered?  Was the physician trying to rule something out or confirm a clinical finding or suspicion?  Did the physician NOT order testing, despite the injured party’s request for it? Did the injured party complete the ordered diagnostic tests? Sometimes confirmatory testing will have to be done with in a specific time parameter, so follow the order trail and request test/lab results. Review discharge instructions and note how/if/when the injured party complied. Compliance issue can greatly impact the file/case. Also remember that patient does need to take responsibility when following doctor orders....

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Best Practice – Physician Peer Review, LNC Report, or Both?

Posted by on Feb 8, 2012 in Blog, Claims Tools, Litigation Tools, Workers Compensation

It may seem redundant, or not cost effective; to utilize both a Physician Peer Review and an LNC Report. However, they both have a unique perspective. And when you combine the two, the result affords you a more complete timeline of both the events that have happened, and what may still occur with the patient. The Physician Peer Review  i have bad credit and i need a loanconsiders all casestraditional loaning process A major standard in the industry, a Physician Peer Review, or medical review, of the case can give you a pinpointed, detailed reporting of what has happened to date. It provides intricate details about specific pieces associated with the medical event and how those pieces fit directly together. More myopic in construction, the medical review yields very precise answers and insight to a medical event and subsequent treatment strategies. Simply put, consider it a very accurate snapshot in time of the patient and the event. The LNC Report  Also a major standard in the industry, the LNC takes the medical review and expands it. It provides information about peripheral factors relevant to the case as well. It considers long-term patient care and interaction, the insurance role in the completion of the case, and a review of all record keeping involved. This broader approach can easily yield inconsistencies that may otherwise go undetected. It can also yield administrative concerns that can directly affect other cases. Using a Whole Person Approach The patient involved may have a single event or episode in your facility. But the effects and ramifications of that single event can weigh heavily on the future treatment of all patients. By utilizing both reports you garner a more complete picture of the patient’s impact on the health care profession and the associated support industries. Without using both reports, you could very well end up making future patient decisions with one eye closed. Crossexamine: Do you utilize LNC reports and Physician Peer Reviews as litigation tools?  Image credit: shutterstock dot...

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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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Proper Litigation/Claims Tools Are a Must

Posted by on Apr 4, 2011 in Blog, Claims Tools, Legal Nurse Consultant, Litigation Tools, LNC

When dealing with dollars and the bottom line, proper litigation/claims tools is a must -not a frill! LNC/medical reviews are critical to the proper management of a case.  Why?  You are not only obtaining invaluable information, but you are also sourcing a specific LNC function or duty. Adjusters, attorneys and paralegals alike wade through stacks of medical records, OR they will refer the case out to a pricey physician advisor. But is this the best way?  If you are not reviewing the medical records through the prism of a medical perspective how useful is it?  Or perhaps you are using a specialty physician advisor, but has that physician advisor looked at the records with a purposeful, broader view and gleaned additional, critical patient information? Either way you might not be spending your case dollars wisely. By using a LNC to review medical records and create a chronology, add medical/LNC comments to an existing paralegal generated chronology, or helping to steer your physician advisor, you are MAXIMIZING everyone’s time and money.  You are also gaining important insight from a wealth of nursing and LNC experiences. I once countered an attorney’s comment of “Kari, I can read a MRI report”, by replying “I understand that, but can you understand the report as a registered nurse or medical provider?”  I further elaborated and said “And more importantly how do the findings impact your case and casualty issues?  You need to look at the information with LNC glasses.”  He sent the records over and I was able to help by reviewing the records and creating an abbreviated LNC report. Don’t waste your valuable time! Use the resources out there to help analyze, create AND understand your medical...

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