Medicare/Medicaid guidelines, Milliman & Robertson (M&R) guidelines, Interqual and the Official Disability Guidelines (ODG utilized for Workers Compensation). The primary focus of our medical case management services is on patient recovery and well-being to achieve maximum medical improvement (MMI), obtain the permanent partial impairment rating (PPI) when applicable, and return the employee to work (RTW).

Case management services:

• Medical case management
  
• Review of current procedural terminology (cpt) and diagnosis (dx) codes
  
• Review/auditing of the medical record along with the billing/claims history
  
• Case reviews
  
• Legal nurse consulting
  
• Return to work resolutions
  
• Deposition summaries
  
• Report evaluations

Analyzers R Us specializes in medical case management, vocational case management, and cost-containment services for the insurance industry and employers. We help solve the problems of hundreds of our business partners every day. Our unique passion for customer service, and for earning our business day by day, means we will do the job right the first time. It’s what every one of our customers can expect, because it's what we deliver.

Catastrophic Case Management Services

In the event of catastrophic injury or disabling events, catastrophic case management is the most cost-effective method of providing optimal recovery and reintegration into society.

We offer a highly specialized team of credentialed professionals with expertise in catastrophic injury case management, capable of immediate response to a claim. Our goal is to provide direction and control of the medical care to the benefit of the injured worker and his/her family, including comprehensive medical and vocational intervention, life-care planning and long-term cost impact analysis.

Telephonic Case Management (TCM)

Telephonic case management (TCM) is an early intervention program aimed at promoting proper medical care at the onset of injury. Immediately upon notification, our Telephonic Nurse Case Managers establish contact with the injured employee, health-care provider, and employer. We feel strongly that TCM is an effective early-intervention tool and that it is imperative we receive TCM referrals as soon as possible following an injury.

Our ultimate goal is to achieve a successful return to work while decreasing medical, disability, and litigation costs. Throughout this phase, our nurses aggressively manage each case to its optimal medical outcome.

TCM is most effective in the first 30 days following an injury. If a claimant has been off work for more than 30 days, it is likely a serious injury and will then be reviewed as a potential candidate for field case management services.

Definition of Case Management

Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human service needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes.

**Commission for Case Manager Certification

Philosophy of Case Management

Case management is an area of specialty practice within the health and human services profession. Its underlying premise is that everyone -- the clients being served, their support systems, the health care delivery systems, and the various payer sources -- benefits when clients reach their optimum level of wellness, self-management, and functional capability.

Case management facilitates the achievement of client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation. Based on the needs and values of the client, and in collaboration with all service providers, the case manager links clients with appropriate providers and resources throughout the continuum of health and human services and care settings, while ensuring that the care provided is safe, effective, client-centered, timely, efficient, and equitable. This approach achieves optimum value and desirable outcomes for all.

Case management services are optimized when offered in a climate that allows direct communication among the case manager, the client, the payer, the primary care provider, and other service delivery professionals. The case manager is able to enhance these services by maintaining the client's privacy, confidentiality, health, and safety through advocacy and adherence to ethical, legal, accreditation, certification, and regulatory standards or guidelines.

Certification demands that the case manager possesses the education, skills, knowledge, and experience required to render appropriate services delivered according to sound principles of practice.

**Commission for Case Manager Certification

Facts about case management

The practice of case management is a process that manages client wellness and autonomy through advocacy, communication, education, and the identification and facilitation of services.

To obtain optimum value for clients and reimbursement sources, case managers identify appropriate providers and facilities across the continuum of health care and human services while ensuring that available resources are timely, cost-effective, and efficient.

Case management help all health care policy holders

The benefits of case management accrue to all participants in the process. Consumers gain an advocate and emotional support. Physicians and hospitals have complex cases facilitated. And payers' costs are reduced while their customers are retained.

Four important factors will continue to impact the practice of case management:

• Explosion of managed care
• Burgeoning elder population
• Increasing number of chronically ill patients maintaining an improved quality of life through newly developed drugs and requiring complex, ongoing treatment
• Spread of state legislation requiring certification and licensing

Case management practice will continue to grow.

Advances in health care technology combined with diminishing resources increases the demand for case management of complex cases in the best interests of consumers while saving time and money.