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Wednesday, June 26, 2013
Julia Harper RN, CCM  
Nurse Case Manager 
Julia graduated Cum Laude with a Degree in Nursing from John A. Logan College in Carterville, Illinois. She is a Certified Case Manager working in the field of Workers' Compensation in the Carbondale, Southern Illinois, and the Cape Girardeau, Missouri areas for many years.  Julia has experience as a Case Manager for numerous, large Medical Case Management companies, as well as serving as Case Manager for post-acute Head Injury patients in a rehabilitation facility.  Her Nursing background includes working as a Clinical Level 3 Nurse in a large hospital environment, with a background in high risk Labor and Delivery, Neonatal Intensive Care, as a Neonatal Transport Nurse, and in Medical-Surgical.  Julia is licensed in both Missouri and Illinois.  
Give Julia a call at 618-713-4939. She´ll be more than happy to assist you with any of your case management needs in Southern Illinois. 

Jill Pessman RN, MSA recently managed several Utilization Reviews. In one case, the injured worker (IW), a carpenter, reported having had discomfort, numbness and tingling in both hands for more than a year. The IW related that the cause of his ailment is the repetitive motion at work. The pain also bothers him at night, producing hand weakness and causing him to  frequently drop objects. 
An Electromyogram (EMG) revealed mild right median mononeuropathy at the wrist, and mild right ulnar mononeuropathy at the elbow.
The physician noted positive findings for right carpal tunnel syndrome. The injured worker felt that the left carpal tunnel condition is more symptomatic than the right. The physician recommended bilateral endoscopic carpal tunnel release.
Despite complaints of discomfort, numbness, and tingling in both hands, Jill found a lack of sufficient documentation of positive objective findings and deficiencies to support the necessity for surgery. The EMG and Nerve Conduction Study provided no evidence of left carpal tunnel syndrome. Furthermore, there was no indication that the claimant tried adequate conservative treatment including steroid injection, exercise, and night splints for the carpal tunnel syndrome.
Without documentation of positive physical findings suggestive of carpal tunnel syndrome and absence of conservative treatment, Jill concluded that the proposed surgery was not necessary.
Requested Treatments: Bilateral carpal tunnel release
Determinations: Bilateral carpal tunnel release

Cost savings: Surgery $8,450.00, therapy $1,150.00
Total savings: $9,600.00

Contact Jill at 815-772-8375 or Jill.Pessman@triunehg.com.
Let her help YOU save money too! 
Tuesday, June 25, 2013

Thousands of Dollars Saved!

A Utilization Review Success Story

In another of Jill Pessman's recent Utilization Reviews, an injured worker (IW) complained of low back and hip pain and recently reported increased pain even during normal activities. The IW had difficulties getting to the chiropractic office for treatment and remained off work.

The Official Disability Guidelines for Treatment in Workers Comp supports up to a maximum of 10 chiropractic treatments for the hip/pelvis and allows up to 18 chiropractic treatments with documentation of objective functional improvements for the lumbar spine.

With the symptoms present, a course of six chiropractic treatments was reasonable. The chiropractic notes, however, did not reveal objective or functional improvement with treatment. 

Without a history of positive results, the medical necessity for additional treatment was not established.  Jill's conclusion was to recommend partial certification for six chiropractic visits, and avoid the unnecessary cost of further treatment. 

Requested Treatment: 22 chiropractic visits, MRI left hip without contrast, MRI lumbar spine without contrast
Determinations: Partial-certification: Six chiropractic visits, Non-certification: MRI left hip without contrast, Non-certification: MRI lumbar spine without contrast
Cost savings: Chiropractic treatment-$4,620, MRI's 1,100.
Total savings: $5,720.

Interested in saving money too? 

Please contact Jill Pessman at 815-772-8375 or Jill.Pessman@triunehg.com
Saving Money with Utilization Review!
Another Success Story

The Injured worker (IW) in question had a restricted range of motion in his neck, thoracic, and lumbar spine. Jill Pessman was asked to complete a Utilization Review for 38 chiropractic visits which took place almost three years ago.

The Official Disability Guidelines for Treatment in Workers Comp states that manual therapy and manipulation are recommended for chronic pain if caused by musculoskeletal conditions, and manipulation is specifically recommended as an option for the low back and neck. A trial of 6 visits over 2 weeks, with evidence of objective functional improvement, with a total of up to 18 visits over 6-8 weeks is allowed. 

In the case of this IW, there was no clear evidence of objective functional gains that would justify treatment beyond the initial 6 visits. The medical necessity for further treatment  was not established according to documentation and evidence-based guidelines. Jill recommended a partial certification for 6 chiropractic treatments only, for a cost savings of $6,720. 
  
Requested Treatment: Chiropractic treatment, total of 38 visits.

Determination: Partial certification: Chiropractic treatment, total of 6 visits.

Cost savings: $6,720.00

Interested in saving money too? 
Please contact Jill Pessman at 815-772-8375 or Jill.Pessman@triunehg.com.
Olivia Davison LPN
Nurse Case Manager 

Olivia received her nursing degree from Triton College in River Grove, Illinois.  She has had many years' experience in Medical Case Management and Workers' Compensation injuries for Managed Care companies and in Occupational Medicine Nursing for a large national corporation.  Olivia has extensive experience in both field case and telephonic case management.  Her hospital-based nursing background is in Operating Room Nursing working in Recovery and Triage.  Olivia has also worked as a Staff Nurse in Wound Care and has experience as a Supervisor in an Alzheimer's Unit.  Her work with Workers' Compensation case management coordinating care with medical providers, employers, and the injured worker has resulted in positive, appropriate, and timely return-to-work outcomes.  Olivia is fluent in both English and Spanish.
  
Give Olivia a call at 708 990 7688. She´ll be more than happy to assist you with any of your case management needs in the Chicagoland area. 

CoraLeah VandenAvond RN, BSN
Nurse Case Manager 

CoraLeah graduated from the University of Wisconsin, Green Bay, with a Bachelor of Science Degree in Nursing.  Her background includes hospital-based Nursing in a large hospital environment where she provided direct Medical and Rehabilitative care and served as mentor to the licensed and certified staff.  CoraLeah also has experience working as a Private Nurse providing Critical Care nursing to a patient while traveling.   Her background abroad was as a Registered Nurse for a large employer implementing care for work injuries, on-site accidents, and emergency care situations.  CoraLeah is CPR certified and licensed in the State of Wisconsin.  She is fluent in both English and Spanish. 

Give CoraLeah a call at 630 586 9440. She´ll be more than happy to assist you with any of your case management needs in the Green Bay area.  



A Medical Case Management cost savings success story.

TRIUNE Health Group's Nurse Case Manager, Michael Sharp RN, recently adeptly and efficiently brought a case to closure, ensuring the well-being of the Injured Worker (IW) but also skillfully avoiding unnecessary costs. 

Michael Sharp received this referral for nurse case management services on March 1, 2013. The IW was treating with her family practice physician for a diagnosis of a closed head injury/concussion. Before her injury she was employed as a registered nurse.

Prior to this time, the treatment plan did not identify a clear plan towards the goal of Maximum Medical Improvement(MMI). Michael Sharp's knowledge of practicing physicians in Iowa was instrumental in obtaining treatment with a qualified specialist knowledgeable in Worker's Compensation injuries.  

On March 29, the injured workers medical records were reviewed by the specialist and a full unrestricted RTW and MMI was obtained along with a no-impairment rating.  Case Closed.   
 
Let us help you manage your next Workers' Compensation file and experience the TRIUNE Health Group difference! 


Give Michael a call at 630 586 9440 or send him an email: michael.sharp@triunehg.com