• Menu
  • Skip to main content
  • Skip to secondary navigation
  • Skip to primary sidebar
  • Skip to footer

Before Header

  • About
  • Contact
  • Privacy
 
Paradigm

Amaxx Workers Comp Blog

Reduce Workers Compensation Costs By 20-50%

Header Right

  • Home
    • Training Center
  • Search
    • Free Resources & Solutions
    • Subscribe to Free Newsletter
    • Create Free Training Center Account
    • Enroll in On-Demand Courses
    • Activate WC Mastery Membership
    • Request Strategic Coaching Session
    • Buy WC Guidebooks
  • Membership
    • Insider (free account)
    • WC Mastery
    • Teams & Managers Mastery
    • Training Partners
  • Products
    • On-Demand Courses
    • Specialty Courses
    • Certifications & Mastery Courses
    • Ultimate Guidebooks
    • Coaching
  • Blog
    • Video Blogs
    • COVID-19 / Coronavirus Pandemic
  • Login

Mobile Menu

  • Home
    • Training Center
  • Search
    • Free Resources & Solutions
    • Subscribe to Free Newsletter
    • Create Free Training Center Account
    • Enroll in On-Demand Courses
    • Activate WC Mastery Membership
    • Request Strategic Coaching Session
    • Buy WC Guidebooks
  • Membership
    • Insider (free account)
    • WC Mastery
    • Teams & Managers Mastery
    • Training Partners
  • Products
    • On-Demand Courses
    • Specialty Courses
    • Certifications & Mastery Courses
    • Ultimate Guidebooks
    • Coaching
  • Blog
    • Video Blogs
    • COVID-19 / Coronavirus Pandemic
  • Login
  • About
  • Contact
  • Privacy
You are here: Home / Medical Cost Containment / Coordinating Medical Care / Nurse Case Managers are Well Worth the Cost

Nurse Case Managers are Well Worth the Cost

February 24, 2014 By //  by Michael B. Stack Leave a Comment

Are most carriers taking advantage of using nurse case managers to help move claims along to facilitate closure?

I think it is safe to say some are, and some are not. Usually adjusters are told to use case management only on the severe high-exposure cases. These being major spine surgeries, multiple fracture injuries, and cases with multiple surgeries and different medical care needs to be implemented and coordinated.

But what about average surgical lost-time work comp cases? Carpal tunnel, a knee surgery, a bicep tear. Typically the adjuster is left to handles these claims themselves. They will use their diary system as their fallback so they can monitor what is going on medically with the claim.

But that is also the problem. If you have a lot of cases with the majority of them being cases involving lost time either surgical or not, then how are you being proactive in bringing the claimant back to work and back to full duty? Just monitoring the claim as it goes from doctor appointment to doctor appointment is not being very proactive. I understand that sometimes that’s what you have to do, but you have options.

Click Link to Access Free PDF Download

“The 6-Step Process To Determine Workers’ Comp Injury Causation”

Nurse Case Manager Brings Communication and Medical Expertise to Doctor Appointments

When you have a high caseload, you cannot be everywhere at once. This is where the nurse case manager comes in handy. The nurse can be your eyes and ears at the doctor appointments. They update you the day of the appointment after it is completed. IF you are just waiting for medical records, it can take weeks. Plus, chances are the nurse will be talking to the claimant more than you are, and can tip you off to potential red flags to recovery long before you spot them in medical records.

A nurse case manager can also help you to prevent a file from slipping through the cracks. Even the best adjuster has missed a file every now and then. These misses can be very costly, especially when wage loss is concerned. A nurse will keep you up to date, and will be more reliable than using just your diary system.

They also have the time to work the case from a medical standpoint. They talk with the doctor, and can help in claims where a pre-existing condition is also present around the compensable work injury. The hardest issue in these cases is separating the 2 conditions, and the case manager can help the doctor focus on the work injury while brushing aside the non-occupational condition.

Nurse Case Manager Can Assist With Referrals, Reserves, Medical Plan of Action

Nurses can also help to provide DME equipment quicker, and coordinate any other vendor activity you need done. If you need an Independent Medical Opinion, the nurse may know the perfect doctor for your case. They can also copy the medical records, send them to the IME doctor, draft the cover letter, attend the appointment, and talk with the doctor afterwards to get questions answered. As an adjuster, it would take you a good chunk of time to do that yourself. Plus the nurse will update you right after the appointment instead of waiting days to get the actual IME report.

Reserving can also be assisted by a nurse on the file. The nurse may have a better handle on medical costs, barriers to recovery, prescription costs, and the outlook to a favorable Maximum Medical Improvement projection.

Carriers may have the mindset that an onsite nurse is not cost effective on normal lost time comp cases, but I think this is where they come in the most handy. By being there for the adjuster, it allows the adjuster to focus attention on the more troublesome cases.

FREE DOWNLOAD: “The 6-Step Process To Determine Workers’ Comp Injury Causation”

Adjuster is More Efficient With Expertise of Nurse Case Manager

If you have an accepted claim with a surgery, why not let the nurse run with it and let the adjuster be updated by the nurse? It takes time to place medical records requests, coordinate doctor appointments, and come up with a medical plan of action. The nurse knows how to do all of this. For what they charge, it is cost effective since it frees the adjuster up to handle more important tasks.

Several adjusters that I know have a great network of nurses, and trust their opinions. But they only use them when a severe case comes around. Try using the nurse case manager on normal lost time cases. You will find out that not only is it cost-effective, but it makes the adjuster more efficient at moving cases on to closure. It is all about efficiency these days, and anything that can make an adjuster more efficient should be seen as a positive.

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

WORK COMP CALCULATOR: http://www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR: http://www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP: http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

FREE DOWNLOAD: “The 6-Step Process To Determine Workers’ Comp Injury Causation”

Filed Under: Coordinating Medical Care

Related Articles

Whole-Person Care, Real Results: The Impact of Behavioral Health Expertise, from Injury to Recovery

Whole-Person Care, Real Results: The Impact of Behavioral Health Expertise, from Injury to Recovery

Value-Based Care Model Offers Solution to Wide Swings in Outcomes and Costs for Injured Workers

Value-Based Care Model Offers Solution to Wide Swings in Outcomes and Costs for Injured Workers

Careful Pre-Planning is Key to Mitigate Financial, Human Impacts of Catastrophic Injuries

Careful Pre-Planning is Key to Mitigate Financial, Human Impacts of Catastrophic Injuries

Episodes of Care Has the Power to Transform Recovery

Episodes of Care Has the Power to Transform Recovery

Careless Mistakes With Workers’ Comp Doctor Selection

Careless Mistakes With Workers’ Comp Doctor Selection

Paradigm and Shirley Ryan AbilityLab Announce First-of-Its Kind, Value-Based Partnership

Paradigm and Shirley Ryan AbilityLab Announce First-of-Its Kind, Value-Based Partnership

Kevin Turner Featured in AMAXX Webinar on Catastrophic Workers’ Comp Claim Strategies

Kevin Turner Featured in AMAXX Webinar on Catastrophic Workers’ Comp Claim Strategies

Independent Study by Actuarial Firm Finds Paradigm Catastrophic Care Management’s Improved Outcomes Managing Workers’ Compensation Claims

Independent Study by Actuarial Firm Finds Paradigm Catastrophic Care Management’s Improved Outcomes Managing Workers’ Compensation Claims

Catastrophically Injured Workers: How to Protect the Most Vulnerable During COVID-19

Catastrophically Injured Workers: How to Protect the Most Vulnerable During COVID-19

How Targeted Behavioral Health Support Keeps Catastrophic Claims on Track for Best Outcomes

How Targeted Behavioral Health Support Keeps Catastrophic Claims on Track for Best Outcomes

Paradigm Deepens Behavioral Health Support for Catastrophically Injured Workers with AiRCare Health Partnership

Paradigm Deepens Behavioral Health Support for Catastrophically Injured Workers with AiRCare Health Partnership

Covid-19 Clinical Management for Injured Workers

Covid-19 Clinical Management for Injured Workers

Train to Succeed

BECOME CERTIFIED IN WORKERS’ COMPENSATION

Proven Course Catalog & WC Toolbox Give You The Power To Achieve Lower Costs and Better Injured Worker Outcomes

VISIT WORKERS' COMP TRAINING CENTER

Free Download

The 6-Step Process To Determine Workers' Comp Injury Causation - FREE Download Click Here Now!

Previous Post: « Singapore’s MOM Concerned over Workplace Accidents
Next Post: Ohio’s BWC Awards City for Safety Efforts »

Reader Interactions

Leave a Reply

Your email address will not be published. Required fields are marked *

Primary Sidebar

FREE DOWNLOAD

The 6-Step Process To Determine Workers' Comp Injury Causation - FREE Download Click Here Now!

Our Sponsors

Catastrophic and Risk Solutions, Case Management Solutions, and Specialty Networks
 

Medcor

Injury Triage, Onsite Clinics
 

ARCADIA - Enhancing Settlement Outcomes

The Structured Settlements Company
 

Post-Settlement Administration

Read Our Award-Winning Blog

Blog Categories

Search Our Archive

Subscribe to Our FREE Newsletter

Return-to-Work Essentials

Footer

Search Our Archive

Search our continually growing archive of over 2500 articles about Workers' Comp issues.

Quiclinks

  • Calculators
  • Terms & Abbreviations
  • Glossary of WC Premium Terms
  • WC Resources
  • Best Practices
  • Industries
  • Return-to-Work Essentials

RSS Recent Blog Posts

  • Dealing with Death: A Claim Handler’s Primer to Death Claims
  • Tips and Traps to Effective Medicare Secondary Payer Compliance
  • Work Comp Expectations Dictate Injured Worker Experience
SUBSCRIBE TO OUR FEE NEWSLETTER
Let Us Help You Stomp Down the High Cost of Workers' Comp!
Top of Page ↑
  • Home
  • Training Center
  • Search
  • Membership
  • Products
  • Blog
  • About
  • Contact
  • Subscribe
  • Login
Copyright © 2022 Amaxx, LLC. All Rights Reserved. · Privacy Policy / Legal Notice