Thought Leaders
Our professionals speak and publish frequently on the complex medical issues facing business owners and executives, lawyers, insurance claims adjusters and others dealing with claims and medical expenses. Our blog is a way for us to contribute to our field and to demonstrate the depth of our experience.
Case Study: When subjective claims and objective findings don’t match
In this case, a low-velocity Motor Vehicle Accident resulted in injury claims that were not clinically consistent with objective findings. The data points suggested other motives for treatment or possible drug seeking behavior. These data points were: The...
When delayed treatment and professional activities come knocking
This nurse review of the medical records revealed data points which raised concerns with this Motor Vehicle Accident-related claim. Despite his injury claim, the claimant delayed treatment -- raising the possibility of an intervening injury -- and the initial...
Lung Disease, COVID-19, and Claims
NOTE: This article originally appeared on theskylinegroup.org. Long before the novel coronavirus became front-page news, we knew that respiratory diseases were serious business. In fact, respiratory diseases are the leading causes of death and disability...
A refresher on the basics of ED records
It's always good to be reminded of the importance that emergency department (ED) records play in the management of a medical claim. As we've written before: An emergency room is the first place many go for medical care. And those ED records provide a critical,...
Spotting red flags in a motor vehicle injury claim
In this MVA-related case study, MKC red-flagged some big inconsistencies that helped to mitigate a $2.85 million demand. It underscores the importance of Mechanism of Injury (MOI) and of sounding the alarm when key records are missing! See if you can...
Understanding radiology basics
Radiology studies play a huge role in the world of third party claims. As a result of the radiological studies performed in third party claims, acute, degenerative and chronic conditions can be seen, results which are then evaluated within the context of the...
Chloroquine and the coronavirus disease
The medication chloroquine has been in the news recently as a possible treatment for the coronavirus disease, COVID-19. Known primarily for nearly 90 years as way to prevent and treat malaria, chloroquine is also occasionally used for lupus and rheumatoid...
Bill audit basics
If you've ever dealt with a leaky garden hose, you know what it's like to be a payor facing a costly medical claim or a big bill from a provider. The reasons range from errors in CPT coding to cost shifting from scheduled care, inflated claims, fraud and just...
The development and discovery of SSRI antidepressant drugs
Selective serotonin reuptake inhibitors (SSRIs) are a class of chemical compounds that have contributed to major advances as antidepressants, revolutionizing the treatment of depression and other psychiatric and medical disorders. The first and most famous SSRI was...
America’s truck drivers and COVID-19 relief efforts
Truck drivers provide safe and timely movement of vital products and supplies, doing a difficult, lonely job that too often goes unrecognized and underappreciated. Many are single owner operator businesses, something that has its own set of unique challenges. The...
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