Utilizing Nurse Case Management During COVID-19

During this challenging time of Covid-19, it is important that all of us at Approach are doing everything we can to support our clients. One of the ways we are doing this is by highlighting services and resources available to reduce costs and accelerate claim resolution.

Nurse Case Managers (NCM) have a critical role in this. They serve as a liaison between all parties involved in a claim, which includes any providers, the injured employee, the employer, the L&I claim manager and the third-party administrator.

At Approach, we recognize the value of having an expert on staff, and that is why we have a full-time NCM available to assist our clients and their injured employees as a complimentary resource.

 

Common Services Provided by the Approach Nurse Case Manager

Below is a list of some common services provided by our NCM.  As an Approach client, your dedicated Retro Coordinator evaluates if it would be beneficial to draw upon these services while managing your claims:

  • Complex Medical Review

Complex medical reports and diagnostic studies can be challenging to interpret and even more challenging to understand their impact to a claim. Our NCM can provide guidance to what matters most and how to navigate the various aspects of medical case management to secure clarification, direction and resolution.

  • Emergency Response

The Approach NCM provides compassionate assistance to employers, injured employees and their families should a serious injury occur. Our NCM can navigate the healthcare system in order to coordinate treatment, facilitate resources, and keep the lines of communication open to all concerned parties.

  • Permanent Partial Disability Review

A rating error for a permanent partial disability impairment award could result in the loss of several thousand dollars or more for an employer. Our NCM reviews ratings for appropriateness and accuracy, and if an error is found, we coordinate with L&I to correct it.

  • Return-to-Work Coordination

As with vocational experts, NCM’s are also able to meet with providers to strategize and facilitate return-to-work options. By being able to ‘speak the same language’ as the provider, our NCM can deliver positive outcomes for our clients.

  • Surveillance Review

The power of persuasive surveillance can change the trajectory of a claim. Our NCM can direct the attention of the attending provider to those aspects of the evidence which highlight the necessary points to support a release to light-duty, termination of time-loss benefits, etc.

  • Treatment Facilitation

When treatment stalls on a claim, the duration of that claim is extended which results in additional costs. Our NCM can assist in the coordination of care to decrease treatment lag time and expedite the healing process.

 

Other Options

In addition to the services outlined above, NCMs can also be brought into a claim directly by L&I. As an employer, you can also hire an NCM, through a firm such as NurseWorks Northwest, to assist with any needs.

Our second online Brain Trust featured Tricia Daniel RN, CCM, WWCP of Nurseworks Northwest, a local firm specializing in nurse case management.

You can watch the full Nurse Case Management presentation here and get the presentation slides inside the Client Portal.

 

Top 3 Questions From the Webinar for an Outside Nurse Case Managers

We also wanted to share the top three questions during the Q&A portion of the webinar with you here, in this week’s Ask Approach.

 

  1. How do the Approach NCM and an Outside NCM, such as NurseWorks Northwest Work Together?

The simplest way to answer this question is to use an example. In an injury where an employee has a catastrophic accident resulting in significant long-term disability, the Approach NCM will assist all parties involved in the coordination of treatment, resources, and communication. Due to the extent of the injury, recovery will be a long process that can take months or years, that is when an outside NCM can step in and assist with the long-term recuperative process.

 

  1. How Does an Outside NCM Fit (Into the Claims Process) and How Are They Paid?

Outside NCMs can assist with workers’ comp cases in two ways:

The first is when L&I requests an NCM for the claim, in which case L&I pays the direct cost.

Note: Although L&I pays the bill in these cases, the costs are assigned to your claim. This means your company can still be liable for the costs in the form of higher workers’ comp rates!

The second is that employers can hire an NCM (such as Nurseworks Northwest) and pay for their services directly. This allows the NCM to communicate directly with all parties as an authorized representative of the employer. Some of main ways that NCMs assist employers with workers’ comp claims are:

  • Sign-off on return-to-work
  • Present surveillance results in order to get sign-off

 

  1. If We Have a Claim That Needs an Outside NCM, Can We Assign Tasks Rather Than All Aspects of a Claim?

Absolutely. Nurse case management firms do a lot of work with employers on one specific area of a claim. In these cases, they do not need the full claim file, but it is helpful to have any relevant medical/claim notes.

 

 

Learn More with Approach

Prior to hiring an NCM, we recommend discussing your options with your Approach Retro Coordinator in order to develop a game plan and to ensure that nurse case management is the right call for your claim.

We have many more online Brain Trusts coming up during the COVID-19 stay-at-home order. These Brain Trusts are a great way to keep in touch with colleagues while staying on top of the latest in workplace safety and claims. Learn more and sign-up for free on the events page.