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Happy National Nurses Day from the Review Med family! We want to express how grateful we are to the workers in scrubs who risk their lives daily in order to care for others. Now more than ever, nurses should be valued and praised for their courage and resilience on the front lines. A special thanks to our nurses at Review Med – you are our heroes!
During this public health crisis, we at Review Med are committed to supporting safety for our clients and employees. This is a time when we all need the support of others and we are here to assist you.
Review Med staff are working remotely to complete peer review, pre-authorization, and bill review with no disruptions to our clients. Keeping in mind the health of our case managers and injured parties, our strong telephonic case management can accomplish case specific goals in a safe and efficient manner.
Please remember that we are open for business and here to help you. Feel free to call on me or your Review Med representative if we can answer any questions or be of assistance.
Mark Parker, M.D.
Case Managers must make impossible choices to manage the complexities of an unstoppable pandemic—and they are working against the clock.
Unless, like me, you are married to or related to a Case Manager, you’ve probably never thought about what they do, yet they are critical to the healthcare system that we all rely on. They reside in the central command center of a crisis. The unrecognized role of Case Managers changes slightly depending on whether they work for a healthcare organization or hospital, long-term care facility, or social service department, but in general, they are responsible for overseeing a patient’s case to ensure the best outcome.
Case Managers, most of them registered nurses and social workers, coordinate with physicians, nurses, mental health and insurance companies, and family and friends of the patient, their client. They receive constant input from stakeholders with vastly different viewpoints, and it’s their job to bring all of that information together to ensure the best interest of their patients is being served. In addition, as part of interdisciplinary teams, professional Case Managers are responsible for tracking outcomes, not only for case management but also for the interventions of the entire team.
Case Managers have a stressful job on the best of days. COVID-19 has made it untenable.
The coronavirus has had an extraordinary impact on their professional and personal lives because we’re dealing with a pandemic that could not only infect patients but also the very system tasked with mitigating the outbreak. Doctors and hospital nurses are often spoken about as being on the frontlines of the coronavirus. I would argue that Case Managers represent another frontline; one that requires them to take incredible risks and make difficult choices every day. And for them, there is no triage.
As I mentioned, my wife is one such person. Due to the unwelcomed, invisible intrusion that is COVID-19, she is now working from home, but with an increased caseload, greater complexity, and more responsibility. And that is on top of adjusting to the reality of being isolated in our home day in and day out. As the world we’re in now calls for social distancing there’s no way for her to distance herself from the call of duty. Things were very different for her when she was able to walk down the hall to speak with a doctor or nurse about something. Now, she is tasked with coordinating people without the benefit of human connection. As many workers in America are finding out, working from home often results in a loss of work-life balance. This is especially true when your job was already taking over your life.
This week alone my wife has been charged with helping cancer patients who are unable to have critical follow-up appointments because oncology offices are closed. A two-year-old asthma patient who was discharged home because his lung doctor’s office is closed. Patients with terminal diseases who came down with coronavirus and, therefore, are unable to see their families when time with them matters most. And patients who are discharged from the hospital after testing for COVID-19 who are being told to self-quarantine but are then unable to get their results.
A lot of patients have become stranded, and even getting critically ill patient-placement has become a challenge. It’s like a scavenger hunt for empty hospital beds! And the virus hasn’t even peaked yet. All of these situations bring tears, confusion, fear, and loss—all of which my wife, and Case Managers like her, are supposed to alleviate from a remote location with little support and in the middle of a system plagued by glitches and breakdowns.
This is ground zero, folks. Case managers are in a battle behind the scenes, huddling daily to plan for the next six months. But mostly these men and women are alone, hunched over computers in trenches of their bedrooms or living rooms, making frantic phone calls, staying focused on the needs of patients even when their families need them, too.
There is no denying that the doctors and nurses you see online sharing photos of their bruised faces after spending hours in protective masks and goggles are heroes. But when those people need the go-ahead to perform surgery or need to know where to send a patient next, they turn to a Case Manager like my wife. She is a hero, too.
If God forbid, you or a loved one ends up in a hospital during this pandemic, utilize your Case Manager, trust your Case Manager, and, please, be kind to your Case Worker. He or she is making a great sacrifice to ensure the best outcome for you.
CEO of Wil Power Integrated Marketing, harnessing the power of word of mouth in the African American market through Urban Beauty Salon/Barber Shop Marketing. View all posts by Wil Shelton
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.