• Medical Records Review: A medical record review is a formal examination of patient data and personal medical records for the purpose of validating a diagnosis, settling billing disputes, or to facilitate paying a health insurance claim. We also review and timeline records to assist the attorney’s understanding of the medical records in a more concise manner from before or on the date of injury forward.
• Medical Case Management: The Medical Case Manager Coordinates medical care and provides ongoing communication between injured worker, employer, medical provider and insurance carrier. A Medical Case Manager is assigned to manage the care of an individual to promote a safe and timely return-to-work. This may include the identification of a temporary modified duty position or the development of a permanent modified duty position when medically appropriate. This coordinated effort helps control costs and provides effective medical care.
• IME coordination and attendance: PIRS will schedule IME recommend the best physician for the type of injury, notify IW of appointment via certified mail, arrange transportation and attend appointment.
• Catastrophic Case Management: In the event of a catastrophic injury, our Registered Nurses are available on a priority basis. The Catastrophic Nurse Case Managers are trained to assess complicated medical issues related to a Catastrophic Injury and to report those issues back in layperson’s terms. The Nurse Case Manager can also assist the injured worker’s family with questions and help them coordinate the transition from the hospital to home by creating a comprehensive care plan to include home health care, in-home preparation, medical equipment needs, transportation of the party, and so on. The Case Manager may also utilize components of our Life Care Planning System to identify vendors and short term costs for in-home care and durable goods.
• Medicare Set Asides: Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) is a financial agreement that allocates a portion of a workers’ compensation settlement to pay for future medical services related to the workers’ compensation injury, illness, or disease. These funds must be depleted before Medicare will pay for treatment related to the workers’ compensation injury, illness, or disease.
• Life Care Planning: Consistent process for analyzing the immediate and lifelong needs of patients necessitated by the onset of a disability. Our certified life care planners will provide a report that will outline the lifelong needs for an injured party.
• Legal Nurse Consulting: PIRS will work with attorneys in complex legal claims assisting in obtaining records, summarizing the conditions, and answering questions.
• Provider Panels: PIRS will implement a customized provider panels tailored to your company’s goals, recommending the best physicians available in your geographic area with a focus on cost containment and return to work.
We also offer ACT 6 Repricing and Workers Comp Repricing.