Are you aware that the guidelines for processing private health insurance and Medicare claims differ drastically from personal injury and auto accident claims?
In fact, the data required is so different that you need two different electronic health records. We’ve made it easy for you. We proudly announce our partner program with many EHR Companies to bring you the Zeusclaim personal injury record system to counter Colossus. Now available as an add-on to our partner EHR companies. (See Our EHR PARTNERS on this site)
We and our partners now empower our practitioners who practice in personal injury to collect maximum reimbursement because your documentation meets the auto insurance company’s expectations.
You’ve gone to great lengths to practice with high integrity. You comply with documentation, billing & coding, medical necessity and utilize an electronic health record (EHR) system. This works fine on your private insurance patients, HMO’s, PPO’s and government Center For Medicare service guides. Unfortunately, electronic health record systems are designed for private insurance and Medicare Center For Service Guidelines. Standard record systems do not convey sufficient data to exchange into a personal injury, Colossus claim.
Too often, in a personal injury claim, physicians must defend against adjusters and IME’s who often disagree about:
- The types of injuries
- The degree of impairment
- When clinical findings aren’t obvious
- When injuries are difficult to see with the naked eye
- When low speed impacts do not produce property damage
- When there have been prior accidents or pre-existing conditions
Insurers created the following “Unfair Claims Acts” designed to lower claim valuation and increase their profits:
- Business Process Improvement
- Claim Core Process Redesign
- Dragging the Trauma Severity Line
- Reduced Severity Non-Rate Action Plan
- Benchmark Tuning Bias
Zeusclaim empowers you to prevent unfair claims acts.
The insurance companies hired consultants who created a “procedural intelligence code” system to make settlement valuation based on the following “DECISION POINTS”:
- Decision Points
- Value Drivers
- Case Maximizers
- Prolonged Modifiers
- Injury Severity Points
- Severity Drivers
Additional Increase Multipliers
Point to Dollar Translation Percentage Multipliers
The insurance company’s use a formula to translate “Decision Points” into dollar value based on each insurers own rate. Their “Decision Points” are “intellectual property” and they are not readily available to the public. This results in the physician missing the documentation of the Decision Points and missing “Decision Points” = missing settlement valuation.
How A Colossus P.I. Injury Case Settlement Value Is Determined.
Decision Points Translate Into Settlement Valuation Based On:
The Point To Dollar Translation Percentage Multiplier Formula
When the Decision Points are missing in the medical records, the dollar value that would have been assigned to them is also missing. This allows insurance companies to dispute, deny, delay and defend their decision to cut fees and make unfair, unrealistic settlement valuations.
The physician can not document the Decision Points if he is not aware of them.
That is where Zeusclaim comes in.
Zeusclaim is a specific personal injury medical evaluation EMR exam and soap note system that locates decision points so they will no longer erroneously be omitted from the medical file.
Evaluators often disagree. To offset such varying medical opinions, establish the preponderance of the evidence and win the “Greater Weight” of the Evidence challenges, today’s physician must utilize the “Gold Standards” and “Quality Systems” of assessment as listed below to counter Colossus.
Zeusclaim is a personal injury EMR System you can add-on to your current EHR to evaluate injury claims according to the “Gold Standards” and “Quality Systems” of assessment as:
- AMA Guidelines (5th & 6th Editions)
- Injury Model
- Diagnostic Related Estimates Of Injury
- Diagnostic Based Injuries
- Specific Disorders Of the Spine
- Spine Impairment Summary
- Abbreviated Injury Scale
- Quality Systems Of Control
To win the “Great Weight” of the evidence challenges, the medical documentation must meet court approved evidentiary “burdens of proof” to establish that “soft tissue” injuries meet “serious injury thresholds” and utilize the above “Gold Standards” in the Electronic Medical Record documentation.
Exchanging data into a Colossus claim is virtually impossible to do without a personal injury specific EMR System designed exclusively for this purpose. Zeusclaim provides this and is available through our partners as an add-on to your EHR system.
Zeusclaim Personal Injury Specific EMR System Is Now Available Through Our Partner Program
Zeusclaim personal injury EMR software can counter the insurance companies’ software’s to ensure the physician documents according to these Gold Standards and includes the missing decision points to enhance settlement valuation, prevent IME cut offs and eliminate varying medical opinions.
We host live webinars weekly and have a series of “on-line” training videos and “Quick-Start” manual to demonstrate how Zeusclaim documents the medical Decision Points that are missing in a private insurer, Center For Medicare Service center based system.
Interested physicians may contact us for more information, including a screen share to see the Zeusclaim personal injury EMR System in a live demo.
Zeusclaim is partnering with many EHR Companies to make this add-on available and affordable. (See Our EHR Partner Section on this site).