55 Ferncroft Road Suite 201
Danvers, MA 01923

(866) 630-CPSC Toll-free
(978) 774-0540 Facsimile

www.CPSCmsa.com

55 Ferncroft Road Suite 404
Danvers, MA 01923

(866) 630-CPSC Toll-free
(978) 774-0540 Facsimile

www.CPSCmsa.com

Most claims that get settled have incurred significant medical expense and often involve the expectation of continued medical care expense (assuming the state WC statute allows for closing out future medicals).

There has been some third party effort to manage the claimant’s medical care and expenses prior to settlement discussions. Unfortunately, the claims person settling the claim may not have had any influence on the course of treatment. When part of the rationale for a claim settlement offer is future medical costs, assistance is often sought from a Certified Nurse Life Care Planner to develop a medical cost projection. This considers the past, current and future course of treatment, as well as the claimant’s life expectancy, using the available medical reports and billing records as a basis to project future costs. Often, the “relatedness” of all the care and medications provided has lacked thorough review.

One area where there is the potential for future reduced costs is through the peer review process. Consider how much peer review can save by: • Identifying non-related care from the work injury treatment

• Identifying a more cost-effective alternative treatment such as generic drugs and peer to peer conversation

• Curtailing treatment that is no longer as “necessary and reasonable” or that would be harmful to the patient

In healthcare utilization management, the concept is to approve only such care as is necessary and reasonable. When no guideline is available for the treatment being provided, it is appropriate to use peer review. The process of peer review not only reviews care against established treatment guidelines and clinical standards, but also allows for a conversation between the treating provider and the peer reviewer to resolve any questions or misunderstanding that may arise in the review process and or to suggest more effective and/ or cost effective alternatives to the treating provider.

Influencing treatment plans through the use of peer review when possible can be critical. Expert peer review can bring great value.

By Chris Wood, PhD, CRC, CDMS, and Senior VP of Integrated services for MCMC, LLC. *

Medicare Set-Aside Professional Certificate Program - University of Florida

The University of Florida is pleased to announce a new Medicare Set-Aside program. This program was designed with the assistance of Crowe Paradis’ Chief Legal Counsel, Robert Lewis. The program will equip participants with the knowledge and practical skills required to acquire certification in the Medicare Set-Aside Allocation (MSA) field. The University of Florida’s certificate program is a dynamic, interactive learning experience. Upon completion of this program, participants will be eligible to sit for the national (MSCC) certification exam offered by the Commission on Health Care Certification and receive the designation of Medicare Set-aside Certified Consultant. Topics addressed in the comprehensive curriculum include:

· History and Background of Medicare Set-Aside Arrangements

· Impact on Workers’ Compensation Claims

· Identification of Conditional Payments

· Administration Requirements

· Effective use of Structured Settlements

For More Information and to Register Please Visit: http://msa.dce.ufl.edu/ or Call 1-800-327-4218 Ext. 218

Would Your Company Like An In-House Training Sesssion?? If so, please contact rlewis@cpscmsa.com

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