Time is money! Dramatically reduce the time it takes your independent physician consultants to review medical documentation associated with your IMEs. MedConnect Pro is now offering Nurse Consulting Services as an adjunct to IMEs.
Usual Customary Review (UCR)/Billing Code Review (BCR)
UCR - Do the amounts billed for medical services seem to be too high? Too low? Now you can be sure! Using one of the industry’s leading independent Usual and Customary databases, the nurse consultant can create a report for you based on the billing codes presented on the invoices for medical services. Using postal zip codes, the report will show you how much providers in the given geographical region charge for doing medical procedures. Use this report alone, with the Billing Code Review, or with your MedConnect Pro IME physician opinions.
BCR- Are you absolutely certain that the medical care that has been billed for was actually performed? The Billing Code Review is your answer! The Nurse Consultant reviews the invoices and compares each individual medical charge against the clinical documentation to assure that the provider has done the services that are on the invoice. With the implementation of HIPAA laws in 1996, the use of billing code sets that were developed by the American Medical Association for healthcare services became mandatory. Our nurses comb through the records to make sure that each billing code is supported and that coding rules are followed.
A good adjunct to the Billing Code Review is the Usual and Customary Review. Once the invoices have been reviewed and all coding errors have been identified and corrected to match the clinical records, the codes are subjected to an independent Usual and Customary database to assure that the amounts billed by the providers are within range of what other providers are charging for doing the same services.
Surgical/Settlement Cost Projection
The purpose of the Settlement Cost Projection is to provide, or estimate, the approximate costs for proposed procedures that may be required in the future.
The Settlement Cost Projection is a service that can be of benefit to defense attorneys, plaintiff attorneys, paralegals, and claims representatives. This report will give an estimated cost for proposed future surgeries or treatments, including costs for dental, surgical, medical, anesthesia, facilities, durable medical equipment, and supplies.
When you are faced with these questions:
• What does a medical procedure or surgical procedure cost?
• How much are the preoperative services going to cost?
• What if the doctor says the surgery will cost $100,000.00?
• How much is the surgeon’s fee for a procedure?
• Is an assistant surgeon required; what is his fee?
• How much will the anesthesia provider charge?
• What is the facility fee for the proposed procedure?
• Will there be any postoperative services i.e.: physical therapy needed?
A nurse consultant prepares this report. An appropriate physician consultant provides specific details pertaining to the proposed procedure and what type of care is going to be required pre-operatively and post-operatively, i.e. laboratory tests, x-rays, physical therapy, orthotics, et cetera. If the physician consultant offers any additional information pertaining to the efficacy or appropriateness of the procedure, a notation will be added to the report. The appropriate CPT codes are then applied to all of the procedures, tests, and treatments that will be involved, and then these codes are subjected to a fee schedule database to determine the appropriate costs for the specific zip code region in which the services will be provided.
Medical Doctor Questions
Not quite sure what questions to ask your independent IME and Record Review physician consultants? The nurse consultant can provide you a standard set of questions with additional file-specific questions so that you will always get the appropriate answers that you need for claim settlement.
Medical Records Chronology
MedConnect Pro is now offering Nurse Consulting Services as an adjunct to IMEs. The Medical Records Chronology can turn volumes of medical records into an organized, concise report that can help your experts easily scan and quickly review the pertinent documents rather than plowing through mountains of unrelated records.
The medical records are received, sorted and put in order, copied and sent to the nurse consultant. The nurse consultant goes through each medical document, condenses the information into a three-columned report that includes the date of service, the provider, and a brief outline of what the medical document says, in non-medical language.
The purpose of the medical records chronology is to organize the available medical records from the earliest treatment to the present. This organization allows the consultant to then determine patterns of treatment, number of treatment providers, discrepancies in the objective findings, duplicity of treatment, missing records, drug seeking behaviors, concurrent or pre-existing conditions, etc. Once the chronology has been completed, the consultant can then concisely summarize the treatments, discrepancies, etc. in the medical record review.