Method for case management of workplace-related injuries

• US 20020069089A1
• Filed: 07/05/2001
• Published: 06/06/2002
• Est. Priority Date: 11/30/2000
• Status: Abandoned Application

• Current Assignee: Nupath Solutions Limited
• Original Assignee: Nupath Solutions Limited
• Inventors: Holbert, Michael, Seddon, Donald L., Larkin, John J., Seddon, Thomas L., Santoiemmo, Carl V.
• Application Number:
  US09/899,425
• Publication Number:
  US 20020069089A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 20/30 relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 70/40 relating to drugs, e.g. their side effects or intended usage

Abstract

A case management system has a central data store (4) comprising at least one data storage unit. An injury classification code database (4A), treatment database (4B), and diagnosis database (4C) are maintained thereon. A processor (8) in operative communication with the data store (4) and the Internet (2) performs the steps of: creating (14) a claim file on the data store (4); receiving information (12, 22, 36, 86, 88, 102, 304) about the claim via the Internet (2); storing (16, 52, 308) the received information in the claim file; establishing a diagnosis (32, 34, 36); creating a treatment plan (50) based on the diagnosis using the treatment database (4B); and transmitting (82, 84, 90, 301, 302) information from the claim file via the Internet (2) upon receipt of valid security information. Establishing a diagnosis (32, 34, 36) optionally includes receiving responses (22) to an Internet questionnaire and determining a suggested diagnosis by comparing with the diagnosis database (32). The treatment plan is preferably divided into intervals (60) corresponding to pre-selected time intervals.

Claims

1. A case management method for managing a worker injury claim, comprising:

maintaining a database of suggested treatment plans;

recording a first report of injury (FROI) date;

identifying an injured body part;

obtaining an injury diagnosis;

assigning an injury classification code based on the obtained diagnosis and the identified injured body part;

receiving an associated job code;

identifying a degree of disability management (DoDM) code based on the injury classification code and the associated job code; and

providing a treatment plan based on the diagnosis, said treatment plan being extracted from the database of treatment plans.

2. The case management method according to claim 1, wherein the step of assigning an injury classification code includes assigning an ICD-9 code.

3. The case management method according to claim 1, wherein the step of receiving an associated job code includes receiving an associated NCCI job code.

4. The case management method according to claim 1, wherein the step of identifying a DoDM code includes:

identifying a loosely managed benchmark code; and

identifying a well managed benchmark code.

5. The case management method according to claim 4, wherein the step of identifying a loosely managed benchmark code includes:

identifying a statistical average period between injury and return to work corresponding to the injury classification code and the associated job code.

6. The case management method according to claim 4, wherein the step of identifying a well managed benchmark code includes:

estimating a period between injury and return to work corresponding to the injury classification code and the associated job code based on the provided treatment plan.

7. The case management method according to claim 4, further comprising:

estimating an estimated return-to-work date based upon the first report of injury (FROI) date and the well managed benchmark.

8. The case management method according to claim 7, wherein the step of estimating an estimated return-to-work date includes adding the well-managed benchmark to the FROI date.

9. The case management method according to claim 1, wherein the step of obtaining a diagnosis includes:

receiving responses to a diagnostic questionnaire; and

supplying a suggested diagnosis by comparing the responses with a preexisting diagnosis database.

10. The case management method according to claim 1, further comprising:

dividing the treatment plan into treatment intervals wherein each said interval is assigned to a time block subsequent to the first report of injury (FROI).

11. The case management method according to claim 10, further comprising:

receiving updated information on the injured worker, said updated information having become available after the first report of injury (FROI) and after the obtaining of the injury diagnosis;

updating a treatment interval based upon the updated information; and

updating the estimated return-to-work date based upon the updated information.

12. The case management method according to claim 11, wherein the step of receiving updated information includes receiving information from a diagnostic testing of the injured worker.

13. The case management method according to claim 12, further comprising scheduling the diagnostic testing in accordance with the treatment plan.

14. The case management method according to claim 12, further including pre-certifying the diagnostic testing conditional upon the diagnostic testing being included in the treatment plan.

15. The method according to claim 1, further comprising:

displaying initial case management tracking information;

receiving from the user additional case management tracking information; and

appending the received additional case management tracking information to the initial case management tracking information without modifying the initial case management tracking information.

16. The method according to claim 15, wherein the step of displaying case management tracking information includes displaying URAC-compliance case management tracking information.

17. The method according to claim 16, further comprising:

setting a URAC compliance flag conditional upon meeting a preselected set of conditions indicating compliance with URAC standards.

19. The case management system as set forth in claim 18, further including:

a diagnosis database that is maintained on the central data store; and

an Internet diagnosis questionnaire that is accessible via the Internet.

20. The case management system as set forth in claim 19 wherein step of establishing a diagnosis includes the steps of:

receiving responses to the Internet-based diagnosis questionnaire via the Internet; and

providing a suggested diagnosis by comparing the received responses with information contained in the diagnosis database.

21. The case management system as set forth in claim 18 wherein the step of creating a treatment plan includes the step of:

dividing the treatment plan into treatment intervals corresponding to pre-selected time intervals.

22. The case management system as set forth in claim 18, wherein the processor performs the additional steps of:

pre-certifying a diagnostic test in accordance with the created treatment plan;

receiving results of the diagnostic test; and

updating the treatment plan based on the received results and the treatment database .

23. The case management method according to claim 18, wherein the processor further performs the steps of:

identifying a loosely managed benchmark code; and

identifying a well managed benchmark code.

24. The case management method according to claim 23, wherein:

the step of identifying a loosely managed benchmark code includes identifying a statistical average period between injury and return to work corresponding to the injury classification code and the associated job code.

25. The case management method according to claim 23, wherein the step of identifying a well managed benchmark code includes:

estimating a period between injury and return to work corresponding to the injury classification code and the associated job code based on the provided treatment plan.

26. The case management method according to claim 23, further comprising:

estimating an estimated return-to-work date based upon the first report of injury (FROI) date and the well managed benchmark.

27. The case management method according to claim 26, wherein the step of estimating an estimated return-to-work date includes adding the well-managed benchmark to the FROI date.

18. A case management system for managing rehabilitation of an injured worker, the case management system comprising:

a central data store comprising at least one data storage unit;

an injury classification code database maintained on the central data store;

a treatment database maintained on the central data store; and

a processor in operative communication with the central data store and in operative communication with the Internet, said processor performing the steps of;

creating a claim file on the central data store,

receiving information about the claim via the Internet,

storing the received information in the claim file,

establishing a diagnosis corresponding to the claim,

creating a treatment plan based on the diagnosis using information extracted from the treatment database, and

selectably transmitting selected information extracted from the claim file via the Internet conditional upon receipt of valid security information.