The right EMG test needs to be done at the right time
Adjusters need to think outside the box a little, and look at the other symptoms as well as the medical history. Adjusters can also utilize their Utilization Review department, a nurse case manager, or a Record review from another physician to see what type of test should be done. All of these steps need to be taken in order to avoid medical cost leakage due to a hunch from the treating physician.
Does an MRI really need to be performed?
- Does the injured worker need months of physical therapy?
Some statistics to keep in mind (stats pulled from GAO Analysis of Medicare Part B Claims data; Boden et al. JBJS, 1990; Friedly J, Chan L, Deyo R; Spine, 2007)
- Billing from 2000-2006 increased from $6.89 billion to $14.11 billion for lumbar imaging.
- MRI research with patients that had “no back pain” showed that of those under age 60: 36% showed herniated discs, 21% had spinal stenosis, 79% had a bulging disc, and 93% had a degenerated disc.
- The Medicare population increased 12% from 1994-2001, but billing for services increased 637%.
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