August 2010

As a Certified Legal Nurse Consultant, I focus on helping hospitals reduce Medicare denials and win more Medicare Part A appeals. My photo and short bio on my websites generate four to five calls from hospital attorneys each month.

Hospitals want to be paid and I’ve learned that the first level of preventing Medicare denials is the assessment of the patient and the physician’s documentation of medical necessity. It’s usually the lack of this information that triggers a Medicare denial of payment.

The first rule to get the physicians to buy into what you are trying to teach them is to feed them. So, I contact the hospital administrators in question and explain that I have a plan that will help them reduce Medicare denials and change their doctors’ bad documentation habits. If lunch is not within the facility’s budget, then I work with ancillary vendors who might want to participate and provide lunch.

I use exhibit posters and flip charts to present during lunch (provided by the hospital). I also use a dry-marker board and include actual excerpts from Medicare’s denial documents. The exhibits show what was missing and how to correct it. My program includes hand-outs with the information from the posters, dry board and flip charts.

This educational approach usually works and I receive calls from physicians with questions for some time after each event. The marketing benefit is that people from different hospitals talk to one another, which often generates calls from other facilities wanting presentations and I get more clients.

My marketing strategies include:

• Bulletin board teasers with movie ad-like messages: “For Doctors: Coming soon to your hospital…” posted a couple weeks before the presentation.
• Hand-outs placed in facility mail boxes at least two weeks ahead of time.
• Posters on stands just inside the entrance to the presentation room at least 30 minutes before start time.
• Enlargements focused only on the most important pieces of Medicare rules on the subject that affects physicians.

One of the most rewarding experiences occurred while I was auditing a telephone conference regarding Medicare appeals with corporate attorneys for two of my hospital-clients. One hospital administrator on the call wondered why two facilities seemed to be doing much better than the others in overturning denials. The attorney explained, “That’s because they have a Camy,” as though I were a product brand name.

Another time a different hospital-client armed with the education and hand-outs I provided, was able to make enough immediate and lasting changes that they, effectively, stopped their denials cold. Most hospitals make changes slowly and with a lot of kicking and screaming. This hospital’s collective, firm resolve made the changes using the education they paid me to give them – and won big!

Medicare is my specialty and marketing, as I learned from Vickie Milazzo, is what sells my CLNC^® services.

Guest Blogger Profile

Camy Joyner, RN, BSN, CCM, CLNC, CEO and co-owner of C. Joyner and Associates, LLC. Consults/manages Medicare Part A appeals for acute general rehabilitation hospitals. Consults for records review/audit for physician medical pertinence. Also consults in non-Medicare negligence cases.

Some time ago I blogged about privacy concerns for legal nurse consultants and using a frameless privacy filter on your CLNC^® business’s laptop screen. A privacy filter keeps people (like your spouse or some other nefarious villian) from looking over your shoulder while you’re working (or not) and seeing what you’re working on (or not). I spend a lot of time on airplanes and am amazed at the things I see on people’s computer screens, things that make me blush!

I’ve noticed that more and more people use iPhones^®, BlackBerrys^®, Droids^® and other phones to view video, html email, etc. Studies show people spend more time texting and emailing from their cell phones than they do talking. The result? Now, while I’m waiting in the checkout line at Walmart^®, I can often see what a person is doing on their phone and sometimes even read what’s on the screen! 3M^®, maker of the nifty privacy filters for computers, now makes a Mobile Privacy Film for Blackberry and iPhone phones.

Yes Virginia, I did say iPhone phones. Because of the amazing ability of the iPhone to display on either a vertical or widescreen frame, you’ll actually need two different Mobile Privacy Films! Using your iPhone as a phone (and who really does?) requires a phone film and using your iPhone in horizontal mode, requires a different film.

As your ace tech tipper, my advice for Certified Legal Nurse Consultant iPhone users is fuhgeddaboudit! CLNC^® consultants using a BlackBerry, could give one of these filters a try, or, keep your money and just check your immediate area for rapscallions, miscreants and other blackguards (like insurance defense attorneys) before you use your phone, then use it discreetly.

Keep on techin’ (under cover),

Tom

Screening medical-related cases is one of the most important legal nurse consulting services you will provide as a Certified Legal Nurse Consultant. Not only is it one of my favorite CLNC^® services but it is the first CLNC^® service you usually provide for new attorney-clients. Do it well and the attorneys keep coming back for more. Here are 16 screening strategies to keep your attorney-clients coming.

Stay Focused on the Essentials

1. Give the attorney an objective, candid and honest opinion without regard for what you think the attorney wants to hear. Put aside interests in personal gain (e.g., more billable hours) and focus only on what is ultimately best for the attorney, the client and the case.
2. Discuss the issues and theme of the case with the attorney-client and ascertain the date of the incident (when known) to help you focus quickly on the important events. If the case has been filed, request a copy of the complaint or petition. You will screen many cases in which the attorney knows little about the facts and has formed no opinion. If the attorney does have an opinion and you believe he is focusing on the wrong issues or your opinion is different, be sure to communicate your reasoning right away.
3. If you do not have time to do the screening as soon as you receive the case, at least read the cover letter and scan the medical records. This helps you to establish deadlines, determine the basic issues of the case and assure you have all the necessary records. If relevant records are missing, inform your attorney-client immediately.
4. Scan all relevant medical records and, where appropriate, note important observations and opinions. Avoid excessive writing at the screening stage, especially if you haven’t yet identified the essential issues and themes of the case. Your goal at the screening stage is to be efficient, and until you’ve reviewed all relevant records and identified key issues, it is very easy to go down unnecessary rabbit trails.
5. Use the screening form to track all possible defendants, types of experts needed, additional documents needed and recommended research. When you give your screening opinion to the attorney, you can incorporate some of these into recommendations for the next indicated steps.
6. Screening a case is similar to reading a mystery novel. You may even be surprised by the outcome because the focus may shift from something obvious, like a patient fall, to a less obvious issue, such as medication administration or safety policies and procedures. As new and more relevant issues arise, determine their significance and how they impact the essence of the case.
7. Do not overlook the obvious by overanalyzing the records. Likewise do not assume that the issues will automatically jump out at you. If you become overwhelmed by the task at hand or the volume of medical records, walk away for a while, or a day or two, then come back fresh and start again.
8. Do not assume the case has no merit simply because a physician reviewed the records and found no merit. Physicians tend to limit their reviews to doctors’ records and in so doing, they often miss vital information. For example, many MD experts do not review the nursing records and often it’s the nursing notes that shed the most light on what really happened to the patient. Always review the records completely and look for discrepancies in documentation by different providers.
9. If you were hired by the plaintiff attorney, look at the case from the defendant’s viewpoint. (What are the defenses or rationales in this case?) If you were hired by the defense attorney, look at the case from the plaintiff’s viewpoint. (What went wrong, if anything? Could anything have been done differently? Were any standards of care or practice guidelines breached?)

Efficiency Saves You Time and Saves Your Client Money

10. Don’t organize the medical records before you screen and you will save valuable time in the initial review process. If organizing the records is necessary before screening, do not organize them for comprehensive review and analysis, but organize only with the objective of making screening easier.
11. Do not do a formal report during the screening stage – just complete the screening form to facilitate communicating your opinion clearly and concisely. More comprehensive reports are only indicated once you have communicated your screening opinion and both you and the attorney agree that a comprehensive review and analysis of the medical records is indicated.
12. Access relevant healthcare references as needed while you are reviewing but don’t overdo it at this stage. Unless you need some piece of information before you can move on, make a list of topics to search on the Internet and do all your searching at once. This will keep you focused as you read through the record. Narrow your searches to match the factors in your particular case (e.g., octogenarian, female, femur fracture, mortality). Be sure to research any articles and publications authored by all the relevant players in the case.
13. Consider subcontracting the screening if the issues are outside your area of expertise. Make the decision to subcontract quickly, then act on it. Don’t wait until you need a CLNC^® subcontractor to try to find one. Develop a pool of CLNC^® subcontractors who are ready to respond to your needs. All successful CLNC^® consultants know what they don’t know and wisely tap the expertise of their peers.
14. Use a magnifying glass (buy the best one you can afford) so you can read those little squiggles and impress the attorney with your knowledge of hieroglyphics. You may determine the outcome of the case by being able to decipher something illegible to the average eye.
15. Keep a calendar of the year in question close by. Look for weekends and holidays when short staffing is common.
16. Pay particular attention when operative notes, admission history and physicals, discharge summaries and autopsy reports are dictated and transcribed. If an unusually long period of time elapsed between the event and the transcription, note that for future consideration.

Use these 16 strategies to make screening medical-related cases one of your most popular and satisfying CLNC^® services. Keep your attorney-clients coming back for more.

Success Is Inside!

While I was pursuing my nursing degree in the late 90s, I was also working on my Spanish degree. Being from North Dakota where few people speak Spanish, Hispanic friends and colleagues often ask me how in the world I learned Spanish. I tell them I just fell in love with the language when I started taking Spanish in the 7th grade. I received my Spanish degree in 1998 and have been speaking Spanish since then.

I remembered what Vickie taught me in the CLNC^® Certification Program about using my unique selling position (USP). So, I started including the phrase, “I also have a degree in Spanish” in emails to attorney-prospects and paralegals. In one email to an attorney-prospect, I briefly told her about the services I offer as a Certified Legal Nurse Consultant and mentioned that I have a Spanish degree. A couple of weeks later, I received an email from a paralegal at that law firm asking if I could attend an independent medical examination (IME) for his Spanish speaking client. Two months later, I received a voicemail from another paralegal at the same law firm requesting my services at an IME for a different Hispanic client and a different attorney.

Each CLNC^® consultant brings something unique to the table. Like Vickie says, we are in the business of marketing. After attending both IMEs, I realized that I always need to market my USP of speaking Spanish. Marketing your USP will save a lot of time and energy. I kick myself now for not using my USP the first day I began marketing to attorneys.

Maybe your USP is speaking another language. Maybe it’s the fact that you have 25 years of nursing experience and you’ve worked in every area of the hospital. Maybe your nursing specialty is forensics. Whatever it is, every Certified Legal Nurse Consultant has a USP. The question is, are you marketing your USP to attorneys?

Guest Blogger Profile

Brian Brandser, RN, BSN, CCRN, CLNC assists attorneys with personal injury and medical malpractice cases. Brian also serves as clinical coordinator in a critical care unit at a Washington state hospital. Brian has a Spanish degree and lives with his wife and two boys.

I’ve been working with and around Certified Legal Nurse Consultants for a long time and one of the things I’ve learned is that nurses are generally germ-o-phobics. Vickie tells me nurses don’t sit on toilets – they squat. I’ve seen nurses walk out of restrooms with their hands mummy-wrapped in paper towels so that they don’t have to touch the door handle. All CLNC^® consultants know that there are a lot of scary germs out there and they do their best to avoid the obvious ones.

But, here’s something I’ll bet you didn’t know. According to a study by Dr. Charles Gerba from the University of Arizona, there are more germs on your cell phone than on a toilet seat. Healthcare workers’ cell phones carry more germs than those that belong to us mere tech-types. (We have our own issues with dirty keyboards and mice.) Now, not too many of you will walk or drive around town talking to your attorney-clients with a toilet seat pressed to your ear but you’re doing much worse when you talk to them using your cell phone. I suppose a wireless headset might keep the germs at a distance but you’re still transmitting them back and forth every time you handle your phone. The good news is that as long as you only use your own phone, whether it’s for your legal nurse consulting business or anything else, you’re probably not at too much risk (unless you’re in healthcare).

For the real germ-o-phobes, instead of wiping down your phone every time you unholster it, consider purchasing a “skin” for your phone from iSkin. They make a variety of products for iPhones^®, BlackBerries^® and more that contain Microban^® antimicrobial protection. This won’t be a fail-safe, but at least it will make your cell phone a little safer (unless you drop it into the toilet). Check them out for yourself!

Keep on techin’ (germ-free),

Tom