Specialty Services

The following categories highlight our ability to work collaboratively and effectively with various stakeholders. While we are emphasizing our non-clinical administrative services below, our scope of expertise does go well beyond those listed.

Life care Plan

Coordination of Medicare Benefits

Life care planning involves coordinating various aspects of care and services for individuals who have experienced catastrophic injuries or have chronic health conditions. Coordination of Medicare benefits is a crucial part of this process, ensuring that the individual receives the necessary medical services and supports covered by Medicare. 

Here are some services that fall under the coordination of Medicare benefits in a life care plan

  1. Medical Services: Coordinating with healthcare providers to ensure that the individual receives necessary medical treatments, surgeries, therapies, and medications covered by Medicare.
  2. Durable Medical Equipment (DME): Coordinating the purchase, delivery, and maintenance of DME such as wheelchairs, hospital beds, and oxygen equipment covered by Medicare.
  3. Home Health Care: Arranging for home health aides, skilled nursing services, physical therapy, and other home-based medical services covered by Medicare.
  1. Transportation: Coordinating transportation services to and from medical appointments, which may be covered by Medicare if medically necessary.
  2. Medicare Advantage Plans: Assisting the individual in understanding and selecting Medicare Advantage plans that may offer additional benefits beyond traditional Medicare.
  3. Medicare Part D Prescription Drug Coverage: Coordinating with pharmacies and healthcare providers to ensure the individual has access to necessary medications covered by Medicare Part D.
  1. Medicare Appeals and Grievances: Assisting the individual in navigating the Medicare appeals process if there are issues with coverage or services.
  2. Coordination with Other Insurances: Coordinating benefits with other insurance policies the individual may have, such as private health insurance or Medicaid, to maximize coverage and minimize out-of-pocket costs.
  3. Healthcare Advocacy: Serving as an advocate for the individual to ensure they receive appropriate and timely healthcare services covered by Medicare.
  4. Education and Counseling: Providing education and counseling to the individual and their family members about Medicare coverage, benefits, and options.
  5. Coordination with Legal and Financial Professionals: Collaborating with legal and financial professionals to address any legal or financial issues related to Medicare coverage and benefits.

Overall, the coordination of Medicare benefits in a life care plan aims to ensure that the individual receives comprehensive and coordinated care that meets their medical, physical, and emotional needs while maximizing their quality of life.

Medical Set Aside (MSA) Administrative Coordination and Support Services

When administering a Medical Set Aside (MSA) for claimants, there are several supportive services that can be provided to ensure effective coordination and management. Here are some key services:

  1. **Medical Case Management:** Coordinating medical care and treatment for the claimant, including scheduling appointments, arranging transportation, and ensuring compliance with treatment plans.
  1. **Medication Management:** Monitoring and managing prescription medications, including refills, dosage adjustments, and interactions.
  2. **Provider Network Development:** Establishing a network of healthcare providers to ensure access to quality care for the claimant.
  3. **Utilization Review:** Evaluating the medical necessity and appropriateness of treatment plans and services to ensure cost-effective care.
  4. **Medical Bill Review and Payment:** Reviewing medical bills for accuracy and compliance with fee schedules, negotiating discounts, and processing payments.
  1. **Medical Records Management:** Organizing and maintaining medical records, including collecting, storing, and retrieving records as needed.
  2. **Vocational Rehabilitation:** Assisting claimants in returning to work through vocational assessments, job training, and placement services.
  3. **Legal Support:** Providing legal guidance and support related to the administration of the MSA, including compliance with Medicare requirements and regulations.
  4. **Financial Management:** Managing funds allocated for the MSA, including tracking expenses, preparing financial reports, and ensuring compliance with accounting practices.
  5. **Coordination with Medicare:** Communicating with Medicare to ensure compliance with reporting requirements and coordination of benefits.

These services can help streamline the administration of an MSA and ensure that claimants receive the necessary care and support to manage their medical needs effectively.

Coordination of Insurance Services

Medicare MSP (Medicare Secondary Payer) refers to the process of ensuring that Medicare is not the primary payer for healthcare services when another insurance plan should be responsible. The Medicare Secondary Payer program requires certain group health plans, liability insurance, no-fault insurance, and workers’ compensation plans to pay claims before Medicare pays.

MSP Coordination of Insurance services typically involve identifying when another insurance plan is primary, coordinating benefits between Medicare and the primary payer, and ensuring that Medicare pays only what it is legally responsible for. This process helps prevent Medicare from overpaying for services and helps individuals maximize their healthcare benefits.

Collaborative Case Management

  • Working hand in hand with Nurse Case Management Assigned Individual.Β 
  • Working in harmony with other healthcare professionals in a collaborative environment.

Non-Clinical Interface

  • Non-clinical expertise in case management.
  • Ability to interface with self-insured staff, case managers, licensed professionals, and claimants.

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