The Medical Legal Nurse Consultant – A Jack of All Trades

Medical legal claims typically involve complicated, long-term medical issues and represent an enormous financial burden for Payers. In order to mitigate this financial exposure it is crucial for Payers to accurately assess the true value of alleged damages. But this is no small task and it often requires extensive investigation and expert interpretation. Let’s be honest, mitigating financial exposure can only effectively be done by a highly credentialed few, those with a hybrid skillset of healthcare expertise, specialized legal training, and first-hand experience in complex liability matters such as GL, toxic exposure, personal injury, and malpractice. 

With qualifications in both medical and legal fields the Legal Nurse Consultant is perfectly poised to aid insurance companies who want to optimize their results and settle large claims once and for all. By definition, a Legal Nurse Consultant is an individual with healthcare expertise who has taken additional specialized legal training so that they can consult as an expert on medical cases, but this is just the tip of the iceberg.

Medical Legal Nurse Consultant Litigation Support

In litigation support, the data and reporting generated by legal nurse consultants can provide an extraordinarily powerful legal instrument in the negotiation of a claim. At ANS, our strategy for mitigating and defending medical legal claims involves a host of strategic activities including:

·         The critical analysis and review of initial complaints, supporting medical & legal documentation and pricing to allow for an accurate assessment of true damages.   

·         Review of medical causation and exposure to effectively gauge merits of alleged injuries while identifying any missing medical information that may prove valuable to the claim.

·         Generating an expert assessment and opinion based on a detail of record and all documented encounters with medical systems. 

·         Uncovering causation, mitigating factors, unreasonable medical charges, inappropriate/red flag patterns of care, and unnecessary and unrelated care issues are exposed

·         Providing a counter analysis in the event that a plaintiff future cost of care report is submitted.

Medical Class Action & the Medical Legal Nurse Consultant

Navigating a medical claim involved in a class action is difficult to say the least. Class actions are very large in scope requiring the dissection and digestion of thousands of pages of legal and medical documentation. Fortunately, medical class actions are another area of support fielded by ANS’s legal nurse consultants.  We have extensive experience in handling class action and large tort cases. If you have a medical legal claim involved in a medical class action case, our medical legal nurse consultants can assist by providing:

• Initial screening for merit and damages.
• Analysis of massive amounts of data quickly and accurately creating a snapshot of the case.
• Recommendation for appropriate next steps based on medical review.

At ANS, our team of nurse experts, are highly credentialed and wield an average of 25 years in specialized nursing experience. In addition, their scope of jurisdictional expertise yields unparalleled results. To find out more about ANS Solutions’ superior medical legal nurse consulting services visit us at http://www.ans-solutions.com.

This content was originally posted on http://www.ans-solutions.com.

The Financial Repercussions of MSAs on Large Loss Claims

Medicare recommends an allocation of funds in a Workers’ Compensation settlement that is set aside to ensure that the injured party’s qualified medical expenses are funded, also known as Medicare Set Aside. These funds must be used to pay for treatment related to the Workers’ Compensation injury, that would otherwise be paid for by Medicare. The financial repercussions of MSAs on settlements can be significant.

Part D Exposure

As part of the Medicare Modernization act of 2003, Medicare indoctrinated what is known as Part D prescription drug coverage beginning in 2006. In other words, an allocation must be made for future prescription drug treatment in a Medicare Set-Aside. Rising pharmacy costs, including medications an injured worker may have been prescribed once in the previous 2 years, along with treatment, has created an environment in which Payers are subject to unreasonably high claim settlements.  The “Prescription Affliction” suffered by Payers is lovingly referred to as Part D exposure and it leads to claims staying open longer or not settling at all. As a result, these claims rack up millions of dollars in cost for Workers’ Compensation Payers.

Reducing Medicare Set Aside and Part D Exposure

A proactive approach is necessary before settlement and preferably early in the process for optimal results. At ANS, we mitigate Medicare Part D exposure with a three pronged approach:

• PharmReview – during this stage, the injured worker’s existing pharmaceutical regimen is assessed and modification recommendations are determined.
• PharmIntervention – a face-to-face discussion with the treating physician to achieve consensus on a modified medication regimen and commitment on a future course of treatment.
• PharmCompliance- an ANS Clinical Liaison Officer ensures compliance with the new prescription treatment plan. This provides a proactive management of the case to optimize hard cost savings.

Only highly credentialed legal nurse experts who are experienced in the treatment of catastrophic injuries, such as those employed by ANS, can provide actionable recommendations based on the individual patient and engage effectively with treating physicians. This technique yields a clear medical action plan that drives down costs while simultaneously improving the quality of care for the injured worker, allowing for reasonable settlement of the claim.

ANS’s pharmaceutical cost containment technique has reduced pharma costs by up to 25%. To find out more about reducing MSA and Part D exposure, contact us today.

This post was originally published at http://ans-solutions.com/.

Curtailing the Pharma Cost Cycle

It feels as though the Worker's Compensation industry is at the mercy of the pharma cost cycle. In this cycle we see injured workers being prescribed opioid analgesics for pain and becoming dependent on or addicted to them only to require higher doses to keep pain levels under control. Not only does this create a substantially higher cost burden on Payers, but it is also detrimental to the long-term health of the injured worker. Pharma costs have become the runaway train with no one at the helm, leading Payers to wonder, "How do we curtail the pharmaceutical cost cycle?"

A Truly Effective Approach to Drug Utilization Review

Drug utilization review programs are a tool to help control the costs associated with large pharmaceutical claim costs as well as injured claimant outcomes. However, some drug utilization review programs are not as effective as others. Many are based on analysis work that overlooks important details and lacks in-depth jurisdictional and medical insight.
Unfortunately, but all too often, drug utilization review programs fail to provide actionable treatment recommendations, let alone reductions in cost. To realize optimal outcomes, Workers Compensation Payers need to go a step further with a cost containment strategy that employs a Pharmacotherapy Review Program.

Results Through Collaborative Effort

Realizing concrete, actionable results requires a collaborative effort among stakeholders who share a common goal of achieving optimal outcomes for all parties involved.
During the pharmacotherapy review process, a nurse expert evaluates the current treatment regimen of an injured worker. The expert nurse's professional knowledge base spans from intimate knowledge of injury specific medical treatments to state specific jurisdictional expertise.  The assessment is based on current medical best practices and the medical information of the injured employee. This expert review is used to develop clinically appropriate recommendations which are then presented to the treating doctor.The newly proposed treatment plan, typically one that bypasses the inflated costs of pharma regimes, is agreed upon and endorsed by the treating physician's signature.
The implementation of the signed treatment plan is enacted through continued collaboration between the nurse expert and treating physician. This type of collaborative effort is especially crucial when alternative dosages or weaning of certain medications is recommended, as this often requires several months to achieve. A more cost-effective pharma plan is final out-come.

Looking After the Injured Worker

There is more to a pharmacotherapy review than just generating alternative, clinically-proven drug alternatives that can save Payers money. A quality pharmacotheraphy review also promotes the creation of a more responsible pharmacy industry that exclusively addresses the workers' injuries and utilizes clinical expertise and knowledge gained from reviewing the injured workers’ medical background and prescription history.
Together, these factors reduce the possibility of creating cumulative, drug-related problems for the injured worker such as drug overdosing and adverse drug interactions. Collaboration between the nurse expert and the doctor issuing the prescription further promotes an action plan that supports the injured workers’ overall well-being.
ANS Solutions is an industry leader in Workers' Compensation medical cost containment. To find out more about our cost containment services including pharmacotherapy review, visit http://ans-solutions.com.

This blog post was originally posted on www.ans-solutions.com.

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. 

About ANS Solutions

The ANSwer to Medical Cost Containment

ANS Solutions is one of the fastest growing health care cost management companies in the USA. Over the course of a decade, we have designed and honed a series of medical cost containment strategies that are truly unique in the industry.Our expertise includes the entire suite of Workers’ Compensation Medical Cost Containment Services designed to help our customers lower claim costs, improve loss rations, reduce risk and exposure, and dramatically improve the quality of care for injured employees. Our clients include some of the nation’s leading insurance carriers, Fortune 1000 self-insured companies, and the largest third party administrators in the United States. ANS is also one of the few Medical Cost Containment providers able to successfully perform pharma reviews and interventions with clients operating in ex-parte states.

A Better Drug Utilization Review 

ANS is an innovator in the field of Drug Utilization Review and implements a 360 degree approach to pharma review and intervention that we call our Pharmacotherapy Review. Because we have highly credentialed and experienced professionals on the ground in all 50 states, the analysis and intervention we do with doctors, lawyers and other claim stakeholders is highly effective.  Our face to face approach has set a new standard in our industry, a standard so high that we are able to offer our 1 Million Dollar Pilot Program Guarantee on case savings.  

The Road To Settlement  

ANS Pharma Cost Containment, Medical Cost Projection, and Legal Nursing Services programs enable ANS to achieve optimal outcomes for both workers and insurer’s alike.  To learn more about how ANS can help you navigate complex Workers Compensation Medical Cost Containment visit our website today.