Legal Nurse Consultant
- What is a Medicare
Set-Aside Allocator and what are their key
functions in the submission process of a
Medicare Set-Aside (MSA)?
The
Medicare Set-Aside Allocator is an individual
with advanced training in the area of Medicare
Set-Asides. The ideal allocator has achieved
recognition for this specialized body of
knowledge through the national certification
process. Having passed the national examination,
the MSA Allocator is entitled to use the MSCC
credentials after their name: signifying
Medicare Set-Aside Consultant Certified. The
preparation and submission of the MSA to the
Centers for Medicare and Medicaid Services (CMS)
involves a comprehensive multidisciplinary team
effort that may include the allocator, adjuster,
attorneys, structured settlement brokers and MSA
administrator. The MSA allocator is responsible
for the MSA report which includes the First
Report of Injury, review of medical records,
claims payment histories that include both
medical and pharmaceutical services and when
appropriate a rated age as well as the
individual's life expectancy. The report
includes current and future treatment and the
individual's prognosis. Both Medicare and
non-Medicare related services and costs as well
as medications are included. The report is
submitted to the referral source for completion
of the entire submission process to CMS.
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- What is a Medical Cost
Projection and how can this product be
utilized?
A Medical Cost Projection
(MCP) is a detailed report that identifies the
current and future medical needs, services and
costs for an injured party. In preparing a MCP,
a review of all medical records, medical and
pharmacy billing records and a life expectancy
are utilized. At times, the referral source may
choose to utilize a rated age. Unlike a Life
Care Plan, it does not require onsite visits to
the injured party, letters to the treating
physicians and extensive research and averaging
of medical costs: nor does it require the
preparer to serve as an expert witness to defend
the plan. The MCP may be used to assist the
claims department in establishing reserves,
obtaining settlement authority or it may be used
as a supporting document for attorneys as a
point of negotiation when they expect that the
case will settle out of court.
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- What is a Legal Nurse
Consultant (LNC)?
A Legal Nurse
Consultant is a licensed, registered nurse who
performs a critical analysis of health care
facts and issues and their outcomes for the
legal profession, health care professionals and
others. With a strong education and clinical
background, the LNC is qualified to assess
adherence to standards of health care practice
as it applies to nursing and health care
professions. The scope of practice for the LNC
has been developed from data gathered by the
American Association of Legal Nurse Consultants.
This definition reflects the diveristy of
practice settings and services performed by
LNC's nationwide. In addition, the American
Association of Legal Nurse Consultants has
developed a code of ethics for the profession.
These ethical guidelines affirm the values and
practice of both the American Nurses Association
and the American Bar Association.
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- Why should an attorney or
other agent use a Legal Nurse Consultant (LNC)
to screen a case instead of a Physician
Consultant?
Economics! Screening a
medical malpractice case is far less expensive
to use a LNC than to send the case to a
physician expert witness to review. The fees of
a physician review,in the role of an expert
witness, can range from $300 to $500 or more per
hour. Our fee is substantially lower. We can
identify the four elements necessary to win a
malpractice case. The patient must prove the
following:
1. The provider had a duty to
provide care.
2. Standards of care were not
followed, i.e.,: breach of duty.
3. Deviation
from the standard of care was the direct cause
of the injury to the patient.
4. The patient
suffered some type of injury or damage as a
direct result of the break in the standard of
care.
If the case does not contain all four elements,
then medical malpractice cannot be established.
We can analyze the four elements and advise the
attorney or agent if the case has merit. The
final decision rests with the attorney. This
allows the attorney to focus his time, energy,
and resources on cases that do have merit. This
decreases office time on a case and is a postive
cost savings.
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- What is the difference
and/or similarity in services provided by a
Paralegal and a Legal Nurse Consultant
(LNC)?
Both roles are complimentary
in nature. Legal Nurse Consultants' key funtions
are:
1. Identify standards of care and
deviations in medical management
2.
Recognize medical issues not previously
addressed
3. List potential medical
complicaitons of injuries and possible outcomes
4. Screen case for causation and merit.
The Paralegals' key functions are:
1. Obtain medical records
2. Oganize the
medical records
3. List any missing records
4. Provide summary list of all records
5. Quantify cost associated with an injury
or accident.
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- Do you assist injured
patients who do not have an
attorney?
No. If an injured party has
decided to utilize an attorney, we can assist
the patient in locating an attorney.
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- Why is it important to
have a nurse review and summarize the medical
records rather than a paralegal?
The
nurse is better able to review complex medical
records. The nurse is able to read the doctors'
handwriting, interpret medical terminology and
medical abbreviatons. Significant clinical
information and its implications can be
identified by the nurse. These issues may not be
noticed by a non-medical individual. The LNC has
extensive educational preparation in anatomy,
physiology, pathophysiology and related fields.
This knowledge combined with clinical practice
can readily identify those factors that
contribute to the alleged damages and injuries
sustained by cliets.
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What are
the advantages of utilizing an Independent Nurse
Consultant Company rather than using in-house
personnel?
Some of the benefits include the
following:
1. Developing a long-term
professional relationship with a company who has
access to several nurses with a wide varitety of
clinical backgrounds
2. Receiving a known and
reliable high quality work product
3. Delgating
work activites to the off-site Company to maximize
projects tasks, to meet project deadlines and
maintain a timely revenue flow
4. Generating
consistent billable hours to maintain or increase
revenue to the firm or agency
5. Increased
flexiblity as work loads rise without adding
additonal stff in-house
6. Insuring revenue
generation during unexpected staff vacancies,
recruiting efforts or illnesses
7. Avoiding
benefits and bonus packages.
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How can one find out
about more about your services?
Please see our
Services Page!
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