Click on the service below for more information.
When questions arise regarding an injury, diagnosis, level of impairment or appropriateness of medical treatment, peer reviews are comprehensive reports based on available medical records. Medical Equation’s independent board-certified specialists review and address issues and questions using the most current evidence-based medical rationale including Official Disability Guidelines, MDGuidelines and current literature. Peer reviews are valuable tools in helping adjusters determine a reasonable course of action for medical claims.
An independent rating review (IRR) is an independent review of impairment ratings from any state to ensure the rating meets standards set forth in either the 3rd, 4th, 5th and 6th editions of the AMA Guides to the Evaluation of Permanent Impairment, the statute, the rules, and any applicable appeals panel decisions. These reports assist the adjuster in meeting the Texas Department of Insurance mandated timeframes.
Board-certified specialists conduct Required Medical Examinations (RME) to the same high standards that control the Designated Doctor examinations. Assessments are clear, concise and accurate. Impairment ratings are conducted under the provisions of the 4th, 5th, and 6th Edition AMA Guides to the Evaluation of Permanent Impairment.
The ECA is a great tool utilized early in the claim. It reviews the mechanism of injury; the findings at the time of the first examination, and assesses what is, and what is not part of the compensable injury.
CFA provides a comprehensive medical record review; listing all disputes (per PLN-11), a full medical time line, return to work history (per DWC 73), previous DDE’s and RME’s, and a list of references including the ODG, MDA and Impairment guides.
Medical records are placed in chronological order and summarized in accordance with selected goal oriented questions. The records and CFA are provided to the Designated Doctor in a prompt and efficient manner. As noted in the rule, 127.10, the designated doctor is required to read the summary, which ensures accuracy in the final report.
Medical Equation, Inc. will complete the DWC 32, Request for Designated Doctor Exam, along with all administrative functions associated with the exam. Medical records are placed in chronological order and provided to the chosen doctor in a prompt and efficient manner. Our process includes re-scheduling and re-designations, if necessary, at no extra charge.
This service is a direct support to your pre-authorization system. This timely review determines medical necessity based on the clinical documentation provided. If the determination is adverse, then our Board Certified Specialists makes every effort to contact the treating provider giving them a reasonable opportunity to discuss the requested service. Pre-Authorization is also used to identify members for case management or disease management programs.
Pre-authorization addresses medical necessity only and does not guarantee payment. It is not a treatment recommendation or a guarantee that your patient will be insured or eligible for benefits when services are performed. The pre-authorization process is not complete until patient benefits and eligibility have been verified.
EMG/NCV test results are reviewed by a Board Certified Electromyographer, each with over 25 years of experience, to insure that the assessment made is consistent with the raw data obtained or presented by the reporting clinician. We highly recommend that you obtain an EMG/NCV review on all of your abnormal electrodiagnostic reports as, in our experience, many EMG/NCV interpretations have been found to be incorrect, leading to misdiagnosis.
Medical Equation, Inc. has physicians that are certified as Designated Doctors by TDI-DWC. The physicians would provide a consultative report comparing the Designated Doctor’s recommendations with the statute, rules, ODG, MDGuidelines and the AMA Guides. This independent review is performed by a Board Certified Specialist who is fully licensed in the state of Texas in accordance with HB 1003 regulations. This comprehensive review will provide well thought out opinions based on the medical documentation presented for review and will help resolve issues related to certification of MMI, degree of permanent impairment, extent of injury, and return-to-work.
Medical Equation bill review analysts are highly experienced and knowledgeable about medical billing, CPT coding, ICD-9 and ICD-10, along with having expertise in proper documentation for provided services. Medical Equation can recommend fair and reasonable value ranges for diagnostic testing, hospitalization, trauma fees, surgery, implants and other procedures for medical services. Bill review services include coding, clinical and documentation reviews. Services ensure adherence to each state’s regulatory requirements and recommendations for defensible reductions. Medical Equation also provides coordination between a peer review report for extent of injury and a bill review for charges casually linked to the injury. Medical Equation reviews use current, evidence-based medicine, allowing the client to make informed, equitable payment decisions regarding medical expenses.
Letter of Clarification on a prior 32 Processing with Summary as completed by Medical Equation, Inc. or a prior 32 Processing with Summary that was not completed by Medical Equation, Inc.
A comprehensive Physician Peer Review narrative report, answering questions regarding treatment and prescriptions. In addition, this report has the added benefit of doctor to doctor communications; a doctor to doctor telephone call regarding the prescriptions.
File Reviews of the highest level with issued reports that provide a concise and final answer regarding initial rulings regarding treatment authorization.
We coordinate all aspects of scheduling an examination with a Board-certified specialist fitting the injury and location of the employee. Medical records are placed in chronological order and provided to the chosen doctor in a prompt and efficient manner.
We coordinate all aspects of scheduling the examination with a Board-certified specialist who conducts a Required Medical Examinations (RME) or Post-Designated Doctor Examination (Post-DD) to the same high standards that control the Designated Doctor examinations. Medical records are placed in chronological order and provided to the chosen doctor in a prompt and efficient manner.
Board-certified specialists conduct Independent Medical Examinations (IME) to the same high standards that control the Designated Doctor examinations. Assessments are clear, concise and accurate.
The goal of medical case management and medical bill review is coordination of medical service provision with cost containment in mind. Through the provision of medical case management services, we make decisions regarding the frequency and duration of medical treatment, with appropriateness of care and medical necessity as driving forces. These decisions are made with the assistance of industry accepted medical treatment criteria and state guidelines. Medical Case Management services are delivered through field case managers, however often can effectively be provided telephonically. Nurse Case Managers share the goal of cost containment and will work within account guidelines and provide recommendations of what delivery method is necessary to reach optimum recovery through appropriate care. Services include Task Based, Catastrophic, Telephonic and Field Case Management.
Board-certified specialists provide expert witness services in a court of law or contested case hearing (CCH) with the purpose of defending a report or examination previously conducted.
*We have physicians that are certified as DESIGNATED DOCTORS by TDI-DWC.