A Case Review is a medical review in which the clinical care is cross checked against a specific set of standards. An expert reviewer looks for missed diagnosis, standard of care deviations, intensity of treatment and other specifications to ensure the care ordered or provided was appropriate and necessary.
Case reviews are generally requested by insurance carriers, attorneys or individuals and their families who feel reviewing medical records is essential to understanding the details of a case in order to identify strengths and/or weakness.
Future Medical Cost Projections
*******************************************************
*******************************************************
Medical Case Review
What is Case Management?
A Life Care Plan is a dynamic document based upon published standards of practice, comprehensive assessment, data analysis and research, which provides an organized concise plan for current and future needs with associated costs, for individuals who have experienced catastrophic injury or have chronic health care needs. Source: International Academy of Life Care Planners Standards of Practice (2015).
What is a Life Care Plan?
What are Medical Case Reviews?
Life Care Plans are developed for individuals with injuries or chronic conditions requiring complex long-term medical care. Within the judicial setting LCP's are used to establish an accurate profile of the recommendations and costs associated with the onset of a particular disability or chronic illness. A Life Care Plan Can Be Helpful for: Traumatic and Anoxic Brain Injuries, Spinal Cord Injuries, Birth Injuries, Burns, Amputations, Neck and Back Pain, Chronic Pain, Upper and Lower Extremity Injuries, Complex Regional Pain Syndrome, Cerebral Palsy, Multiple Trauma, and more...
Medical Cost Projections are used most often in the judicial system by attorney's and by insurance adjusters to set aside case reserves, negotiate a settlement or compare exposures ( i.e. costs with surgery vs. without). MCP's consider many aspects of a claim such as: current medications, equipment, physician visits, diagnostics, surgical procedures, injections and rehabilitation therapies.
Who Needs Cost Projections?
Who Needs Case Management?
Nurse Case Managers are utilized by employer's, insurance carriers, and attorney's to insure disabled, ill or injured individuals receive appropriate medical care. Case Managers act as subject matter experts, translators, navigators, confidants, and aides providing specialized knowledge and expertise in each individualized case.
*******************************************************
Who Needs a Life Care Plan?
Westfield Medical Management Inc.
Who Needs Medical Case Reviews?
A Medical Cost Projection (MCP) is a forecast of reasonable and expected future medical and prescription costs within a specific period of time customized to each individual claim. MCP's produce the usual, reasonable and customary costs that research reveals for the geographical area treatment or equipment is received.
Case Management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost effective outcomes. Source: cmsa.org
Life Care Planning
What are Cost Projections?
Case Management
Copyright Westfield Medical Management Inc.. All rights reserved.