Future Medical Cost Projections Module 12 Worksheet, with handout Hi. Welcome to Module 12 of the InSitu Academy training program for Future Medical Cost Projection. My name is Kathryn and I will be guiding you through the training program. In Module 12 we will discuss how to complete the worksheet of the cost projection report. Please open the Module 12 handout on your computer. The handout is the worksheet template we will refer to for the cost projection report.

Copyright InSitu Academy Template Design Portrait view Auto wrap cells Addition Subtraction Multiplying Division =sum(cell range) =cell Auto-calculating cells (available through subscription service) Can insert or delete rows Suggest color coding to prevent writing over formulas The worksheet template is formatted in portrait view for easy insertion into the cost projection report. Columns 5 (E) and 6 (F) are highlighted in yellow to indicate there are formulas built into those cells and will auto-calculate when information is entered. Cells highlighted in blue indicate that information is to be added to them. Rows may be added or deleted according to the information required. If inserting additional rows, you may need to add the auto-calculating functions and to check to see if your added rows are included in the bottom total. You may develop your own worksheet but it is strongly suggested that you color code the formula cells to prevent overriding the formulas. You may also obtain the worksheet template through InSitu Academy’s subscription service where it will be updated and revised as needed on a continuous basis. If you choose to use the InSitu Academy version of the worksheet through the subscription service, please enable editing before entering information. Copyright InSitu Academy

Copyright InSitu Academy Header and Footer Client name Date of birth Age Date Prepared Title of worksheet: Future medical cost projection Footer: client name and date Now let’s discuss each section of the worksheet template to better understand the necessary information required to complete it. In Module 10 we reviewed the header and footer information for the medical records chronology. If you are uncertain how to insert a header and footer into the report, please refer to Module 10, Slide 6. A header and a footer with the client’s information is required on every worksheet. Included are the client’s name, birth date, current age, the date the worksheet was prepared and the title of the worksheet. The client’s name and date of preparation should be in the footer. Copyright InSitu Academy

Copyright InSitu Academy Life Expectancy 1 Calculate from date of birth, determine age, then use appropriate life expectancy chart 2 Enter into cell 3 This will auto-calculate lifetime totals The estimated life expectancy of the client is key to determining the annual cost of medical services. Calculate the client’s age from their date of birth and current year’s birthday. When you have determined the current age, use the appropriate life expectancy chart to determine the estimated years of life remaining. Refer to Module 8 if you are unsure which life expectancy chart is appropriate for the case. Enter the life expectancy number in the blue cell of Column 6 (F), row 2. Once this number is entered, the cells of Column 6 will auto calculate the lifetime totals. Copyright InSitu Academy

Columns Use actual CPT codes Description of service Column 1: category and CPT code Description of service Column 2: item Use standard scheduling percentages Column 3: units per year (frequency) Use midrange or average costs Column 4: unit cost Auto-calculate using unit cost and frequency Column 5: yearly cost Auto-calculate using yearly cost and life expectancy Column 6: lifetime cost The worksheet has 6 columns requiring information. Column 1 (A), lists out the categories you reviewed with the client during the interview process. Included with the categories are the CPT codes where applicable. Please note that there are available rows toward the bottom of the worksheet for adding categories not listed. Column 2 (B), gives a description of the most common services required for medical care. These may be modified or new ones added as needed. Column 3 (C) indicates how many units of service are required each year. Standard scheduling practices are used unless otherwise indicated by the physician in the medical records. Column 4 (D) is the cost of each unit. Generally, a midrange or average cost of the service is used. Column 5 (E) has the ability to auto calculate the unit cost and frequency when the information has been entered in Columns 3(C) and 4 (D). Column 6 (F) will auto calculate the annual cost of the service by multiplying by the life expectancy.   Copyright InSitu Academy

Copyright InSitu Academy Rows Life expectancy Diagnostics Laboratory Physician Equipment Medications Injections Physical Therapy Transportation Home Modifications Other Surgery Spinal Cord Stimulator Total yearly and lifetime costs Now let’s take an in depth look at each of the service items in the rows. It is important to have the appropriate services for the injury and accurate costs and frequencies as much as possible. There will be times when services are to be determined and we will review when it is necessary to insert TBD into the worksheet. Copyright InSitu Academy

Copyright InSitu Academy Diagnostics Can use standard allowance unless specific recommendation If finding actual CPT code, remember to calculate professional component into total cost (typically a -26 modifier) Allowance includes money for MRI, CT, x-rays Allowance frequency (units per year) typically every 5 years Can adjust both the allowance amount and the frequency as needed Other conditions may suggest additional types of diagnostics Refer to previous modules for standard of care protocol The first category on the worksheet is Diagnostics. Remember that diagnostics include MRI’s, CT scans and x-rays. Unless otherwise indicated the frequency is typically every 5 years. If you have an actual CPT code for the examination remember to calculate the professional component into the total cost. Refer to Module 2 for information on CPT codes. The standard allowance for the cost can be used unless you have more specific information. Both the frequency and allowance amounts can be adjusted on the worksheet. Certain conditions or injuries may require additional types of diagnostic testing. Costs and frequencies may require some investigation of these tests. Copyright InSitu Academy

Copyright InSitu Academy Laboratory If laboratory studies indicated (refer to previous modules, or specific recommendations), include: CBC CMP Venipuncture Urine drug screening Can insert additional rows if needed Other types of laboratory testing may be needed For laboratory studies refer to Module 4 for frequency of testing. Whether annual or bi-annual testing is required, remember to include CBC, CMP and a urine drug screen. Depending on the client’s needs, additional lab tests may need to be included. You may insert additional rows to accommodate these tests. Note there are CPT codes on the worksheet next to the standard tests. Venipuncture, while not a test, is a necessary component for drawing the blood and is a reimbursable service.   Copyright InSitu Academy

Copyright InSitu Academy Physician ProjectWorks worksheet has pre-set rows for the primary types of physicians typically involved in injury situations Orthopedic, neurosurgeon Pain management Family practice Neurology Behavioral counseling Additional rows may be inserted for other types of physicians Refer to previous modules for standard protocol on type and frequency Listed on the worksheet are the most frequently encountered physicians for worker’s compensation and personal injury cases. Please refer to Module 5 for the standard protocol for the type of physician required for the injury and the frequency in which they should be seen. Occasionally a specialty physician is required that is not listed. Additional rows may be added to accommodate the specialty physicians. Copyright InSitu Academy

Copyright InSitu Academy ProjectWorks worksheet has TNS unit and supplies on template since this is a very common equipment need, delete rows if not currently used or recommended Add additional rows for all other equipment Calculate frequency according to standard protocol Remember to include maintenance and associated supplies for all equipment Helpful to have a cheat-sheet for commonly used equipment Internet research a good resource, especially Amazon.com since readily available provider Equipment In the category of equipment, a TNS unit is commonly used for injuries. When including a TNS unit on the worksheet, be sure and include the supplies as well. The frequency of replacement and supply use is calculated from the standard protocol. If a TNS unit will not be included, delete the rows for this item and its supplies. Additional rows may be added for other equipment. An example would be a wheelchair. Include the costs for maintenance and associated supplies for all equipment. It is highly recommended that you create a cheat-sheet for commonly used equipment and the supplies, the cost, frequency and maintenance information associated with them. Amazon.com is a good resource to research the costs of equipment. Copyright InSitu Academy

Copyright InSitu Academy List name of drug, dosage, and units per month in Item column (meloxicam, 15 mg, 30 per month) If taken daily on a monthly basis, put 12 in Units per Year column If prn medication, adjust the Units per Year—depends on how often medication is taken Include OTC preparations, topicals/creams/gels, compounded drugs Be cautious in including herbs, vitamins, minerals, supplements unless specific medical recommendation Medications Medications are a large part of the client’s recovery. Make sure you have accurately recorded and included all prescription and over the counter medications. However, unless there is a specific medical recommendation in the medical record, be cautious about including herbs, vitamins, minerals and supplements. Be sure to include the name of the drug, the dosage and the units per month in Column 2 (B). In column B, put name of drug, mg, and units per month (taken once daily=30 per month, if twice daily=60 per month, etc). In Column 3 (C) ---put how many months per year---most often it is 12. if prn, then can adjust to 4 units (months) per year, or whatever number is appropriate. Calculate cost of drug (column D) according to information in column B---especially number of pills per month. PRN medications are medications that are taken on an as needed basis. An example is Tylenol. During the client interview you should have determined the number of PRN medications ingested daily. Adjust the units per year for this amount. Topicals, creams and gels often come in a tube for administration. Determine from the client interview how often the tube lasts and adjust the amount on the units per year. For information on compounded drugs, refer to Module 4. Additional rows may be added if necessary for medications. Copyright InSitu Academy

Copyright InSitu Academy Injections ProjectWorks template has most common injections listed in template Adjust accordingly Very difficult to find exact cost of injections Physician charge Facility charge Supply tray Medication Fluoroscopy charge The Project Works template lists the most common injections clients receive. You will need to enter the frequency of the injections based on the client and medical record information. Additional rows may be inserted for any injections not listed. The exact cost of injections can be difficult to determine. Not all injections require the use of fluoroscopy for administration and the facility charge, supplies and medications are not readily accessible from the facility. The cost information on the Project Works template is from research and historical data.   Copyright InSitu Academy

Physical Therapy Allowance provided for lifetime maintenance therapy Specific recommendations may include visits/year/lifetime, adjust accordingly May need to add rows for occupational therapy, speech therapy, massage therapy, fitness therapy, etc. For physical therapy services an allowance is provided for a lifetime maintenance program unless otherwise stated in the medical record. Specific recommendations would include the number of visits per year or over a lifetime. Adjust the amount accordingly in Column 3 (C), row 24. Some injuries, such as brain trauma, may require other types of therapies. Refer to your medical records information for other required therapies, their frequencies and add rows accordingly. Copyright InSitu Academy

Copyright InSitu Academy Used for Worker’s Compensation cases only since medical mileage reimbursement a benefit under most states’ worker’s compensation coverage Consider a monthly allowance unless excessive mileage and/or expenses involved in obtaining medical care If translation services needed, address in an additional row insertion If medical transport required, address in an additional row insertion If accessible van required, address in this section Transportation Remember to include transportation costs for medical services for worker’s compensation cases. It may be easier to consider a monthly allowance unless there is excessive mileage to obtain services. Other areas requiring cost information would be the use of translation services, medical transport or use of an accessible van. Personal injury cases do not allow for transportation reimbursement Copyright InSitu Academy

Copyright InSitu Academy Home Modifications May be necessary in all cases requiring wheelchair use Significant brain injury Spinal cord injury Amputations This is typically a life care plan item May need an ADA certified renovation opinion For cost projections, can give an allowance, or leave as a ‘To Be Determined’ Item Discuss need with attorney Option: include bathroom safety bar installation for cases involving balance issues, medication side effects, upper/lower extremity conditions Home modifications may be required for an individual to maintain independence. An item to be included on the cost projection report would be bathroom safety bars. Insert additional rows for other home modification items. If the client has sustained a significant brain injury, spinal cord injury or amputation, a life care plan may be necessary. For the cost projection report either give an allowance or leave as “to be determined”. Discuss with the attorney the need for a life care plan. Copyright InSitu Academy

Copyright InSitu Academy Other This row/s reserved for all other treatment needs not addressed in previous rows Need to address in narrative portion of report Also need to address in unusual charge for any row in the narrative portion of report The Project Works template has included rows for any other treatment needs not previously addressed. Any item you place in these rows will require an explanation in the narrative portion of the cost projection report. In addition, any unusual charge in any row will need to be explained in the narrative portion of the cost projection report. If no other treatments are needed, the rows may be deleted. Copyright InSitu Academy

Copyright InSitu Academy Helpful to have a cheat sheet for all common surgeries As you do bill reviews, keep copies of surgical procedures Very difficult to capture all the costs of a surgery Disclaimer language in narrative report that costs are estimates only Refer to previous modules for protocols discussing inclusion of future surgery Surgery You may find it helpful to create a cheat sheet for the most common surgeries performed. Reviewing bills will help in understanding the most common surgeries. Obtaining all costs of a surgery is difficult but again the bill review may be able to give you a ball park figure. Remember to place disclaimer language in the narrative portion of the cost projection report that the costs are estimates only. Refer to modules 4 and 5 for protocols for the inclusion of future surgeries. Copyright InSitu Academy

Spinal Cord Stimulator Very costly item Very difficult to determine cost of implantation Trials can be done as an ‘in-office’ procedure, but permanent placement in some locales is only done as an inpatient procedure Follow algorithm for inclusion of row items Can use ‘to be determined/TBD’ if unsure of recommendation or placement Most attorneys will want this addressed if physician has made any comment about being a future consideration Implantation of a spinal cord stimulator is a major decision. While it is difficult to determine the exact cost of the implantation, it remains a very costly treatment. Preparation for spinal cord implantation includes a psychological examination and a trial placement of the device for effectiveness. Supplies and replacement of the device are figured into the cost of the spinal cord stimulator as well. Trial placements are typically done in the physician’s center and cost considerably less than a permanent placement. In some states, permanent placements can only be done in a hospital/facility, not a surgicenter or ambulatory care center. Check with your community on protocol. Typically if placements are done in a hospital/facility, the cost can easily exceed $100,000. If the possibility of a spinal cord stimulator implantation has been mentioned by the physician, the attorney will want to address the situation with the physician. Until the recommendation of the placement of the spinal cord stimulator has been verified, TBD may be entered in the rows of Column 3 (C) of the rows for spinal cord stimulator. Copyright InSitu Academy

Copyright InSitu Academy Totals Some attorneys will want an annual total for annuity purposes Annual totals Based on today’s dollar value Some attorneys will send report to economist who will reduce to present day value or factor for medical inflation Attorney may ask if you have ‘reduced to present day value’; we don’t do that Lifetime totals Usually lifetime totals are all that are needed for the cost projection report. However, occasionally an attorney may want an annual total for annuity purposes. Lifetime totals are based on today’s dollar value. An attorney may elect to send the cost projection report to an economist to have the present day value or factor for medical inflation. The cost projection specialist does not provide this service.   Copyright InSitu Academy

Use handout (ProjectWorks worksheet template) to build your own working template if not going to sign up for InSitu subscription program After completing own worksheet, practice with various ways to use your form Module 14 will require the use of a worksheet Start cheat-sheets for equipment, surgeries, common CPT codes---this is a dynamic chart, with future additions as you gather more information Home Work Listed on slide 20 are activities for follow up and learning. If you will not be subscribing to the InSitu Academy subscription service, try building your own worksheet template and practice using it. Start developing cheat sheets, making them dynamic charts for updates and future additions. Upon completion of homework assignment, please write a summary or overview and submit to InSitu support team for review. A Certificate of Attendance for CEU credit will be issued after the summary/overview is submitted. Copyright InSitu Academy

Copyright InSitu Academy Contact Information info@insituacademy.com Thank you for joining us to learn how to prepare the worksheet for the cost projection report. We hope you have found the information beneficial. Please contact info@insitutraining.com for any questions or assistance. Copyright InSitu Academy