Frequently Asked Questions — Physicians Medical Review — Expert Medical Record Reviews, Expert Witness Referrals, Medicare Set-Aside Allocations, and Other Medical Litigation Services
Physicians Medical Review provides exceptional, personalized service in all aspects of medical litigation and allocation services. PMR is a physician-owned and operated medical consulting firm. PMR board-certified, in-house physicians and certified life care planners provide a full range of services to our attorney clients and insurance industry professionals. PMR peforms thorough evaluations of the medical circumstances surrounding a case and, if necessary, provide expert witness referral services for testimony during settlement negotiations or trial. PMR medical allocation services include the development of Medicare set-aside allocations, life care plans, medical cost projections, medical peer reviews, and pharmacological reviews.
To obtain a comprehensive medical review, the referral of a highly qualified expert witness for testimony, or any other medical litigation or allocation service, contact Physicians Medical Review.
Medical Litigation Services FAQs
Q:
What makes Physicians Medical Review different from all other expert medical referral services?
A:
Physicians Medical Review is not a “medical expert referral service.” Physicians Medical Review is a physician-owned and physician-operated comprehensive medical-legal-consulting firm. Our in-house physicians assist our attorney clients with the relevant medical aspects of personal injury, medical malpractice, mass tort, and nursing home negligence cases.
Q:
Who performs medical record reviews for medical merit of cases?
A:
Medical record screenings for merits (of cases) are done by Physicians Medical Review’s highly qualified, board-certified in-house physicians. Physicians Medical Review’s in-house physicians cover all specialty areas of medicine and are able to review medical records in any health related area.
Q:
How quickly is a medical record reviewed for merit?
A:
A medical record review will be performed within 10 working days.
Q:
There are circumstances in which a medical review needs to be performed in an expeditious manner. Can this be done by Physicians Medical Review?
A:
If a case needs to be reviewed in an expeditious manner due to statute limitations or other qualifying conditions of legal significance for our attorney clients, a priority rating is established. Completion of a case with high priority status will be accomplished quickly — sometimes within as little as 24 hours.
Q:
Does a review for merit include a written review, telephone, or e-mail response?
A:
Telephone and/or e-mail responses can be performed in a more cost efficient and expedient manner than written reviews. Physicians Medical Review will perform comprehensive written reviews, telephone conferences, or an e-mail response, depending upon how the attorney client wishes to obtain information.
Q:
Will Physicians Medical Review perform any type of phone consultations to determine if it is worthwhile to obtain the medical records and have a medical review performed on a new case?
A:
Once an attorney client has a relationship with Physicians Medical Review the attorney may contact PMR’s 24-hour hotline to discuss questions regarding a new case with an in-house physician reviewer at no further cost to the attorney.
Q:
How does Physicians Medical Review screen its medical expert physicians for testimony?
A:
Each expert witness who provides testimony is contacted by one of our board certified in-house physicians. The potential expert is thoroughly screened regarding his or her medical background, expertise, subspecialties, and their medical legal experience. The potential case is discussed in detail by the two physicians for its medical merit.
Q:
How does a Physicians Medical Review attorney client retain the expert witness for testimony?
A:
When the in-house physician is satisfied that the appropriate expert witness to provide testimony for the specific case has been identified, Physicians Medical Review will directly recommend the expert to the attorney client. Physicians Medical Review will provide the attorney-client the expert physician’s curriculum vitae and all other pertinent information necessary to make an informed decision.
Q:
Will the medical experts Physicians Medical Review recommends sign letters of affidavit and provide expert witness testimony at depositions as well as trial?
A:
A medical expert that has been thoroughly screened by Physicians Medical Review will sign letters of affidavit of merit, be available for depositions as well as expert witness testimony at trial. If they are not fully committed to a case, then they will not be judged by Physicians Medical Review to be an appropriate expert for the case.
Q:
How quickly can Physicians Medical Review obtain a pre-qualified expert witness for testimony?
A:
Obtaining experts in certain medical subspecialties can be difficult. In the majority of cases one can expect a response from Physicians Medical Review within a period of 2 – 3 weeks. There are some cases in which Physicians Medical Review can obtain an expert witness testimony provider sooner.
Q:
Will Physicians Medical Review provide more than one choice of expert for the case?
A:
If the attorney client wishes to have a choice of multiple physician experts, Physicians Medical Review will provide multiple CV’s and the appropriate information to the attorney client about each potential expert.
Q:
Will an attorney be working directly with the medical expert that is retained or through an assigned case manager at Physicians Medical Review?
A:
Once the expert is retained by the attorney client Physicians Medical Review’s further involvement is only at the request of the attorney client.
Q:
How will Physicians Medical Review help my medical experts and how does Physicians Medical Review charge for their services?
A:
Experts that PMR recommends for a case have been thoroughly screened during discussions with a PMR in-house physician. The recommended expert is hired directly by the attorney as an arms-length transaction. PMR does not pay the acquired medical expert. PMR does not receive commission or compensation from the medical expert after the fact. Physicians Medical Review only receives compensation from the attorney client for the time spent in finding, approving, and recommending the expert, as well as those additional services asked of PMR.
Q:
What services does Physicians Medical Review perform in mass tort cases?
A:
PMR provides a complete expert approach to the mass tort case which includes research and “intake” questionnaire development and response evaluations. PMR Physicians then determine which records are pertinent to the mass tort litigation, review the records, and identify the expertise requirements. Finally, our physicians will find, interview, recommend and organize the medical expert panel for the mass tort case.
Q:
What services does Physicians Medical Review perform with regard to assisting with defense DPR issues?
A:
Physicians Medical Review has had a broad experience with defense cases involving the physicians who have had quality assurance or DPR issues.
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Medical Allocation Services — FAQs
Physicians Medical Review certified nurses and life care planners provide a full range of medical allocation services to workers’ compensation and liability industry professionals. The attorney clients of PMR also benefit from a thorough review of Medicare set-aside allocations and other documentation of future medical care and related expenses by board-certified in-house physicians.
If you are in need of comprehensive medical litigation or allocation services, contact Physicians Medical Review today.
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Medicare Set-Aside Allocations
Q:
What is a Medicare set-aside allocation?
A:
A Medicare set-aside allocation is a document specifying future injury-related medical needs and associated costs. This document is required when settling workers’ compensation and liability claims involving injury-related medical expenses of the type typically covered by Medicare. The Center for Medicare and Medicaid Services (CMS) stipulates that a Medicare set-aside arrangement must be developed in order to protect Medicare’s interests when setting future medical expenses. Through Medicare set-asides, CMS seeks to establish Medicare as the secondary payer in cases involving Medicare beneficiaries who are also covered by other insurance carriers.
Q:
When is a Medicare set-aside allocation necessary?
A:
CMS requires the review and approval of a Medicare set-aside arrangement if the claimant is eligible for Medicare and the total settlement value is $25,000 or greater. The document will also be required if the claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the total settlement value is expected to be greater than $250,000. The medical allocation service professionals at PMR can quickly and easily help you determine if a Medicare set-aside allocation is required in a case.
Q:
What are the consequences of non-compliance with the CMS statute?
A:
If a Medicare set-aside allocation is not developed when required, the consequences of non-compliance can be severe. Future medical care may be denied to the claimant. CMS may also sue the claimant, his or her attorney, or the insurance carrier, or designate their own allocation. A malpractice suit may also be carried out against the attorney for failing to obtain the report.
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Medical Cost Projections
Q:
How is a medical cost projection at Physicians Medical Review performed?
A:
At PMR, medical cost projections are performed by our highly experienced certified nurses and physicians. With the help of these professionals, thorough analysis of expected future medical costs are obtained through the review of medical records as well as communication with treating physicians.
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Q:
Under what circumstances would a medical cost projection from PMR be necessary?
A:
Medical cost projections at PMR are typically obtained to assist our attorney clients in mediation and settlement disputes.
Q:
What steps are taken to ensure that a PMR medical cost projection is accurate?
A:
At PMR, medical cost projections and other allocation service documentation is reviewed by our board-certified in-house physician quality assurance team to ensure the most accurate possible report is obtained. Our in-house certified nurses and physicians can also act as an expert witness, if necessary, to provide testimony during trial or settlement negotiations.
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Life Care Plans
Q:
What is a Life Care Plan?
A:
A life care plan is a dynamic document that offers an organized, concise plan for current and future medical needs, including associated costs, for catastrophically injured or chronically ill individuals.
Q:
How is a life care plan created at Physicians Medical Review?
A:
PMR certified life care planners perform this service for both plaintiff and defense attorneys involved in liability and workers’ compensation cases. PMR life care planners create comprehensive and reliable reports outlining current and future medical costs. Each life care plan is then reviewed by our quality assurance team to ensure accuracy and thoroughness.
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Peer Reviews
Q:
How are peer reviews performed at Physicians Medical Review?
A:
At PMR, our in-house physicians are highly experienced in assessing standards of care and conducting thorough evaluations of medical records for workers’ compensation industry and liability professionals. PMR has individual sub-specialty physicians in the areas of orthopedics, neurology, and physiatry to perform expert, individualized peer reviews. If required, PMR in-house physicians also provide expert witness testimony during trial or settlement negotiations.
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Pharmacological Reviews
Q:
What does a pharmacological review at Physicians Medicare Review involve?
A:
At PMR, each pharmacological review is performed by a board-certified in-house physician. A PMR pharmacological review thoroughly outlines the history of a patient’s injury or illness to determine if current pharmaceutical treatment is appropriate. Potentials side effects, drug interactions, and dosage errors are also analyzed.
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Medicare Eligibility
Q:
Who is eligible for Medicare?
A:
A person who is eligible for Medicare typically has been working in Medicare-covered employment for at least ten years. The person will also likely be over the age of 65. Recipients must be U.S. citizens and / or permanent residents. It is possible, however, that a disabled person will be eligible for Medicare if they do not meet the usual criteria.
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Q:
Who would benefit from a Medicare eligibility analysis from Physicians Medical Review?
A:
Among those who may benefit from a Medicare eligibility analysis of their clients include plaintiff attorneys, defense attorneys, insurance company professionals, as well as others taking part in workers’ compensation cases involving Medicare.
Contact Physicians Medical Review
We will be happy to answer any additional questions you may have regarding Medicare set-aside allocation development, or any of our other allocation services. Contact PMR today to learn more.
David Gold, Attorney At Law
"In claims that PMR's in-house physicians found to be meritorious, their assistance has been invaluable... They have found extremely highly qualified medical experts to support our cases..."
Robert Boyers, Attorney at Law
"I got what I thought was the best testimony, during trial, that I had ever seen..."
- How does Physicians Medical Review screen its medical expert physicians for testimony?
- Will the medical experts recommended by Physicians Medical Review sign letters of affidavit and provide expert witness testimony at depositions as well as trial?
- How will Physicians Medical Review help my medical experts, and how does Physicians Medical Review charge for its services?
- When is a Medicare set-aside allocation necessary?
- How is a medical cost projection at Physicians Medical Review performed?
- How is a life care plan created at Physicians Medical Review?