What is a Medical Cost Projection?

Medical Cost Projection (MCP) is a medical cost containment analysis often used to set reserves in complex cases where multiple factors drive exposure, and complex medical and legal information needs to be considered. Most people look at it as “what this case is worth,” but that’s not really accurate.  MCP is a comprehensive and expert analysis which generates reliable, evidence-based recommendations to positively manage the medical portion of a claim.

Key Attributes of a Medical Cost Projection

To fully understand what a Medical Cost Projection (MCP) is, we need to boil a MCP down to its most basic form.  Below are the five key attributes that define Medical Cost Projection: 

1. It’s an educated speculation made by highly credentialed medical experts. Our expert Legal RNs harness a wealth of knowledge giving ANS the advantage of being able to make specific detailed recommendations that that achieve improved quality of life and identify financial savings for payers.   
2.  MCPs should include state specific jurisdictional expertise, married to intimate medical knowledge, and specific experience with catastrophic injuries. At ANS, the complexities of each case are matched to the relevant expert knowledge and experience of a highly credentialed RN from our national network.  
3. The cost figures in MCPs are based on the use of today’s dollars.   The cost remains static unless it is a known fact that something will increase in cost at a given point in the future. ANS evaluates potential areas of exposure and savings for the most comprehensive medical action plan possible. Anyone can take what someone is currently paying, multiply it by their life expectancy, and get a number. But a truly useful MCP is far more detailed than that. 
4. At ANS, it involves breaking down a case to each specific service and requirement.  This includes an injured worker’s past complications, current needs, co-morbidities, etc.  We also take into account future needs, based on a reasonable degree of certainty, using costs specific to each jurisdiction.  
5. MCPs projects costs within a specific period of time. Everyone has a life expectancy and every insurance company has their own way of calculating said life expectancy, be it rated ages, discounts, etc.  Our reports are fully customizable to fit any carrier’s policies in this area.  We can base our reports on any time frame requested.
 

ANS Medical Cost Projection Services

When it comes to complex claims, an accurate evaluation to identify the value of a claim can only be reached with the kind of comprehensive research and analysis that comes from ANS Solutions’ Medical Cost Projection services. The recommendations from our highly credentialed nurse experts, along with their local jurisdictional prowess, create an analysis that allows Payers to accurately set reserves for the life of the claim.

If you would like to learn more about our Medical Cost Projection programs and other medical cost containment services contact ANS Solutions today.