Presumptive vs Confirmatory Drug Testing – Which Is Appropriate?

A prevalent practice among prescribing doctors is to automatically send a urine sample out for confirmatory (quantitative) drug testing.  Average billing for the confirmatory testing is around $2000 but if they test for an extensive number of drugs, it can be as high as $4000.  This is different than qualitative testing, also known as point of contact or presumptive testing, which identifies drug classifications, such as opiates, muscle relaxants, anti-depressants, etc., but not specific drugs, and is a lot less expensive.  Many physicians perform the qualitative testing in their own offices, then send the sample to an outside lab to perform the quantitative confirmatory testing for specific drugs.  There are some practices that send urine samples out to a lab for qualitative (presumptive) testing also, because they don’t have the capability to perform that testing onsite.  CPT codes allow us to recognize whether they are obtaining presumptive or confirmatory testing.

A recent trend we are beginning to see is that doctors, particularly those in the larger pain management practices, are obtaining the testing equipment to perform the confirmatory testing in their own office.  The problems with that are 1) the more drugs they test for, the more they can charge which potentially leads to excessive testing on multiple patients; and 2) ODG recommendations are that confirmatory testing only be done if the presumptive qualitative testing shows inconsistencies, other red flags,  or the claimant is considered high risk for abuse as evidenced by either previous irregularities with testing or using objective testing tools to show the patient is predisposed towards high risk behaviors.  

We monitor  all requests for UDS very closely, both by report and CPT codes, to watch for confirmatory testing done by rote as a business practice which is not according to ODG, versus medical necessity which is compliant with treatment guidelines.  Many times, the adjusters don’t realize ODG has criteria for the use of confirmatory testing or don’t know quantitative testing is performed until they get the bill.  Those tests would, therefore, be subject to retrospective review.  The doctor would be responsible for appropriate documentation to support medical necessity.  It usually only takes one or two denials of the expensive quantitative drug test bills for the treating doctor to rethink the wisdom of automatic confirmatory testing.  Outside labs are not pleased to have their bills delayed for retrospective review or denied because the confirmatory quantitative testing is not compliant with ODG criteria.   

Those labs have rendered their services at the request of the physician, and most likley are not familiar with ODG recommendations and criteria for confirmatory drug testing.

National Workers Compensation and Disability Conference Keynote Breakfast

Review Med will once again host the opening keynote breakfast at the 25th Annual National Workers Compensation and Disability Conference, Wednesday November 30th 7:00-8:30 am. This will be the 6th year the managed care firm will sponsor the opening event.

The industry’s largest conference in the nation will be held November 30th through December 2nd at the New Orleans Ernest N. Morial Convention Center. The expo will feature more than 260 vendors and over 35 different breakout sessions.

Opening Keynote speaker Tim East, Director, Corporate Risk Management at The Walt Disney Company, will present “Fueling Injury Recovery with Engaged Workers,” discussing “how changing demands for technological experiences provide clues for how workers’ comp must evolve to meet the claims experiences workers now demand.”

The 25th Annual National Workers’ Compensation and Disability Conference (NWCDC), November 30 – December 2 in New Orleans, provides the best training available for enhancing workers’ comp, disability management and RTW programs. Thousands of professionals will gather to gain new solutions for cutting costs, effectively managing claims, reducing lost workdays, implementing an integrated disability management program, avoiding unnecessary lawsuits and much more..

Interested in coordinating a meeting with one of our team members during the NWCDC conference? Contact us at

For more conference information or to register to attend visit


10th Annual TNSIA Conference

Our team will once again exhibit and attend at this years Tennessee Self Insurers’ Associations’ Conference, September 8-9th.

The conference will be held at the Renaissance Hotel in Downtown Nashville and will the be the most attended conference in the associations’ history. The welcome reception will be Thursday 5-7 and will be hosted in the banquet hall 206.

The Keynote  speaker Dr. Robert Barth will present, “Critically Important Claims Management Principles Which are Almost Never Used, But Which Save Money and Lives.

Connect with Review Med! Interested in coordinating a meeting with one of our team members during the 2016 TNSIA Conference? Contact us at or visit us at BOOTH #9!!

Case Study: Traumatic Brain Injuries

60% of workers who experience a Traumatic Brain Injury on the job, never return to work.**


Catastrophic claims are less than 1% of all workers’ compensation claims but account for over 20% of claims cost. Traumatic Brain Injuries are the most common and costly type accounting  for 20% of reported work-related injuries* of catastrophic claims that employers and carriers face.

Catastrophic Nurse Case Management is an effective and necessary tool for employers and carriers to manage cost and improve outcomes.

Work Comp’ Traumatic Brain Injury Employee Back to Work in 14 Months

Claimant: 45 year old male

Occupation: Hotel Maintenance

Injury: Employee sustained reported injury due to a fall from a ladder

Upon initial admission to the hospital, employee required significant sedation and intubation and placed on ventilator support.

Brain Injury Diagnosis:

Cranial CT scan revealed a non-displaced right parietal /occipital skull fracture with soft tissue swelling, bi- frontal hemorrhagic contusions, swelling in both frontal lobes, and subarachnoid hemorrhage.

A secondary cranial CT scan revealed an increased edema around the contusion in the anterior frontal and temporal lobes, mild decrease of subarachnoid hemorrhage, and no new intracranial hemorrhage. Mild decrease in the overall cerebral edema (swelling) was noted.

Recovery Timeline:

  • The claimant was placed in a drug induced coma and transferred to the ICU for multiple months.
  • Upon recovery he was transferred to a Neuro Unit and received intensive physical therapy.
  • CT brain scan findings listed improving bifrontal contusion, improved bifrontal edema, no new areas of hemorrhage, and mass effect or shift present and normal ventricles in size.
  • The claimant was transferred to an inpatient rehab facility where he received intense multidisciplinary therapies where he made significant cognitive improvements under the rehab program and transitioned to an outpatient program and was placed under the care of a neurologist.
  • After several months of intense treatment modalities and therapies, the claimant reached a maximum medical improvement with 0% impairment rating. Within 14 month of date of injury, he was released from care and able to return to work full duty..

Review Med’s Nurse was assigned to provide nurse case management for the entirety managed the case for the entirety of the claimants 14 months of recovery.

Review Med’s Catastrophic Case Management Impact:

Immediate Response:

Review Med’s Nurse Case Manager was tasked to manage the claim from the initial report of injury. She arrived at the hospital to assist employees and family through in processing. This also allowed the employer to have immediate reporting and assessment of injury prognosis.

The Nurse Case Manager complied with the carrier and employer request to visit the claimant on a daily basis in the acute phase of hospitalization.

Clarity and Understanding:

Nurse was a resource to educate the family regarding the claimant’s injury and the complex treatment recovery process.

The nurse was bilingual and functioned as a translator for the claimant and family members with providers and the carrier representative.

Claimant Advocate:

Expedited the request for a neurology consult and CT head scan.

The case manager met with various on-site case managers in order to maximize the claimant’s inpatient care.

The case manager diligently researched and located a rehab facility to adequately address the claimant’s medical and rehabilitative needs.

She kept the carriers’ in-house nurse case manager and adjuster thoroughly and timely informed regarding the employee’s status and progress.

Identified a billing error by the hospital and facilitated the correction of the error, saving the carrier unnecessary and unrelated treatment cost.

Review Med’s Nurse Case Management was instrumental to the successful positive outcome of this claim. Her involvement to function in multiple capacities and report to multiple agencies was executed attentively, effectively, and in the best interest of the claimant and carrier.

*Source References:

*  Faul M, Xu L, Wald M, Coronado V. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Atlanta, Georgia: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010. For Abstract Click Here

** van Velzen, J. M., van Bennekom, C. A., Edelaar, M. J., Sluiter, J. K. & Frings-Dresen, M. H. (2009). How many people return to work after acquired brain injury?: A systematic review. Brain Injury, 23(6), 473-488 link For Abstract Click Here



Tennessee Adopts ODG

Tennessee Bureau of Workers’ Compensation adoption of the Work Loss Date Institute’s ODG Guidelines and Drug Formulary officially took effect this past February. The volunteer state joins 32 other states to officially apply the ODG Treatment Guidelines in some capacity and is the third state to nationally to adopt the ODG’s close drug formulary.

What is ODG

A publication of evidence-based treatment and Return-To-Work guidelines that support managing medical treatment and utilization review for workers’ compensation.

The first edition of ODG Guidelines was published in 2003 and is currently on its 20th edition. Web text is updated continuously in real time to reflect findings of the most current studies and the text version is published annually.

ODG's Purpose?

According to WLDI, the purpose of these guidelines are “to set health policy in workers’ compensation using evidence-based medicine to safeguard access to quality care while limiting unnecessary utilization of medical services.”

Carriers, Self-Insures, and Managed Care companies refer the guidelines as a benchmarking resource to ensure employees are receiving the most effective medical treatment appropriate to their compensable injury.

Why States choose ODG?

ODG is widely used by states as it is considered to be one of the most complete and comprehensive guidelines for treatment recommendations. It cover over 99% of workers comp’ related costs and ODG’s RTW guidelines cover all 10,000 ICD9 diagnosis codes.

Each ODG recommendation includes direct links to data/text and supporting medical evidence of the studies that were applied in determining the treatment recommendations.

ODG’s Impact?

  • Improve recovery outcomes and quality of care by focusing on restoration of workers functional capacity through the delivery of appropriate evidence based treatment.
  • Reduce excessive and unrelated utilization of medical services
  • Identify and refute ineffective procedures
  • Automate approval for supported effective treatment reducing delays in necessary medical care
  • Efficiently process UR by automating first-line approvalAccording to WLDI, the Adoption of ODG has led to:
    • Medical cost-savings of 25%-60% (by state, payer, TPA, and health plan)
    • Average disability duration down 34%-66%
    • Treatment delay (from DOI to initial treatment) down 77%
    • Insurance premiums down 40%-49% as a result of improved health outcomes
    • Access to care up 42% (more treating providers accepting patients under ODG)

    **Source: Work Loss Data Institute

Fast Facts:

  • Adopted by more states than any other guideline.
  • Utilized by the top 10 WC Insurers.
  • ODG includes the most used chronic pain guidelines in workers’ comp.
  • In February 2016, WLDI, the publisher of ODG, was awarded a GSA contract. Allowing all government agencies the ability to purchase and utilize guidelines.

To learn more about the Official Disability Guidelines, visit ODG or ODG FAQ.

Review Med has been subscriber of ODG since 2007, utilizing these guidelines for our clients in Texas and nationwide for managed care services including Medical Case Management, Life Care Planning, Peer Record Review, and Utilization Review. For more questions on how we can help you with ODG, contact us today!







Our team will be once again headed to Florida to attend the RIMS Educational Conference July 26th through July 30th. This year’s conference will be held  at the Ritz Carlton in Naples Florida.

The conference key note speaker is Chris Maleno, Senior Vice President, Chubb Group and Division President, Chubb North America Major Accounts.  His presentation “Property and Casualty Industry Outlook and Hot Topics: M&A Activity,” will be informative discussion on key topics and trends in the Property and Casualty Industry.

Connect with Review Med! Interested in coordinating a meeting with one of our team members during the 2016 Florida RIMS Educational Conference? Contact us at

Part 2: Linda Meik, Q&A

How did you get in to the insurance industry?

There were three doors before me….one labeled “teacher”; one labeled “return to the farm & do whatever”; and the other labeled “health care – this is a fun career”.  Guess what I chose?  Yes, the “fun” one. Actually this is a very long and storied evolution on how I ended up in insurance……and one thing lead to another.

Do you have a professional motto or philosophy?

“LISTEN, LEARN & DEVELOP” and remember “We each are a small part in this grand universe.”  “Remember to make time!”  If one listens and learns from others they can develop themselves and others around them.  Never think you are bigger or more important that someone else because you are just a small part in this universe.  Saying you are to busy all the time, well soon time will pass you by.  Take some time to do small things as they soon add up to great things.

Why did you decide to retire when you did?

I had always thought I would work until I was 70 as I loved what I was doing.  But retirement sort of hit me between the eyes when some former colleagues of mine, who were also much younger than myself, retired and they only got to enjoy retirement for a couple years,before they departed this earth.  I looked around and took stock of what I was doing and realized that my working 12-14 hour days at this desk I was sitting at, and this desk was not going to say thank you when I dropped over dead.  I wanted to really unwind and enjoy what I had worked hard for, so I slowly began to make plans for retirement.  It was a two year process as I did not want to leave any of my clients or colleagues in a dilemma of how to get things done.

What advice would you give to someone starting out in the insurance industry?


What is the most valuable lesson you have learned about leadership?

Maintain your integrity.  Individuals with a strong integrity will have people following them, and if no one is following then you are not a leader.

Why do you feel it important for professional to be involved in industry associations?

There are several reasons why as an individual one needs to get out and be involved in the industry associations.  There is networking, education, new adventures, visibility, civic leadership and one makes some awesome friendships along the way.  Getting acquainted with people face-to-face enhances your career & personal opportunities greatly.  And, as with everything in life, you get out of an organization what you put into it.

How do you feel about being nominated 2016’s “Most Loyal Grand Gander?”

Incredibly honored!  Having ganders all over the USA & Canada supporting me is incredible and very humbling.

What do you hope to accomplish in your year as MLGG?

Today, within the Blue Goose Organization we are the cusp of change.  Managing this change and being part of guiding the organization into the future is an awesome challenge.  Part of this change is reaching our to the millennials and Gen-X’s and mentoring them, as well as, seeking their help in mentoring the older generations. I want to continue building the organization and helping instill “passion” into each Pond (chapter). As I believe if there is no passion there is no purpose, and no purpose does not lead to a journey of significance for an individual, a Pond or the organization.

The longevity of Blue Goose is a result of it’s dynamic membership.  We need to embrace and get the younger folks involved and prepare them for the leadership roles.  With an on-going focus on building the membership whose focus is on the three precepts of the organization: “Fellowship, Character & Charity” is what will continue to keep Blue Goose great.  While all of this is going on we must have fun along this road of growth.

What do you hope the next generation of ganders to take away most from their Blue Goose involvement?

Remember to honor the past, but lead us into the future.

When Linda accepted her  first officer position, she closed her acceptance speech with this:

B = Best of the Best – Yes we are!

L = Love of fellow mankind.

U = Unity through great fellowship.

E = Everywhere – all corners of our great lands.

G = Ganders – heed the call.

O = Onward to great growth in membership.

O = Over the top in charity endeavors.

S = Sailing into the future with new technology.

E = Educate others about our great organization.



Part 1: Linda Meik, Most Loyal Grand Gander

If you are involved in the insurance industry in Texas or active in the Blue Goose, you know Linda Meik. In July at the 110th Grand Nest Convention, Linda will be named the “Most Loyal Grand Gander,” the highest and most prestigious position in the Blue Goose organization. She will be the third women who has achieved this nomination and to hold this position in the organizations century old history. The enthusiasm and dedication she holds for the organization is abundant and inspirational.

As an admiring peer and fellow gander, I am privileged to have had the opportunity to interview this accomplished and humble leader about her involvement with Blue Goose, the industry, and her take on success.

Honorable Order of The Blue Goose, International

Blue Goose was founded in 1906 during the Wisconsin Field Men’s Club annual meeting. Today the organization has 3800 members, who they call “Ganders,” across the United States and Canada. The organizations’ headquarters, or “Home Nest,” is still located in Wisconsin, and has 41 chartered regional chapters, or “ponds.” It is a fraternal organization that was formed for any professional in the insurance industry including, insurance executive, adjusters, auditors, underwriters, brokers, regulators, attorneys, and vendors.

The Texas Pond

Linda started her affiliation with Blue Goose in 1995 when she joined the Texas Pond. Since its’ initial chart in 1907, the Texas pond has faced many ups and downs in growth. When Linda accepted a board position in 1999 as Wielder of the Goose Quill the Texas pond was experiencing a decline in membership, along with several other Southern Region ponds. These ponds considered terminating their charters and even merging some of ponds in the southern territory. Taking on the challenge, she claimed “the south would rise again,” and alongside her board members they worked hard to revive membership and attract new interest. Emphasizing flexibility and focusing on the needs and interests of the local insurance community, membership quickly doubled.

The Grand Nest

In 2005, she decided to join the national leadership ranks at the Grand Nest as Keeper of the Golden Goose Egg. For the past decade she has held many national positions within the Grand Nest and traveled all over the USA growing and building fellowship.

When the Grand Nest was experiencing a decline in membership nationally, she once again was steadfast in her resolution to encourage the importance focusing on the interests of the current market of insurance professionals. Stating she simply felt that “insurance was not dying,” but rather growth and evolution while maintaining their founding purpose was necessary.

It is essential to the organization to preserve their core standards nationally but to also allow each pond to be creative in building a flock that fits their territory and flocks prerogative. Consistently taking inventory of the interest of their ponds the organization is able to thrive and engage their ganders.

It is evident that the key to the Blue Gooses’ survival and success has been its resiliency and willingness to evolve.

In her current role as Grand Supervisor of the Flock, she travels across the nation to work with established ponds on budget management, event coordination, and increase membership.

“Linda Meik has been instrumental in growing Blue Goose as a whole and especially the TN Pond. She is our go-to, whenever we have questions about the organization’s procedures and events. She is a driving force to keep the ponds active and relevant. The TN Pond is grateful for her assistance over the years!”Kathy Johnson, MLG TN Pond


Blue Gooses’ founding precepts are “character, fellowship, and charity.” And by no surprise these values seem to be the core to Lindas’ philosophy and approach to professional success.

A graduate of Dakota Wesleyan University, Linda built a successful career in the insurance industry spanning over 30 years, amassing a wealth of industry knowledge and a vast network of resources.

She says often people remark, “you know everyone.” Her explanation? “No. I knew who to call. I got out and I met with people face to face. When I needed help, I had that network. People must reach out and [authentically] network, not market themselves, but to meet them. You would be surprised, people are marvelous and want to help. It is one thing to have a lot of [industry] acquaintances, but if you don’t have friendship and trust, you will not make it to the top of the ladder.”

We discussed the impending shift the insurance workforce will face with the immense amount of baby boomers anticipated to retire from the industry. Her outlook on how we are to bridge the gap is by preparing and mentoring professionals just entering the market place, similar to how Blue Goose was able to thrive. “Young professionals can teach and mentor the old, it’s a two way street.” She feels it is imperative for older professionals to impart their experience, guide the new generation, and also be open new applying fresh ideas from the new workforce.

During our conversation a quote from Dorris Roberts struck me, “She doesn’t give in. She does not give up. And she never takes no for an answer.” I have not had the opportunity to know Linda long, but I firmly believe this is her philosophy for success.

I took many lessons from our brief interview. When you find an organization, whether it be for career or social association, it should inspire purpose and drive you. She reminded me as a young professional in pursuit of achievement, you must be persistent and deliberate, but the most important thing is to be your authentic self and build meaningful relationships—and then success will follow.

Thank you Linda for sharing your insight and experience. Congratulations on your upcoming appointment as “Most Loyal Grand Gander.” We look forward to seeing the impact you will continue to inspire in our industry.


To find out more about Blue Goose or to find a pond near you, visit the organization here!


19th Annual Tennessee Workers’ Compensation Education Conference

Our team will be headed to Nashville to attend the 19th Annual Tennessee Workers’ Compensation Education Conference June 21-23. This year’s conference is titled “Roads to Recovery” and will be held in a new venue at the Embassy Suites Nashville Southeast in Murfreesboro Tennessee.

The three day event will feature relevant topics impacting employers and workers’ compensation professionals from the volunteer state and nationwide. CEU credits for CRC, CDMS, CCM, CLE, and SHRM will be available. Employers, adjusters, self-insurers, TPAs, attorneys, medical and vocational rehabilitation providers are invited to attend.

Two key note speakers will be presenting this year. Dick Beardsley, a former world class athlete and the subject of the feature film “Against the Wind. Carl Van, owner and publisher of Claims Professional Books Online and author of The 8 Characteristics of the Awesome Adjuster. For registry and conference information visit the IWCF here or the TN Department of Labor and Workforce Development here,

Let’s Connect! Interested in coordinating a meeting with one of our team members during the 2016 Tennessee Workers’ Compensation Education conference? Contact us at

Case Study: Auto Liability

Utilization Review and Medical Bill Audit are services predominantly associated with Workers’ Compensation. Often General Liability and Auto carriers are unaware that there are utilization tools available that can help them mitigate and manage bodily injury claims costs.

 “The peer review found [significant] issues with pre-existing and non-accident related [treatment]. Based on the information [provided] in the peer review I was able to negotiate the claim and settle for $325,000.  I used quotes directly from the peer review [and EOB] in my negotiations.” Auto Claims Adjuster

The following case study is a key example of how Review Med’s Peer Review and Liability Bill Audit solutions can be an essential tool for General Liability and Auto carriers and examiners to use to safeguard against assuming liability and paying for unrelated treatment and significant excessive charges.

Policy Limit Demand: $1,000,000

Demand Medical Specials: $282.687.33

Peer Review Determined Unrelated/Unnecessary Charges: $241,883.23

Liability Bill Audit Determined Unusual/Uncustomary Charges: $13,376.23

Review Med Recommended Payment: $40,804.10

Injury: Sub-mandibular hematoma, Right hip pain, chest abrasion, low back and neck pain.Case Background: Claimant was a 29 year old female located in the backseat of the vehicle when the motor vehicle accident occurred.

Pre-Existing Issues: MRI of cervical and lumbar spine showed multilevel disc bulges, disc herniation at the spine, and face hypertrophy. *These were identified as preexisting issues unrelated to the MVA.

Treatment Rendered: Over the course of 9 months the claimant received 47 physical therapy treatments, 14 cervical steroid injections and a facet block.

Peer Review Determination:

Appropriate treatment recommended was supported the evidence-based ODG:

  • 10 physical therapy sessions would have been appropriate.
  • ODG did not support the 14 Cervical steroid injections or facet block rendered

The orthopedic surgeon reviewed the presented medical and determined treatment was excessive and there was a significant lack of evidence for multiple costly procedures. Per the reviewer, the exam was absent of any radicular findings, the series of epidural steroid injections and the facet block were not supported or necessary.

Utilization Review was a vital tool to contain and identify unnecessary and inappropriate treatment in this claim. The application of Peer Review and Medical Bill Audit resulted in the TPA identifying 37 Physician Therapy treatments, 14 cervical Injections, and a facet block, treatment totaling 228,507.00 as unrelated to the auto accident. Using these findings, the TPA was able to settle a UM $1 Million dollar demand for $325,000.1

Determining and isolating what charges are actually related and valid is essential for negotiations and settling claims.

Find out more about Review Med’s Peer Review solutions and how we can help with General Liability and Auto claims.