by Howmin | May 7, 2015 | News, Q&A
Do you leave money on the table when you use medical cost projections (MCP) in negotiations? You sure do, if you think that surgeon fees are all that count. This is surprisingly common. Let me give you have a fuller idea of what’s involved in getting a good MCP, so I can help you get the most bang for your buck for your client. Here’s an example. I recently had a potential client ask me for a MCP “for a skin graft,” which he thought might have been for a scarred knee. I told him this would likely take me about 6-7 hours of work, including looking at medical records to see exactly what was being proposed and speaking to the physician. He demurred at this, telling me that he needed to keep costs down. “I’ll just have my client ask the doctor,” he said. Well, because the nurse in me really wanted to help him, I said, “Fine, and let me send you a list of what she should ask the physician when she sees him.” I am sure my not-quite-client was shocked to see this list of likely and possible billable items come across the wire: Preop testing charges– for what tests? General health panel, serum proteins, local area tissue oxygenation (get all CPT codes) Surgeon fees– do they include pre- and post-op office visits, or are those separate? (CPT codes for each) Anesthesia: What anesthesia technique– spinal, regional, general? Hospital costs and anesthesiologist professional fees (CPT codes for each) CPT codes for all procedures performed as part of this grafting: graft harvesting (allograft, split-thickness, cultured, or other) or other...
by Howmin | Sep 7, 2014 | Q&A
Q. What is a medical cost projection? Is it like a life care plan? A. Sometimes it’s too soon to do a comprehensive life care plan. For example, the injury may be too recent to know what the long-term effects would be and medical records may be scanty. In that case, a life care planner would likely recommend a medical cost projection, an overview of the usual effects of an injury or illness, long-term progress, and best estimates of the person’s anticipated needs. A medical cost projection is based on evidence-based standards of practice and can give a ballpark estimate of likely costs. This is useful for several reasons. Clients, both plaintiff and defense, often contact me for medical cost projections for preliminary negotiations. We are the medical damages experts with these data ready to serve you. Contact Howland Health Consulting at 866-604-9055 or via our online contact form to learn about our special rates for medical cost projections, our free quick-look consultation, and our new-client...
by Howmin | Mar 7, 2014 | Q&A
Q. Is it Too Late to Create a Life Care Plan for my Grandfather? Mar 22, 2012 09:56AM Question: My aged grandfather is already in a nursing home. Is it too late to create a Life Care Plan? Life Care Planning Expert, Wendie Howland Answer: Life Care Plans are tools to help learn about and plan for expected needs over a person’s life expectancy. This includes costs for medical care, such as equipment, physician and nursing care, medicines, and therapies, and also includes less-obvious things like goods and services to help with safe aging in place, transportation needs, and home modifications. For most people, it is never too late to have a good plan. A certified nurse life care planner can prepare a long term care plan to help a family understand what changes may occur with aging, too. If your grandfather has exhausted his funds down to the Medicaid level in expectation of being a resident of the home for the remainder of his life, or if he has a terminal illness with hospice care and will not return to the hospital, his care needs are already well-known. If he has been admitted to the nursing home for a short stay, as to recover from a surgery or acute illness, life care planning can clarify options to help him life more safely at home after discharge. Many families also appreciate the opportunity to talk about end of life care with the nurse life care planner. Finally, for persons who have no nearby family, funds for their care are often held in trust under a guardianship arrangement. The...
by Howmin | Mar 7, 2014 | Q&A
Q. Nurse life care planners can’t prescribe, can they? A. Yes, we can. There is no legal requirement in any state in the US for all goods and services for a patient’s care to be prescribed (sometimes termed, “ordered”) by a physician. It’s important not to confuse an insurance plan’s requirement to have a physician prescription for a billable product or service, or the legal requirement for physicians to prescribe medication, with the registered nurse life care planner’s ability to assess and recommend. The law requires some things (such as medications and surgery) to be prescribed or performed by physicians, but insurance companies only require that most goods and services be ordered by physicians for billing purposes. My registered nurse professional licensure, certification, experience, education, standards of practice, and ethics are backed by the nurse practice act in every state. I am qualified, as a registered nurse life care planner, to prescribe a plan of care after assessing the patient’s response to injury or illness. Although as a certified nurse life care planner I will collaborate with members of the treating team, most life care plan components will not be involved with a health insurance contract and do not require physician signature. The evaluations and other aspects of my life care plans are within my professional licensure to prescribe. *Update May 2014: Wondering how the ACA will affect life care planning? Most life care plan items aren’t covered by health insurance! Be sure your life care planner is licensed to do the functional assessment that is the basis for the plan’s recommendations. Hint: Look for the initials...
by Howmin | Mar 7, 2014 | Q&A
Q. What educational background should an attorney look for when choosing a life care planner? A. Ask for proof of current, unrestricted registered nurse licensure. A registered nurse with a broad background in nursing, preferably with degree(s) from accredited college or university nursing programs, is essential for assessing the injured person’s function, cognition, and current situation. A certified nurse life care planner has education and experience in case management and life care planning, and has passed a national examination to demonstrate competence. Other certifications, such as for rehabilitation nursing, case management, disability management, legal nurse consulting, and other nursing specialty will testify to the nurse’s breadth and depth of expertise. Attorneys often seek life care planners with extensive testifying experience. However, it’s important to know that the vast majority of life care planning cases are settled before trial. A nurse life care planner with a good methodology, confident manner, and excellent speaking ability to explain to the court may have few or no opportunities to have done so. A personal interview is helpful in assessing the life care planner’s personal presentation and willingness to testify. Finally, ask for a writing sample. A poorly-written life care plan will not help you win your case. SAMPLE (LCP)...
by Howmin | Mar 7, 2014 | Q&A
Q. What records does a nurse life care planner review? A. A nurse life care planner will want to see all available records. Sometimes when records have been compiled by a paralegal or other nonmedical person, they are incomplete because the compiler does not recognize the significance of each piece. For example, EMS and emergency department records describe initial findings and mechanism of injury. While admission and discharge summaries are useful, they are often dictated by residents who are not completely up to date on the range of care and responses during the admission; it is often surprising to see conflicts and errors in them. The life care planner will want to review all team progress notes, laboratory and diagnostic studies, physician order sheets, nursing records, medication administration records, consultant notes, and procedure notes (e.g., surgery, invasive testing). Outpatient therapy and orthotics/prosthetics records include periodic evaluations as well as notes from each session; problems, absences, and adherence to teaching are found here. For a child, school records, IEP (individual education plan), and pediatrician notes are important to assess current developmental state and function. Police accident reports would help the nurse to understand possible mechanisms of injury, and to assess for signs of disability that may not have been evident during initial hospitalization. Finally, billing records can reveal valuable information on physicians and treatment plans that may need to continue in a life care...
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