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- Claim Validation Evaluations
One of the most effective tools in controlling workers compensation costs is prompt referral for Medical Case Management. We can assist at every step along the way to expedite closure with the best possible outcome. For full Medical Case Management or Task Assignments, our RN Case Managers utilize the best specialized providers assuring the most reasonable and necessary treatment.
- Catastrophic Injury Management
In an era of accountability, JMS PreAuthorization Services has the specialized knowledge and tools to eliminate waste and unnecessary services, while avoiding ptentially harmful delays in care. As required by Rule 30 by the ARWCC, JMS PreAuthorization allows for great impact to assure medical necessity in a timely manner for services exceeding $1000 per day.
Outpatient Rehabilitation is a $29.6 billiion industry, with physical therapy accounting for 90% of spending. ARWCC Rule 30 allows for preauthorization of physical therapy, providing for accountability and best practice controls to decrease excessive utilization and costs.
Work comp claims close 70% faster with a RN Case Manager, so you'd love a case manager on every file - but you must be discretionary with CM utilization. Telephonic Case Management (TCM) is designed to impact injury claims with early intervention, and without onsite travel expenses. Our RNs undergo additional training for engagement and impact. RTW is our number one focus! We also have the flexibility for easy Task Assignment to field CM if indicated.
Using expert analysis, our Certified RN MSA Consultant estimates every possible future medical expense related to an injury, including prescriptions, tests, surgeries, other medical procedures, doctor’s visits, supplies, etc. We then file the final MSA proposal with CMS and assist in preparation of settlement documents for funding, and administration of the allocation funds. Our legal partnership will take care of structuring settlement allocations.
Pre-MSA Medical Cost Projections can be performed to determine areas where medical expenditures can be reasonably decreased and lower exposure
- Submissions and nonsubmissions
Our Legal Nurse Consultant can provide critical value in a litigated workers compensation claim. Utilizing specialized nursing expertise we evaluate the standard of care, flag inconsistencies in medical records, collaborate with prescribing physicians, attorneys, and injured workers to evaluate, negotiate and settle a file.
Strategic assessment of each case can provide a recommended course of action to reduce unnecessary claim expenditures.
Workstation Assessments are an ergonomic analysis of a work area to document the physical demands and identify risk factors for: appropriate job placement, musculoskeletal disorders (MSDs), inefficiencies in production, and areas needed for change or adaptation.
Our staff are focused on assisting employers, employees, and carriers with specialized needs in the workplace. Our Occupation Consultants can help you with injury prevention, injury causation determinations, light duty programs, Ergonomics Programs, and RTW Assistance.
Misuse and abuse of controlled substances is a reality of healthcare. In the workers compensation field we strive to ensure legitimate use of these drugs and combat illegal trade and diversion of controlled substances. We provide pharmacy reports to provide objective evidence of addiction risk or suspicious activity such as selling medications. 24-hr turnaround is typical, and multistate reports can be requested.
Dr. Kirk Reynolds, MD, Orthopedic Surgeon
JMS brings expertise to garner additional cost savings with Medical Bill Review. Our customized program applies:
•State Fee Schedule •PPO Discounts •Provider Contracts •Integration with Utilization Review decisions •Duplicate provider billings •Improper billing codes
Although automation has become standard for processing claim billings, JMS again uses our attention to detail by manually reviewing 30-40% for appropriate “level of service” analysis. Certified Auditiors and RNs review medical reports and supporting documentation to assess proper coding.
Higher volume of manual analysis and customization for our customers…It’s the JMS way of Bill Review.
Our comprehensive range of services and solutions means we can guarantee success for every company we advise, no matter the size or industry. Learn more about our areas of expertise below.