Medical Bill Audits

Bill audits ensure charges are related to allowed conditions and within medical necessity guidelines.

• A nurse reviews bills to reflect maximum savings while still observing any jurisdictional requirements that may exist.
• Bills are reviewed line-by-line to determine the relationship of billed amounts to documented procedures and relevance to the allowed claim.
• We ensure that the employer only pays for services medically related to the claim and allowed conditions.
• The cost for hospital bill audits is only a percentage of the realized savings; therefore the employer reaps the majority of cost savings.
• Our nurses can defend audit recommendations if questioned by a provider.

Physician File Reviews

Appropriate physician specialty completes a paper review of file to address treatment needs.

• Questions and issues written and reviewed by a Registered Nurse.
• Evaluation by physician to determine if current treatment and retrospective treatment is appropriate and related.
• Written report completed and returned promptly.

Utilization Management

Nurse-driven review to ensure appropriateness and cost-effectiveness of treatment.

By managing treatment—and negotiating the treatment, if necessary—we ensure that the injured employee receives only appropriate necessary care. Employers benefit when costly, unessential medical procedures that could delay recovery are reviewed. National treatment guidelines and appropriateness criteria support the review process.

The Basics of Life Care Planning

Important service option in defense of Permanent Total Disability applications.

What is a Life Care Plan?

• A Life Care Plan is essentially a long-term plan of care that addresses the needs of a person who has sustained a catastrophic injury or illness.
• The goal of a Life Care Plan is to identify services and equipment as well as the associated costs that a person will incur in their life as related to their injury.
• The Life Care Plan is able to serve not only as a case management tool, but also as a tool for litigation to identify the needs and associated costs of those with a catastrophic injury or illness.

Who Needs a Life Care Plan?

• Any person who has sustained a catastrophic injury or a catastrophic illness and needs a guideline for the medical intervention, long-term care, equipment needs, replacement schedule and other associated costs.
• All parties involved including the individual, involved loved ones, treating professionals and legal counsel will benefit from information included within a formal Life Care Plan.

Who Writes Life Care Plans?

• Life Care Plans are written by Registered Nurses or Rehabilitation Counselors and should be developed by a state-certified Life Care Planner.
• Certified Life Care Planners are professionals who have years of experience, have completed rigorous education and testing standards and are trained as formal educators regarding the needs of those with catastrophic injuries or illness. They are also trained to serve as expert witness should litigation become necessary.

Who Utilizes a Life Care Planner?

• Life Care Planners are utilized by attorneys representing those with injuries or illness, insurance firms, trust officers, workers’ compensation agencies, as well as family members of the affected individuals.