1. Future Medical Cost Projections
Module 13
Narrative Report, with handout
Welcome to Module 13 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. Please open the handout, which is a template for the narrative report. associated with Module 13. A word about the narrative report. You may decide to develop a narrative report of your own or you may subscribe to InSitu Academy’s subscription service. The narrative report, once completed, is the form that is submitted to the attorney and constitutes the cost projection report. It is essential that it is accurate and complete with all information.

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Narrative Report
Sections
Header information
Accident description
Injury related conditions
Non-injury related conditions
Treatment history
Current medical status and treatment plan
Medical recommendations
Future medical treatment projections
Basis of cost factoring
Executive summary
Worksheet insertion
Signature
Following the handout for Module 13 we will review the different sections of the narrative report. Listed on Slide 2 are the sections on the narrative report of the cost projection report. While it looks a bit overwhelming, organizing all the information you have collected on the case will assist in breaking the narrative report down and prevent unnecessary information being entered. In this module we will discuss each of the sections and place the collected information in the correct area. The narrative report is designed to insert information directly into the report at the specific sections.
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Header Information
Name
DOB, age
Life Expectancy
Fee schedule used
Date of injury
Referring attorney
Date of report
Cost projection specialist
Total cost, pending economic analysis
Some of the information for the narrative report was covered in previous modules. We discussed that entering information into the narrative report as soon as you have it will decrease the amount of time spent on the narrative report. The Header information is one area where information can be entered early. This information is acquired during the intake referral process with the attorney’s office. Please refer to Module 9. Remember to calculate the life expectancy for the client for this section.
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Brief statement about type of accident
Limited details
Based on review of medical records
Based on client interview
Based on information provided by attorney
Accident Description
As a refresher, the accident description should be stated briefly in 2-3 sentences. The details should be factual and based on the review of the medical records, the client interview and information provided by the attorney. Opinions and presumptions should never be in the accident description.
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5. Injury Related Conditions
From review of medical records only
Include diagnoses
Include conditions
Include primary injury
Include secondary, related conditions
Include significant symptomatology
Injury Related Conditions
Injury related conditions come from the medical records review. Because you want to make sure all diagnoses, conditions, secondary related conditions and symptoms to the primary injury are included in the narrative report, a thorough review of the medical records is necessary. Again, opinions and presumptions are never stated by the author of the narrative report. However when information is reported by the client it is best to indicate the statement is from the client in the narrative report.
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6. Non-related Optional section From review of medical records
From client interview
While there is not a specific area for non-related conditions on the narrative report, there may be information, unrelated to the current injury, that may be helpful in understanding the current situation. This information can be placed under the “injury related conditions” with a separate title of “Non-Related Conditions”. This information may have been discovered in the review of the medical records or during the client interview.
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7. Treatment History Insert medical chronology
List of medical records, optional
Summary of medical care in lieu of chronology, optional
The treatment history will include the medical record chronology you have completed. Please refer to Module 10 for a refresher on how to complete the medical record chronology. Inserting the chronology into the narrative report may increase the size of the report by several pages. You may choose to add a list of the medical records you have reviewed if they are from several different facilities. A summary of the medical care in lieu of the chronology is an option, but be careful not to leave out any significant information.
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Current Status
Follows intake summary
Discusses current medical status
Discusses current treatment plan
Discusses anticipated future treatment plan
Discusses current vocational status
Written in bullet point or brief sentences
Factual, non-interpretive language
With the medical records chronology you are reporting all historical treatment for the injury. Now it is necessary to report the current status of the injury. By following the items under the “Current Medical Status and Treatments” section, you will be reporting the most recent information regarding the status of the injury. Most of the information will come from the client interview, but there may be statements made by the physician that are in the medical record. When reporting the information on the narrative report, keep it brief and use easy to follow bullet points. Areas to be discussed will be their current medical status, current treatment plan, any future treatment plans and their current vocational status. Factual, non-interpretative statements are used.
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9. Medical Recommendations
Found in medical records
Found in IME reports
Found in questionnaires or letters
Use standard protocol
Quote physician, date of report if available
Medical recommendations may be found through out the medical record. An independent medical exam (IME) may have been submitted by a non-providing physician with a recommendation for treatment. If using a physician quote, include the date of the report if available. Sometimes medical recommendations are found in questionnaires and letters. Be sure and include these. Using standard protocol for the injury may be included with the medical recommendations.
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Projections
Follows worksheet
Discuss each item with a bit of explanation
Can use boilerplate language and comment only on ‘exceptions’
Explain any unusual projection in the category section, help attorney understand inclusion or exclusion
Recommend addressing full algorithm, with language if not appropriate
Not a factor at this time
Remains a future consideration
To be determined
For future medical cost projections, give a brief explanation of each item. The items listed in this section follow the items listed on the worksheet. If an item does not pertain to the client’s situation, leave the area blank or place N/A for not applicable. Information for future medical cost projections may come from the medical record, the client interview or advised by the physician. Explain any unusual projection in the category section. Some attorneys are not familiar with medical decisions and may need assistance in understanding why a projection was included or excluded. For future reference, consideration to addressing the full algorithm is not a factor at this time, but could prove to beneficial at some point in time for the future cost projection report.
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11. Basis of Cost Factoring
Boilerplate language
Discuss methodology used
Discuss data resources
State which fee schedule used
Explain not reduced to present day value or factored for inflation
Advise economic analysis for official total lifetime costs
Advise a supplemental report may be necessary as new medical information becomes available
State client remains in active medical care, with updates to be considered as information becomes available
Under the Basis of Cost Factoring section you will see boilerplate language describing how you obtained the costs projected on the worksheet. Data sources and the methodology for the costs are explained. Identify the fee schedule that was used for the cost and explain that costs have not been reduced to present day value or factored for inflation. If total lifetime costs are necessary, advise the attorney to obtain an economic analysis. Medical research is an ongoing process and new medical information may become available. Advise the attorney that a supplemental report may be necessary as medical information becomes available. Explain to the attorney that updates to the cost projection report may be needed while the client remains in active medical care.
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‘Disclaimers’
State is not a life care plan and cannot be used as basis for expert testimony
Advise if expert testimony is required, then a life care plan written by a life care planner will be necessary
Advise a supplemental report may be necessary as new medical information becomes available
State client remains in active medical care, with updates to be considered as information becomes available
While the future medical cost projection report states the best information for continued care for the client, some disclaimers are required. The future medical cost projection report is not a life care plan for the client and cannot be used as a basis for expert testimony. If expert testimony is required, advise the attorney that a life care plan is necessary and should be prepared by a certified life care planner. Advise the attorney that a supplemental report may be necessary as medical information becomes available. Explain to the attorney that updates to the cost projection report may be needed while the client remains in active medical care.
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Executive Summary
A brief summary of case
Can be an opinion section
An executive summary of the case will place all significant information in an area easy to locate. Keep the summary brief and factual. If you decide to use the area for an opinion section, list the physician’s or professional’s analysis with the date it was stated.
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Signature Line
Optional
Credentials
A signature line is optional as the cost projection specialist’s name preparing the report will be in the demographic box on the first page of the narrative report. However adding a signature line at the bottom of the report provides space to indicate the credentials of the cost projection specialist
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15. Worksheet
Better to have worksheet part of report rather than an attachment
Copy/paste body of worksheet into report
May need to ‘fiddle’ with worksheet size/format to fit onto word doc page
Remember to insert total from worksheet into total in demographic section
Notice on the last page of the narrative report template there is a statement to enter the worksheet here. Copy and past the worksheet information on to the last page of the narrative report. Some configuration of the worksheet may be required to accommodate the word document page. When you have it settled, remember to insert the total cost from the worksheet onto the demographic section on the first page of the narrative report.
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Master File
Save everything in a master file
May need it later
Attorney questions
Subpoena’s
revisions
Once you have completed the narrative report save it in a master file. Develop a consistent filing method, with the client name and date the case was received. You may need to reference the file later if there is a request for a subpoena, revisions or any questions that may come up.
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17. Discussion Subpoenas for production of records
Subpoenas for deposition
Personal injury cases: frequently
Worker’s compensation cases: rarely
On occasion subpoenas are requested for a couple of different reasons. One may be for the cost production report that was prepared for the client’s case. More often subpoenas are requested for deposition in personal injury cases. Rarely are subpoenas requested for deposition in worker’s compensation cases. Having an organized master file will save time when asked to retrieve the case information.
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Post Production
Attorneys may:
Get additional medical records, and want revisions
Want a different fee schedule used
Want items omitted or changed, depending on case facts
Want items added
Want scheduling increased
Often attorneys will ask for modifications, additions or omissions to the future medical cost projection report that has been submitted. There could be several reasons for the requests. Receiving additional medical records after the completion of the report may change the medical care or other information and require revisions. Attorneys may request that a different fee schedule be used, or items be changed, added or omitted depending on the case facts. The future medical cost projection report is complete when satisfaction has been achieved.
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Home Work
Design a narrative report template that works for you if not going to sign up for InSitu subscription program 01
Practice copying/pasting excel spreadsheets into the word document 02
Use information gathered in Module 11 to practice writing a current status section of the narrative report 03
Module 14 will require the use of a narrative report template 04
Listed on Slide 19 are activities for follow up and learning. Completing these activities will assist in learning how to prepare the narrative report. Having a working narrative report template for Module 14 will be necessary.
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.
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Contact Information
Thank you for joining us for preparing a chronology of the medical and billing records and initiating the narrative report. We hope you have found the information beneficial. Please contact for any questions or assistance.
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