Market Surveys
Horizon CCM conducts survey research and analysis of the market for particular services such as Residential Programs/Facilities, Case Management, Skilled Nursing Facilities, Rehab Centers, Home Care Agencies, Attendant Care Services, Therapies and more!
We will provide you a market survey for a service and service area rates for that service.
Our Market Surveys are done by Nurse Case Managers for insurance companies.
Future Medical Cost Projections
Projecting future medical costs begins with a comprehensive review of medical records. The review should include not just a physician’s examination or discharge notes, but also nurse’s notes, laboratory and diagnostic test results, emergency records, ambulance reports, and physician’s orders.
The expert may or may not need to speak to the disabled individual. That interview is essential when preparing a life care plan but may not be necessary when preparing a future medical cost projection. It may, however, be necessary to interview treatment providers to develop a full understanding of a client’s future medical needs, including members of the therapeutic team who participate in developing the individual’s treatment plan.
After identifying all future treatment needs that are either certain or likely, a medical billing expert researches the cost of meeting those needs. Since costs vary from place to place, experts must consult databases that record the actual costs physicians have charged for the identified services within the client’s zip code. Experts may need to supplement that data with their own research when the database is inadequate.
Medical billing experts use other standardized references, in addition to catalogs and online searches of medical supply companies, to obtain the costs of wheelchairs and other needed medical equipment. Research studies help experts understand the durability of medical products and the frequency with which they will need to be replaced.
Common Categories of Future Medical Expenses
Every case is different. Future medical costs can only be determined by assessing the particular needs of an individual, as those needs are evidenced by medical records, physicians, care providers, and references that define the standard of care for particular disabilities. Depending on the disabled individual’s needs, future medical costs might include:
Cost of monitoring and treatment, including:
- X-rays
- MRIs
- CT scans
- Office visits and examinations
- Psychiatric evaluations
- Neuropsychological testing
- Audiology examinations
- Vision screening
- Swallow studies
- Physical therapy
- Speech therapy
- Home-based medical equipment
Cost of Future Surgeries, including:
- Procedures that a physician knows will be necessary
- Procedures that are likely to be necessary
- Procedures that could become necessary
- Replacement of medical devices due to ordinary wear and tear
- Rehabilitation procedures to recover from surgery
Cost projections for future surgeries include:
- Fees charged by surgeons
- Fees charged by anesthesiologists
- Hospital charges, including medical supplies used during the surgery
- Pre-operative examinations
- Post-operative examinations and treatment
Cost of prosthetic and medical devices, including:
- Artificial limbs (initial cost)
- Wheelchairs (initial cost)
- Replacement cost considering patient’s life expectancy
- Wheelchair accessories
- Specialty bed
- Walkers
- Body support equipment
Cost of future medications, including:
- Pain management medications
- Prescription drugs
- Nonprescription drugs
- Skin care products
Cost of assistants, including
- Case management services
- Home health services
Cost of institutionalized care, including
- Nursing home care
- Assisted living care
This list is illustrative, not comprehensive. Medical billing experts consider costs for all identified services that a disabled individual will likely need in the future when they prepare a medical cost projection
Medical File Review
Medical record reviews are required for medical as well as legal purposes. Accurate review of medical records is important for insurance companies to help them ensure a fair claim settlement in personal injury, medical malpractice and other medical litigation.
Medical Review Services for Insurance Defense Attorneys
Insurance defense attorneys have to work with insurance companies and their insured parties and insurance service organizations to provide comprehensive, efficient, and aggressive litigation services. They may have to deal with cases ranging from pre-suit investigation through the appeals process.
Horizon CCM has years of experience in working with insurance adjusters and defense attorneys. Our medical review team utilizes registered nurses who have the knowledge and insight to analyze the records and find sources of information beyond diagnoses, test results, and prognoses that may prove important to the defense.
We look for:
- Prior patient problems, prior medications, and prior medical conditions that could prove to be a potential defense.
- Contradictions if any, to determine if the details of events given to physicians are at odds with other evidence in your case. These can be used to impeach the witness because it raises questions regarding the credibility of the person testifying.
- Missing information in the records that may prove valuable at some stage or other.
We review the entire medical documentation and prepare medical summaries that will show whether the diagnosis is accurate, and whether the treatment/care given is reasonable or necessary. With specialized expertise in reviewing medical records for insurance defense, and extensive knowledge in medical procedures and terminology, we can prepare an accurate chronology of medical records.
Our Medical File Review for insurance underwriting help insurers calculate insurance premiums accurately.
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