ANS Solutions Medical Cost Projection Program

Unlike typical file reviews, an ANS Medical Cost Projection evaluates potential areas of exposure along with avenues of savings, and provides a comprehensive medical action plan.

The ANS approach to Medical Cost Projection starts by matching the complexities of each case to the relevant expert knowledge and experience of a highly credentialed RN from our national network. Our findings are independently researched utilizing expert sources of medical and cost data. This high level expertise allows us the advantage of providing specific recommendations that no one else would consider that achieve improved quality of life and financial savings.

A unique characteristic of ANS’s Medical Cost Projection are two key components and the “plug and play” manner in which these components can be used by the carrier:
  • Potential areas of exposure include reasonable and probable complications that the injured workers may experience based in the overall medical picture with the anticipated costs included. For example, a claimant had an injury for which three surgeries have been performed. There’s no mention of a Total Knee Replacement, but based on the available data (age, the surgeries, co-morbidities, other treatment, how they reacted to the surgeries and treatment) it is not unreasonable to assume that the individual may need a Total Knee Replacement at some point in their life expectancy.
  • Potential savings can come from any part of the projection and because we analyze every aspect of case all savings are identified. This includes strategic areas where a carrier can enact changes that will reduce costs. For example, a claimant is being drug tested every month at $1,200 per test. A recommendation would be to switch to a random drug testing system which involved only 2 to 3 drug tests per year. This modification is still as effective as the monthly drug screens but saves $10,800 per year.
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Medical Cost Projection Programs Optimize Workers’ Compensation Claim Settlements

ANS Solutions Medical Cost Projection Program provides an individually customized and accurate analysis of the medical needs of the injured worker over their anticipated life expectancy. Our Medical Cost Projection professionals take into account the accident or injuries, prior medical history, treatment, co-morbidities, age health status, life expectancy and other pertinent factors. Compiled by a highly credentialed RN, the unbiased independent medical record review:

  • Identifies all future medical treatment for the claim based on payment detail.
  • Identifies costs for expected medical treatment for the claim.
  • Provides supporting medical documentation for ECS development.
  • Separates work injury and non-work injury related diagnoses and costs.
  • Identifies other intervening injuries and is used as a tool for determining appropriate care.

This expert analysis yields reliable evidence-based recommendations to positively manage the medical portion of the claim and achieve the best possible outcome from a cost and quality of care perspective.

Benefits of ANS Solutions Medical Cost Projection Services

  • Detailed projection of lifetime medical costs for settlement or reserving purposes.
  • Provide analysis and actionable recommendations for high cost drivers.
  • Ability to accurately set reserves for life of the claim.
  • Appropriate case settlement based on research and analysis of valid and reliable health care cost data.
  • Assists in evaluating any case with uncertain future medical care needs.
  • Customizeable reports with information provided in a clear, easy-to-understand format.

ANS Medical Cost Containment Strategies

In addition to medical cost projection, ANS provides a suite of complementary services that allow payers to align other elements relating to the quality of life and care of the injured worker with improved  financial outcomes.

These services include:

  1. Drug utilization review through Pharmacotherapy
  2. Legal Nurse Consulting Services
  3. Reducing Medicare Set Aside & Part D Exposure

To speak to a representative about any of these programs, call us today!