Last week I took a BARBRI course on Colossus. I am providing you with a short summary of the suggestions that were addressed by this seminar in an effort to increase the value of auto accident claims.
Auto insurance company handling of auto claims employ concepts of deny, delay and defend to frustrate claimants and their attorneys.
Each auto insurance company use different evaluation programs, but most use some variation of Colossus to place value their claims. For example, State Farm, the largest insurer in the world, uses TEACH. State Farm has 12% of the auto insurance business in the USA and 3% of the auto insurance business worldwide.
Vehicle speed, alcohol consumption, hit-and-run are facts act as value drivers, so make sure that you include these factors in your questions to your patients about their auto accident.
Early objective testing like a CT Scan or a MRI are critical to validate and identify musculoskeletal injury. It is preferable that these scans be performed as early as possible.
It is imperative that chiropractic physicians have a medical doctor validate their treatment and diagnosis.
You must use TBI and PTSD Questionnaires. There is no such thing as a mild TBI. This injury does not go away. PTSD should not be listed as being caused by the accident. It is caused by the injuries. 50 % of all auto accidents cause TBI and 68 % cause PTSD. PTSD includes anxiety and depression. Use ACE Questionnaires (Acute Concussion Evaluation) and BIST (Brain Injury Screening Tool which is a 15-item, 6-minute tool for assessing symptom burden, including emotional factors, following traumatic brain injury (TBI) for individuals aged 8+. It features physical, vestibular, cognitive, emotional, and sleep subscales, with revised versions (BIST-2) including queries about traumatic circumstances to identify potential emotional/psychological risks. CT scans and MRIs of the brain 70% of the time do not show any brain injury.
Treatment must be directed to the injury and not to the symptoms. Use not only CPT codes but also use I CD 9 codes. Also the HICF 1500 billing forms rather than itemized bills which are preferred by all variations of Colossus.
CPT (Current Procedural Terminology) codes represent the medical services or procedures performed (“what was done”), while ICD-9 (International Classification of Diseases, 9th Revision) codes indicate the diagnosis or medical necessity (“why it was done”). CPT codes are five-digit numeric codes maintained by the American Medical Association (AMA), and ICD-9 codes are typically three-to-five digit alphanumeric codes (replaced by ICD-10), crucial for billing and tracking.
Passive therapy is performed by the physician and active therapy is performed by the patient Patient should be sent home with exercise and stretching program to do for 3-6 months. Periodically, ask the patient about compliance to their programs.
Avoid the use regional diagnosis such as cervical strain and sprain.
Injuries need to be specified, by identifying the injured muscle, tendon, facet (upper or lower), disc ALL , PCL, cartilage, etc.. Disc injuries in association with muscle, tendon and facet injuries are value drivers. Emphasis should be placed on the fact on the ligament injury is life-long.
Note that left side passengers in a vehicle, because of the seatbelt, will have injuries to their right side of their body. Right side passengers will have injuries to the left side of their body. Drivers will have injuries to their right hip, right knee and ankle due to braking.
Symptoms such as headaches, visual disturbance , TBI, PTSD, spasm, stiffness, restriction of motion radiation of pain, sleep disturbances, specified pain, rib cage injury from seat belt, anxiety depression, TMJ, behavioral changes,( involving spouse and family), grinding and clenching of teeth must all be noted. Not getting all symptoms identified will reduce the value of a claim.
MMI not accepted unless the it is at least a 2 % whole body impairment. Only then will Colossus programs consider loss of enjoyment of life, future treatment and future medical bills as a part of the claim. Future treatment must be validate by a MD. Loss of enjoyment of life includes the ability to study, the ability to perform work activities, domestic activities (household, chores and yard work and cutting grass) and continuation hobbies and, sports. MMI for a body part must be listed as static and not stable. Duties under duress need to be documented.
We all need work together on medical-legal aspects of auto accident claims in the context of AI and computer evaluation programs.
