Medical Case Management
According to the Commission for Case Manager Certification, Case Management is a dynamic process that assesses, plans, implements, coordinates, monitors, and evaluates to improve outcomes, experiences, and value. Its underlying premise is that everyone benefits when patients reach their optimum level of wellness, self-management, and functional capability. The stakeholders include the patients being served; their support systems; the health care delivery systems, including the providers of care; the employers; and the various payer sources. It is designed to promote optimal recovery and rehabilitation through professional involvement in the recovery process. This service may be performed in conjunction with managed care, which is designed to ensure medical necessity and cost-effectiveness of a proposed service. Medical case management is a balance of both quality assurance and medical cost control. The case manager advocates on behalf of the individual to assure the quality of care and attainment of appropriate goals, as well as promotes self-advocacy skills to achieve maximum independence. At Presque Isle Rehabilitation Service, our highly skilled, and experienced case managers are able to craft creative solutions to whatever situations arise with your cases, in a cost-effective manner, thinking outside the box and simply put, they get the job done.
IME coordination and attendance
An IME is an evaluation of an injured party that utilizes a third-party, independent medical professional to issue an unbiased opinion on the injury. Unlike the treating physician, these doctors are simply consultants and are contracted to supply an objective medical evaluation for a specific case. Scheduling of an IME is completed, medical records are obtained as well as diagnostic films, and are then forwarded to the physician for review before the IME appointment. PIRS will schedule the IME, recommend the best physician for the type of injury, notify the injured worker of appointment via certified mail, arrange transportation, attend the appointment, and we will draft a detailed observation report following the exam.
Telephonic Nurse Injury Triage Program
PI Rehab offers a fully customizable telephonic nurse injury triage program for employers. This program removes the employer from the information taking process and allows the patient immediate contact with a licensed medical professional to triage the facts of the injury and direct them to appropriate care within the employer panels, if applicable, and provide appropriate evidence-based self-care instructions for their reported injury, if appropriate, to avoid unnecessary care for the injured worker, and unnecessary expense for the employer. The process is further defined with completion of first report of injury forms and claim filing with the carrier as well, streamlining the claim reporting and fact-collection process at the onset of the injury when the facts of the matter are fresh.
Follow-up with the injured worker is arranged at pre-determined intervals to document injury evolution and further determine if needs for referral or follow-up are needed, or if continued self-care is recommended. This is a patient-centered process that ensures appropriate treatment recommendations are made. Information is forwarded to invested parties to assist in determination of compensability and benefits.
A 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. Liability Medicare Set-Asides are also available.
Legal Nurse Consulting
PIRS will work with attorneys in complex legal claims assisting in obtaining records, summarizing the conditions, and answering questions. Our certified legal nurse consultants will analyze and evaluate the facts and testimony relative to your case, authoring researched and supported opinions regarding the nursing and healthcare provider services and outcomes and the nature and cause of injury. We uphold the standards for certification in the legal nurse consulting industry, proving our knowledge, skill, and competency for quality practice in the profession.
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.
Physical Therapy Networks
PIRS has access to a nation wide network.
- Catastrophic case management
- IME coordination and attendance
- Legal nurse consulting
- Life care planning
- Medical case management
- Medical records review
- Medicare set asides
- Physical therapy providers
- Provider panels
We also offer repricing with ACT 6 and Workers Comp.
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MA, CRC, NCC, LPC, CLCP, PGAP Provider
Michelle Repman-Pifer has been working in the workers’ compensation, disability, and civil liabilities fields for over 28 years and founded Presque Isle Rehabilitation Service in 2002.
Through innovative thinking, integration of the latest technology, and collaborative teamwork with staff both in-office and in the field, she has created a highly regarded team that, together, ranks among the leading case management companies in the region.
In addition to running the business and overseeing operations, Ms. Repman-Pifer still personally works a small caseload of case management files and expert cases in workers’ compensation, liability, domestic, and disability cases. A believer in lifelong, ongoing education and skills acquisition, Ms. Repman-Pifer is a certified Progressive Goal Attainment Program (PGAP) provider, having attended a workshop led by program developer Dr. Michael Sullivan; PGAP is included in the Official Disability Guidelines as an accepted treatment for workers’ compensation and disability claims.
Finally, Ms. Repman Pifer is a certified life care planner (a designation signifying rigorous preparation and thorough qualifications in this field), making her one of only thousands in the entire country.