Improving Treating Physician Reporting

After roughly 25 years in the business I am absolutely convinced that one of the reasons why insurance companies harass treating physicians with vexatious requests for information is because what they get back is not what they need, or are looking for.

Most treating physicians are very close to their patients and remain supportive during every phase of patient disability. Despite the fact that they are now required to fill out forms from every possible source (SSDI, Worker’s Comp, Private Disability, Personal Injury Litigation etc.), they do the best they can while trying to do their real jobs of providing patient care. The physicians I have dealt with on behalf of my clients have been totally supportive, and it is obvious they care about the health and well-being of their patients.

However, while I am extremely grateful to the physicians who take the time to  support disability correctly, there are some physicians who continue to regard time spent in filling out forms as a waste of their time. All disability claims are paid or not paid based on the quality of medical information sent to the insurance company. And, while insurers are busy doing everything they can to find ways to deny claims, it is now more important than ever for physicians to report the totality of patient impairment, and do a really good job.

DCS, Inc. specializes in assisting treating physicians to report medical disability wisely. Although I can’t go into a great deal of my proprietary strategies in a public forum, here are a few items physicians should be documenting on a regular basis.

  • Diagnoses, both primary and secondary with ICD-10 codes.
  • Prognosis.
  • Statement as to whether patients are at MMI.
  • Details concerning the physician’s treatment plan.
  • Medical restrictions and limitations. (Activities patients may never do, versus activities they may do, but only to a limited extent.)
  • Physicians should always provide what I call a “disability statement.” If the patient is “totally and permanently disabled”, the physician should say so.
  • Physician statement regarding exercise, activity and that it is recommended as part of a viable treatment plan.

Statements from physicians such as, “No work”, or, “Patient is disabled”, is not sufficient to support private disability. The doctor needs to provide much more detail about why his/her patients are unable to work. Of late, I’m hearing physician comments such as, “What does it matter? Insurance companies don’t pay attention to me anyway.”

Although this observation may have some truth to it, insurers do pay attention to medical reports if only to try to find ways around them. Strong, well-documented medical reporting makes it more difficult for any insurer to challenge disability claims.

I also find that some patients are reluctant, or afraid to communicate what is needed to their treating physicians. I can understand this since some physicians fly by during consultations because they are so busy, particularly in the larger physician facilities. It’s hard to try to discuss disability forms when physicians give their patients 5 minutes of follow-up office time.

Physician reporting can be improved when patients also take the time to discuss why they feel they are unable to return to work. Treating physicians are NOT mind readers and shouldn’t be expected to conjure up medical restrictions and limitations relating to jobs or occupations when needed. DCS recommends that insureds and claimants show their treating physicians job descriptions and explain why they are unable to do certain things.

Bottom line, physicians who do not take the time to do a good job reporting impairment are repeatedly harassed by insurers to provide more and more information.

Medical reporting is a priority for private disability.

Filed under: Physician Issues
Source: Linda Nee