Woman speaking with physician

A major challenge for processing claim paperwork is getting the right information in a timely manner. Case managers working to help patients utilize their employer leave policies sometimes have to follow-up with healthcare practitioners’ offices for additional information, especially when extending a leave request. A follow-up may be for original diagnosis documentation, a change in diagnosis, or needing a detailed work limitation or restriction plan. With many medical offices still using older technologies, like fax machines, the question from case managers persists: how can we improve care delivery with more efficient communications?

According to a survey conducted by MDGuidelines examining successes and barriers of case managers interacting with physician offices, 217 U.S. based, short-term disability case managers identified insights for cases that went smoothly:

  • Providing detailed & easy to understand requests for documentation
  • Utilizing the patient as an advocate to complete paperwork

Additionally, experienced case managers indicated if they could easily provide data to the clinicians, the most valued topics would include:

  • Common reasons why patients fail to recover
  • The patient’s daily work tasks related to their diagnosis

The research demonstrates that keeping a two-way communication strategy is a key tool for case managers to improve patient outcomes. Even without a clinical background, case managers can do the leg work to gather relevant information that may assist the clinician with their decision making, such as sharing the patient’s daily expected activities, population-level recovery estimates, or common non-clinical reasons why healing can be delayed.

Organizations can support building these relationships by:

  • Developing easy-to-use forms with specific instructions for how the form is to be filled out
  • Allowing time and training for case managers to add a personal note about how this paperwork supports the patient
  • Setting up procedures and protocols for reaching out to clinicians, such as fax number phone banks checklists including
  • Integrating access to evidence-based guidelines so that case managers can reference the latest information about care

Additionally, survey respondents also had success when including the patient in the request for information, so the patient was likewise advocating for the completed paperwork.

These best-practice strategies can help improve communications with physician offices to ensure that case managers at all levels of experience can streamline claim progression.

Read more about the survey results in the Case Management Society of America’s issue of CMSA Today


Information provided on this blog is intended for general educational use. It is not intended to provide legal advice. ReedGroup does not provide legal services. Consult an attorney for legal advice on this or any other topic.

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