Knights of the Round Table
I have managed medical claims for workers’ compensation payors since 1983. Back then, the greenest adjusters seemed to get the ugliest files. Their training included don’t question the doctor
, don’t challenge the attorneys
let your med-only assistant write checks as fast as possible.
In order to change this culture, we began convening meetings of all professionals working a particular claim with the express purpose of moving the case to stability, settlement or closure.This includes the adjuster, nurse case manager, supervisors, and often defense counsel, employer representative and physician. We call this process a “round table,” and we continue to offer this value-added service to our clients on a nationwide basis.
Specifically, our nurse case managers and physician advisors:
- Obtain and document the historical medical records,
- Evaluate the current medical treatment plans and pharmaceutical regimen,
- Identify and communicate issues of medical concern,
- Initiate peer-to-peer treating physician education and remediation,
- Assist with regulatory disputes/challenges, if necessary.
Thirty years ago it was heresy when I told the round table our client was no longer paying $200 for a physician dispensed hand-held back massager with a monthly $100 adjustment charge.Claim by claim we changed the outrageous billing and treatment practices of rogue providers.
This process is much more efficient today than it was in 1983, thanks in large part to the professionalism, training and work ethic of our clients’ comp adjusters.
And so the round tables continue…
Call us. We can do better.
William Faris, JD
Chief Executive Officer
Posted in Bill's Favorite Files, OMCA