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MedMetrics®,LLC
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MedMetrics predicts potential claim complexity and cost based on medical diagnoses and assigns a score to the claim representing the seriousness of an injury. Medical diagnoses describe medical conditions. The treating doctor uses ICD-9 codes, a standardized system to describe claimants' injuries and other conditions (1). While many factors can contribute to claim complexity, risk, and cost, a highly significant indicator of claim risk is the severity of the injury. MedMetrics Injury Severity Predictive Score is a proprietary methodology for assigning scores to individual diagnoses portrayed in billing or bill review data. The data are continually updated and monitored to track additions and changes in the diagnostic picture. Total diagnostic scores for a claim are calculated for the accumulated diagnoses and MedMetrics client organization is notified when it exceeds a specified level. Research has demonstrated what many professionals have long known. Comorbidity adds to claim complexity and cost. Comorbidity means the claimant has other medical conditions in addition to the workplace injury defined in a claim. For instance, the claimant might also be diabetic or have a cardiac condition. These conditions can have an exponentially negative effect on recovery. When described by a diagnosis in the data, comorbidity is also considered in MedMetrics severity analysis. Research has also shown that age impacts claim complexity and cost. MedMetrics also factors the claimant's age when calculating a severity score. MedMetrics analysis of hundreds of thousands of claims reveals an important and probably well-known fact: diagnoses in claims tend to accrue and migrate over the course of the claim. Consequently, it is important to score injury severity at claim outset and also continuously throughout the course of a claim. Claims that begin as less severe (Medical Only) often insidiously creep into much more menacing status without notice. MedMetrics addresses this by continuously monitoring the data, scoring and reporting. The medical portion of Workers' Compensation claims now accounts for 60% of claim costs, therefore, medical analytics is critical. MedMetrics develops medical analytic tools designed to recharge existing managed care initiatives. MedMetrics clients benefit by setting reserves more accurately at the outset of a claim, and also adjusting reserves in a timely manner over the course of the claim. Moreover, proactive medical management initiatives are put into place earlier to step ahead of the damage, thereby improving outcomes and saving dollars. Additionally, because diagnostic severity scores are just that, scores describing the claimant's medical condition, they can also be applied to other personal injury situations, such as automotive claims. (1) ICD is the abbreviation widely used for the International Statistical Classification of Diseases and Related Health Problems. ICD-9 refers to the ICD version currently in use. The ICD-10 version will be in required use in October, 2013. |
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