Second Opinions Blog

An informative weekly series for the benefit of those managing claims of injury.Last week's issue talked about the concept of developing a plan for closing claims. This week we will discuss the importance of well-coordinated care.A good plan of care involves the creation of a "team" consisting of health care professionals, case manager, claimant, and claims handler (the boss). The case manager coordinates medical resources and makes sure excellent communication is maintained between all parties.The goal is to assure the agreed upon care plan is adhered to and modified only when necessary. The case manager must remain the center of communication for all care givers, claimant, and claims handler so if treatment gets side-tracked it can be quickly put back on course. This is how claims remain on the proper course toward closure and no dollars are unnecessarily spent.Much of what happens in this phase will be dependent upon the case manager's communication skills, and their ability to develop and maintain a positive working relationship with the treating physician and claimant. The success of your case manager can easily be judged by the rapport you have developed with them and if understanding them is effortless.Next week's edition will further underscore the importance of good communication to the success of the case manager.For more information please visit our website at www.MedicalSystemsUSA.com

An informative weekly series for the benefit of those managing claims of injuryOnce the medical case manager has properly evaluated the medical condition and determined the assigned diagnosis is correct, they are ready to assess whether the claimant is seeing the appropriate type of doctor(s), and develop a plan of care.The plan of care should be designed around the claimant's current status and the response they had to previously provided care (if any). It should be an aggressive (not abrasive) plan with the goal of reaching a finite end of healing date within a reasonable amount of time.The case manager should communicate the plan of care to you before presenting it to anyone else. You should expect to receive a written step by step plan with a verbal explanation of each step in the process. Before any plan is implemented, it should have your "stamp of approval."How do you go about knowing the plan is a good one? One way is to assure it includes a well-coordinated use of all medical resources available. Look for next week’s edition on coordinating medical resources. Next week, we will learn the importance of staying on course.For more information visit our website at www.MedicalSystemsUSA.com

An informative weekly series for the benefit of those managing claims of injuryLast week, we talked about medical case management as a collaborative process. This issue will talk about how a case manager begins by familiarizing themselves with the case. The methods most widely used include:

• Discussion with the claims manager about the course of      the claim
• Review of medical documentation
• Chatting with the claimant (if possible)
• Conversation with health care providers

After the review process is complete, the case manager is ready to evaluate medical aspects of the claim (such as the appropriateness of treatment, relationship of care to work injury, and return to work issues). Following that, cost issues such as what it will take to close the claim and/or return the injured worker to work as quickly as possible need to be considered.After these assessments have been made, the case manager is ready to develop and implement a custom-designed plan of care that takes all issues of the claim into consideration and works toward closing the claim. Next week, we will learn the importance of staying on course.For more information visit our website at www.MedicalSystemsUSA.com

An informative weekly series for the benefit of those managing claims of injuryLast week, we discussed the elements of good case management. This week we will talk about medical case management as a collaborative process, involving all health care providers, the injured worker, and the claims manager. The purpose of using a medical case manager is to facilitate the treatment plan in order to expeditiously bring the injured worker to an end of healing in the most cost-effective manner possible.As such, the medical case manager's role is to assess the care-plan for:

• Appropriateness in relationship to the claimed injury,
• Cost-effectiveness,
• Methods to return the claimant to work, and
• Bring the worker to an end of healing as quickly as possible.

In order to accomplish these goals, the case manager must have excellent medical assessment abilities, great communication skills and be a good motivator. Next week, we will discuss tips for assuring adequate evaluation of a medical condition.For more information visit our website at www.MedicalSystemsUSA.com

An informative weekly series for the benefit of those managing claims of injuryMedical case management, if used properly, can be an effective tool to keep claims costs down. Good medical case management contains the following elements:

1. Thorough evaluation of the medical condition
2. Development and implementation of a plan of care
3. Coordination of all available medical resources
4. Making sure all health care professionals are in communication and working toward one common goal
5. Monitoring and evaluating progress

As the person picking up the tab for case management, your responsibility is to assure that each of these 5 steps are being performed in a progressive manner that is satisfactory to you. Next week, we will explore the role of the medical case manager in the process.For more information visit www.MedicalSystemsUSA.com

An informative weekly series for the benefit of those managing claims of injurySERIES INTRODUCTION: This is the first of a weekly educational series offering insight into case management. You will get valuable tips from this blog on selecting a good case manager so you can get the most from your case management dollars. Here are topics this blog series will address:

• Elements of good case management
• Collaborative process facilitates quick claim closure
• A well-informed case manager is a good case manager
• Aggressive return to work
• Well-coordinated care
• Communication is the key to success

Next week we will define the elements of good case management. Stay tuned!For more information on Medical Systems go to www.MedicalSystemsUSA.com