DISABILITY CASE MANAGEMENT - 24 / 7 Accessible Care

SEMCM goal is to assist in reducing disability cost and absenteeism, while keeping employees healthy and at work. We feel that this is crucial in today’s competitive business atmosphere. Our Certified Medical Case Managers and Certified Rehabilitation Counselors will assess an individual’s level of physical condition, psychological functionality and work abilities, then will implement with the assistant of the injured person’s medical providers, an individualized care plan that will progress towards Medical improvement and Claim Closure for Disability Carrier’s and employers administrating short and long term claims.

Disablity Cae Managment - A key To Health

Services Include:

Medical chart reviews
Field Medical Case Management
Telephonic Medical Case Management
Employability Assessments
Vocational Assessments
Transitional Skills Assessments
Labor Market Surveys
Evaluation of Suitability
Disability Assessments
Medical Bill Review
Utilization Review
In-Hospital Field Assessments
Job Analysis, Job Development and Placement
Vocational Testing
Life Care Plans
Medical Examination Coordination and Referral

Medicare Set-Aside Allocation - 24 / 7 Accessible Care

SEMCM provides Workers Compensation Medicare Set-Aside Trust Allocation Report services. The Medicare Allocation report enables claims professionals, structured settlement brokers and legal professionals to comply with the requirements set by Medicare Secondary Payment Statute (42 U.S.C.1395 y (b)(2) (A) and (B))

Medicare Set-Aside Allocation

The current guideline is that a carrier / employer or claimant must submit a settlement for CMS approval when (1) the claimant is currently a Medicare beneficiary and the total amount of the settlement is greater than $25,000; or the claimant has a “reasonable expectation” of Medicare enrollment within 30 months of the settlement date and the anticipated settlement amount for future medical expenses and disability / lost wages over the life or duration of the settlement is expected to be greater than $250,000.

Prior to settlement, SEMCM works with you and reviews the claim. The goal is to identify if a Set-Aside Trust Allocation is indicated based upon criteria promulgated by Medicare.

A list of SEMCM services levels for the Initial Assessment to full Set-Aside Trust Allocation Report completion. Coordination and submission of this report for approval by your local Center for Medicare Services office are also available.

Evaluate case to determine if Set-Aside Allocation will be required by CMS
If Set-Aside is required, review medical records & prepare cost analysis report for CMS approval.
Breakdown of Medicare and Non-Medicare Costs
Obtain approval of Set-Aside amount from CMS / Medicare. (Will require completion of service 1 & 2)
Any other special instructions

Life Care Planning - 24 / 7 Accessible Care

SEMCM utilizes Certified Life Care Planner, who upon completing the file review, constructs an individualized, detailed, accurate Life Care Plan. We provide the individualized and comprehensive Life Care Plans that project current and future long term needs, costs and are congruent with the disability level. Life Care Plans ease the burden of disease and / or injury, prevent possible complications, promote a meaningful life quality, provide disability sensitive recommendations, and establish expenses involved. The Life Care Plan is updated when the injured person’s functional level changes or when they reach a developmental milestone, such as adulthood. The effects of aging and disability are also considered.

Life Care Planning

Types of Cases Future Care Projections Assist in Preventing or Limiting Include:

Brain Injury
Spinal Cord Injury
Stroke / Cerebral-vascular Accident
Chronic Pain
Burns
Personal Injury
Medical Malpractice
Birth Defects