<img class="alignleft wp-image-310 size-medium" src="https://manleyandassociates.com/wp-content/uploads/2018/01/Screen-Shot-2018-01-11-at-12.06.09-PM-300x201.png" alt="Medical Cost Projection" width="300" height="201" />A Medical Cost Projection (MCP) is a forecast of likely medical costs for a claim, and is the cornerstone for setting case reserves, negotiating settlements and comparing financial exposure with and without procedures. The MCP determines the financial impact of injury cases and its accuracy directly impacts the claim valuation.

At its best, an MCP is an educated speculation by highly-trained medical experts. At its worst, it’s a shot in the dark. Here are some considerations for ensuring your MCP is comprehensive and prescriptive.
<h3>MCP Components</h3>
An MCP includes general information about the injury and diagnosis, expected routine care and rehabilitation, common interventions, and usual and customary costs. During the development of an MCP, be sure to consider the following:

· The expected recovery time for the employee and whether or not he will be impeded once he returns to work. Will he be back two work in a matter of months, or is this claim considered catastrophic and he will never return to work? Will his workload return to normal or will he have light or modified duties?

· The employee's average weekly wage and the indemnity rate. MCPs should consider both components.

· The anticipated costs of medical procedures and prescription drugs for the rest of his life. In addition, projections should also include whether he will need home health care, durable medical equipment or therapies.

· Anticipated ancillary costs associated with the claim, including medical case management, legal and other fees.

· Specific state or jurisdictional treatment requirements that could impact costs.
<h3>MCP Best Practices</h3>
Because of the criticality of MCPs in determining a case's value, it's crucial that your MCP is the best speculation possible. In addition to ensuring you've considered the components above, look for the following:

· The MCP should provide an improved quality of life for the recipient AND financial savings for the claim payer. The MCP should find that sweet spot.

· The case should be evaluated by a well-credentialed RN with specific knowledge of catastrophic injuries. Their medical expertise must match the complexity of the case.

· Ensure the case considers each service and requirement in detail. RNs should look at past and future needs, complications, and co-morbidities.

· Don't consider the initial projection as final. As the patient's condition, complications and rehabilitation progress, more information regarding his needs may come to light. Be sure to revisit the projection at that time.

· Consider requesting a Life Care Plan. Life Care Plans include the components of an MCP, but may also take into account additional information including depositions, day in the life videos, school and employment records, and tax returns. If you determine a Life Care Plan is in order, look for professionals with Certified Life Care Planner (CLCP) credentials.

Medical cost projections set the foundation for the total financial value of a claim. By including the components above and following best practices, you can ensure that your MCPs are rock solid.

Need a compliance advisor and medical experts to assist with medical cost projections? <a href="https://manleyandassociates.com/contact/">Contact our team</a>.

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Manley &amp; Associates is an independent firm of attorneys and certified nurse life care planners serving the workers’ compensation and liability communities nationwide. Our firm assists counsel, insurance carriers, self-insured employers, and third-party administrators in settling workers’ compensation and liability claims while preserving the claimant’s Medicare eligibility.