Worker's Comp Utilization Review

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Disciple

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I'm currently in the process of creating documentation macros (inserted into pt reports) for an EMR to decrease the percentage of my procedure authorization requests that are denied (1st request cycle) through Worker's Comp.

I would appreciate any tips on what to include from some of the experienced pain docs.

From my limited experience, I've noticed that those reviewing the requests could care less about reduction in pain score or VAS and ADLs unless it pertains to the patient's usual and customary occupation.

So what are the vital points?

-Functional Status described how? Weight they can push/pull? Objective increase in sitting/standing tolerance? Walking distance?
-Decrease in use of oral medication?
-Alternative to surgery?

Any Others?

Any differences when requesting from commercial insurance? How about Medicare? or do I ever need to "request" anything from Medicare.

Thanks.

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Bump..

Anyone, anyone?

Need help. Intradiscal procedures not getting approved.:thumbdown:


All joking aside, the worker's comp guidelines manual used in my state refutes the validity of discography. The articles they site (5 or so) are all by Carragee.

To the experienced pain docs, based on clinical observation of efficacy, what is your preferred method of percutaneous disc decompression (Nucleoplasty, Decompressor, Accutherm, LASE?).
 
this would be great.....i was denied a discogram and a perc discectomy because the reviewing doctor said there wasnt literature evidence to support doing them....he even wrote that there was evidence that discograms caused more harm to patients. I think he was going by that study done on prison inmates.

T
 
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Holt and Carregee have really put a bad spin on disco's.

Call the denying doctor and have him get in touch with Carragee- he still does discograms.
 
this would be great.....i was denied a discogram and a perc discectomy because the reviewing doctor said there wasnt literature evidence to support doing them....he even wrote that there was evidence that discograms caused more harm to patients. I think he was going by that study done on prison inmates.

T

This is the relevant article to quote back when they make that claim:
Pain Med. 2005 May-Jun;6(3):213-21: Pressure-controlled lumbar discography in volunteers without low back symptoms. Derby R, Lee SH,Kim BJ, Chen Y, Aprill C, Bogduk N.
 
thanks guys...exactly what i was hoping for

T
 
Bring a thread back from waaaaay back!

Was thinking about doing some utilization review work on the side to earn a few extra bucks while watching sports at home. Wondering if you can help me out with a few questions:

1) I'd be an independent contractor. Do I necessarily need to form an LLC or can I just fill out the W-9, get my 1099 before taxes are due, pay what I need to come tax season, and still get some of the beneficial write-offs as an independent contractor (internet, home office stuff, maybe cell phone if I'm making calls for peer to peer, computer)?

2) The company said they supply Errors and Omissions Coverage. I don't need any other type of coverage, do I? There's no actual patient contact so should be good to far as I know.

3) On the application forms, it asks me to fill out my hourly charges for testimony and deposition. As a dual board certified physiatrist and pain medicine specialist, what would be some reasonable and fair rates?

4) If anyone has done this work recently, about how much extra income can be made and how much extra work does this add to your week?

Thanks!
 
Bring a thread back from waaaaay back!

Was thinking about doing some utilization review work on the side to earn a few extra bucks while watching sports at home. Wondering if you can help me out with a few questions:

1) I'd be an independent contractor. Do I necessarily need to form an LLC or can I just fill out the W-9, get my 1099 before taxes are due, pay what I need to come tax season, and still get some of the beneficial write-offs as an independent contractor (internet, home office stuff, maybe cell phone if I'm making calls for peer to peer, computer)?

2) The company said they supply Errors and Omissions Coverage. I don't need any other type of coverage, do I? There's no actual patient contact so should be good to far as I know.

3) On the application forms, it asks me to fill out my hourly charges for testimony and deposition. As a dual board certified physiatrist and pain medicine specialist, what would be some reasonable and fair rates?

4) If anyone has done this work recently, about how much extra income can be made and how much extra work does this add to your week?

Thanks!

1) independent contractor
2) None.
3) Testimony in half and full day increments only...$5K and $10K not unreasonable. Deposition is $450/hr; 2 hour minimum and you round to the nearest quarter hour.
4) It "depends."
 
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