This is SEAK's most popular supplemental income course. Disability and file review consulting is a growing and lucrative medical-legal field which offers opportunities for physicians beyond the traditional medical-legal work of IMEs and expert witnessing. These opportunities are for physicians of wide ranging specialties for full time, part time, and work at home employment/consulting assignments. It is a perfect field for physicians who dislike testifying, travel, and confrontation and who wish to apply their expertise in a way different from IMEs and testifying. How To Start, Build and Run a Successful Disability and File Review Consulting Practice prepares physicians to excel in the niche of disability and file review consulting. Recommendations will be made as to the best way to solicit and obtain this work. It is taught by a highly-qualified faculty including thought leaders on both disability and utilization review. Upon completion of this course participants will have all the tools and knowledge needed to start performing high quality file reviews.
Includes:
- Almost 12 hours of streaming on demand instruction (1 year license);
- A highly detailed, 348 page handbook provided as both a PDF and hard bound copy (USA only on the hard copy);
- The names and contact information for 100 prime referral sources for file review work;
- A limited time special 50% discount on one new or renewal standard listing in SEAK's National Directory of Medical File Review Consultants;
- The ability to submit questions to SEAK;
- Feedback from SEAK on one of your file reviews;
- Private 15-20 minute phone call with SEAK to answer your submitted questions, follow-up questions, and to provide feedback on your submitted file review;
- Up to 11.75 CME Credits; and
- 30 Day Money Back Guarantee
Learning Objectives
At the completion of this streaming on demand seminar you will be able to:
• Determine the specific supplemental income opportunities available to you in Disability and File Review Consulting;
• Understand what a high quality file review consists of;
• Learn the key medical-legal disability issues;
• Understand the differing disability standards and contractual terms;
• Efficiently write concise file reviews with supportable opinions;
• Understand how to deal with issues such as:
• Functional ability
• Diagnostic tests
• Impacts of medications on ability to work;
• Market yourself directly and confidently to disability insurers and others looking for file reviews;
• Understand the effects of inactivity; and
• Appreciate the pros and cons of developing an independent consulting practice.
Course Content:
Introduction
The faculty is introduced and the goals of the course are explained, i.e. teaching you how to get started in file reviews and do this work at a very high level so that you can earn repeat business. Also included is a discussion of what it takes to succeed as a file reviewer and how this work will make you a better clinician for your patients.
Disability vs. Medical File Review Consulting: Compared, Contrasted, & Explained
Medical file reviews and disability reviews are compared and contrasted with and to IMEs. Different approaches the physician reviewer will take to succeed in each area are provided. Discussion will also cover the clinical review skills applicable to file & disability review work, the nuts and bolts of file & disability review work, and the typical questions medical file review physicians will be assessing.
Medical File Reviews: Evidence-Based Analysis
A discussion of the shift from clinician to evidence and documentation-based analysis that is critical for a physician to be successful at file review work. Discussion will also address the facts, data, and definition restrictions that are typically relevant to performing high level utilization reviews, pre-authorizations, chart reviews, and medical necessity reviews. Sample reviews are analyzed.
Writing Excellent Physician File & Disability Reviews
You will learn a protocol and style physicians can utilize to write high quality file and disability reviews. Included is a discussion of efficiency, conciseness, red flag words to avoid, formatting, attestation, and how to express your opinions properly dealing with the weight of the evidence, collateral evidence, and support with objective facts/data.
Case Studies: Medical File Reviews
Four practice file review case studies that you can complete: an ER visit, cancer treatment, and two surgical authorizations. Each case study is discussed and explained.
How to Succeed as a File Reviewer
An explanation of how file review work is used in the healthcare industry and the life cycle of a UR case is followed by advice on how to efficiently conduct reviews and tips for success in peer to peer calls. Insight on the lifestyle benefits of file review work is provided.
Medical Necessity File Review: Opportunities and How to Succeed
An explanation of the structure of the multi-billion dollar file review industry and the significant opportunities for physicians within this industry. UM process flow and the role of Independent Review Organizations (IROs) are explained. Advice for how to excel at medical necessity reviews and how to meet or exceed client expectations are provided.
Medical Necessity Reviews: A Proven Process To Produce High Quality Reviews, With Examples
The three types of medical necessity reviews are explained (prospective, retrospective, and concurrent). You will learn the techniques for doing reviews at both high quality and high volume. Discussion includes the parts of a high-quality review and using guidelines such as InterQual and MCG. A broad range of example reviews are discussed (inpatient stay, urine drug test, PT, opioid, durable medical equipment, gene testing, and Cologuard DNA analysis).
How to Conduct an Effective Peer to Peer Call
Tips and tricks to conduct effective and productive peer to peer calls with providers. Advice is provided to diffuse potential antagonism, establish collegiality with providers, and properly document your calls and attempted calls. Sample P2P call recordings are analyzed and discussed.
Disability Consulting for Physicians
An introduction to the field of disability consulting including legal issues, the medical and collateral information that is commonly considered, what to look for in the records, how to get better information than the treating physicians, and multiple ways to evaluate functional ability. The fundamental concepts of capacity, risk, tolerance, impairment, limitations, and restrictions are explained and demonstrated. The use of medical and pharmacy records, lab data, surveillance videos, and social media in the file review process is explained.
Disability Contracts: What you need to know
Disability is a legal, not a medical term. In this section you will learn to understand the key terms in disability contracts, including any occupation, own occupation, pre-existing conditions, reasonable and appropriate care, and limitation clauses. The important differences between Group (ERISA) and Individual Policies is explained. Examples are provided.
Red Flags
A review of the potential red flags that physicians doing reviews want to be aware of, their significance, and how to deal with them. Examples include psychosocial issues, pain conditions, doctor shopping, psychiatric conditions, substance abuse, and disciplinary problems.
Medication and Diagnostic Testing
A discussion, with examples, of the role that specific types of medications have on activity restrictions, including dosing, side effects (such as fatigue and drowsiness), and cognitive impairment. Also included is advice on value and limitations of diagnostic testing for disability reviews and an analysis of how the inability to drive (e.g. due to medication side effects) does or does not create disability.
Reasonable and Appropriate Care & FAQs
An explanation of the reasonable and appropriate care requirements and the difference between reasonable and appropriate care vs. regular care. Frequently asked questions regarding disability reviews will be answered.
Disability Opinion Case Reviews
A review and discussion of five complex disability review opinions. Each case includes the diagnosis, questions posed, clinical findings and collateral information, and the answers to the questions posed.
Critiques of Reviews & Avoiding Mistakes
The faculty provide comments on the good and not so good on a variety of sample file reviews including short term disability, long term disability, medical necessity, and veterans' benefits. In addition, a bullet point list of the biggest mistakes file reviewers make is presented and suggestions for avoiding these mistakes are provided.
Marketing
A practical discussion of how to obtain high quality work, what insurance companies are really looking for, and making yourself desirable will be led by the faculty.
BONUS: The attendees will be provided with the names and contact information for 100 prime referral sources for file review work. Recommendations will be made as to the best way to solicit and obtain this work.
Ethics
A frank discussion of the potential ethical challenges faced by physician disability and file review consultants including maintaining your credibility and effectiveness, always being able to defend your findings and never having to say you are sorry.
Practice Settings for Physicians
A discussion of the type of file review consulting practices available to physicians (in-house vs. independent) will be presented and the advantages and disadvantages of each will be explained. The faculty discusses how to start and run a file review consulting practice, working as an employee, and how to find and maintain high quality work.
Course Curriculum
- Introduction (20:48)
- Disability vs. Medical File Review Consulting: Compared, Contrasted & Explained (42:29)
- Medical File Reviews: Evidence-Based Analysis (28:24)
- Writing Excellent Physician File & Disability Reviews (52:56)
- Case Studies: Medical File Reviews (40:30)
- How to Succeed as a File Reviewer (72:23)
- Medical Necessity File Review: Opportunities and How to Succeed (41:13)
- Medical Necessity Reviews: A Proven Process to Produce High Quality Reviews, With Examples (54:54)
- How to Conduct an Effective Peer to Peer Call (59:01)
- Disability Consulting for Physicians (51:45)
- Disability Contracts: What You Need to Know (33:32)
- Red Flags (10:12)
- Medication and Diagnostic Testing (32:58)
- Reasonable and Appropriate Care & FAQs (9:20)
- Disability Opinion Case Reviews (43:19)
- Critiques of Reviews & Avoiding Mistakes (29:07)
- Marketing (52:22)
- Ethics (23:52)
- Practice Setting for Physicians (15:48)
Faculty:
Steven Babitsky, Esq. is the founder and the president of SEAK, Inc. He is the co-creator of the course: How to Start Build & Run a Successful Disability & File Review Course. He taught this course for 8 years before turning over his faculty spot to Attorney Nadine Nasser Donovan. When he was practicing law he represented physicians and others applying for disability benefits. Steve has had the opportunity to teach writing disability reviews to physicians across the United States. He has worked with insurance companies helping them to educate their physician reviewers. Attorney Babitsky also consults with physicians wishing to start or expand their file and disability review practices.
Stephen Broomes, MD is a board certified internist who has over twenty years clinical experience as a hospitalist. Dr. Broomes earned his BS at Morehouse College and his MD at Morehouse School of Medicine. He has extensive file review experience as a result of developing relationships with independent review organizations and big insurance companies. He recently transitioned to becoming a part time Medical Director for two large companies. Dr. Broomes is an alumnus of SEAK training.
Nadine Nasser Donovan, Esq., is a former medical malpractice defense attorney. She has been on the SEAK Faculty since 2002. She is a faculty member of the in-person course, How to Start, Build, and Run a Successful Disability and File Review Practice. Nadine has trained countless physicians in writing effective medical opinion reports at SEAK conferences, and via customized training and mentoring. Nadine is the co-author of the SEAK text How to Write an Expert Witness Report. Nadine is also a Legal Writing Instructor at Boston University School of Law. She spent 21 years practicing litigation, as a medical malpractice insurance defense attorney and previously, as a NYC prosecutor. Nadine received her J.D. cum laude from Boston College Law School. She graduated from Fordham University summa cum laude with a B.A. in French Literature. She can be contacted at 617-791-4282 or [email protected].
Julia Pewitt Kinder, DO is a Board Certified Family Medicine Physician, National Speaker, Author, and Career Consultant. She has served as Medical Director for several national health plans. In 2013, she began consulting with health insurance plans in the areas of utilization management, healthcare quality assurance, policy development, population health, and regulatory compliance. She has collaborated with state and national health plans, and has experience within the commercial, Medicare, and Medicaid arenas. Dr. Kinder has performed various types of medical necessity reviews, including determinations for facility level of care, durable medical equipment, speech and occupational therapy, home health, pharmacy benefits, surgical procedures, and genetic testing.
Dr. Kinder’s expertise in communication skills combined with knowledge of the healthcare industry outside of clinical practice allow her to guide colleagues who are considering a career in file review and utilization management.
Visit www.physiciancareeropportunities.com for additional information.
Alan Neuren, M.D. graduated from Bowdoin College in Maine where he majored in biology. He obtained his medical degree from the Medical College of Georgia in 1972. After completing a residency in psychiatry at the University of Connecticut, he spent two years on active duty in the United States Navy at the Naval Submarine Medical Center in Groton. Subsequent to discharge, he completed another residency in neurology at Albany Medical Center in Albany, NY. During the 1980’s he was in private practice in Ft. Worth, TX where he also served as a medical director for an inpatient rehabilitation unit. He was recalled to active duty during Operation Desert Storm and served at the Naval Hospital in San Diego holding the rank of Commander. In 1993 he returned to private practice in Maine until 2001 when he was offered a job as vice-president medical director at Unum. Dr. Neuren worked full time at Unum for five years. He left to work as a private contractor full-time, reviewing disability claims for various companies including DRMS, Unum, Prudential, Mutual of Omaha and UDC until he retired in 2018. During those seventeen years, he reviewed thousands of claims. Dr, Neuren is board certified in both neurology and psychiatry and is a Fellow of the American Academy of Neurology.
Sample Course Clips:
Disability Reviews for Physicians - Diagnosis Does not Equal Disability.
A Report Writing Exercise For Physicians who Perform Disability Reviews
How a Physician Can Write an Excellent Disability and File Review
How a Physician Can Market Their Disability and File Review Practice.
How to Document an Effective Peer to Peer Call
Continuing Medical Education Information
SEAK, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. SEAK, Inc. designates this enduring material activity for a maximum of 11.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This enduring material activity was originally released on November 10, 2020. This enduring material activity was reviewed on July 31, 2023 and terminates on July 31, 2026.
What Past Participants Have Said:
“I took both the expert witness and file review on-line trainings and they have been game changers for my semi-retirement! I learned so much from these courses and was able to immediately start an expert witness and file review business and within a month after signing up to be listed in the SEAK directories for both services I was contracted with three file/disability review companies and retained by two law firms as an expert witness for two cases! The best money I have EVER spent on my education and career outside of medical school. I am thrilled!"
“Focused, efficient introduction to subject.”
“Opened up a new way of thinking for me - I’m ultra impressed!”
“Well organized and polished.”
“Fantastic! Lively and engaging with a tremendous amount of information.”
“Outstanding! The wisdom of the staff is priceless.”
“Excellent topic with highly applicable practices to both clinical and non-clinical setting.”
“Thank you! I intend to pursue file review as a career immediately. I’ve been doing IME’s for about four years and have developed an interest in the medical-legal field. Your training was my missing link and I’m confident I will be able to move forward. I couldn’t be more grateful!”
“Excellent course. Putting the different aspects of file and case review into perspective with regard to the health industry and opportunities for physician consultants was very enlightening.”
“[The course] was fantastic. I’m definitely going to try to do a few reviews now and thank you for giving me the tools to do so!”
“Thank you for your hard work. I enjoyed the weekend. It was my 4th or 5th SEAK course and they have all been very helpful.”
“Outstanding!”
"A great introduction to get started in the medical file review profession."
“Phenomenal – should be a requirement for all physicians who perform file reviews. The instructors were superb – bright, experienced, excellent presenters, practical, and humorous.”
“A very informative seminar. I learned a lot about a source of revenue that I had not previously been aware of.”
“Very informative and practical.”
“Well organized with highly experienced staff”
“Excellent, stimulating, useful, very helpful”
“Lots of content, thank you”
“Excellent, enjoyed all faculty very much. Found [case studies] especially helpful”
“Very informative and practical. Makes me feel prepared to start a disability review career”
“Awesome”
“Very good, taught by very experienced faculty”
“Well organized, packed with info”
“Stimulating and challenging”
“Excellent very informative”
“[Learned the] wide range of possible opportunities in this field”
“Excellent instruction in proper format, writing style for reviews”
“Presenters were experts in their field”
“Excellent presentation, kept my interest, clear and practical. Generous with tips – I so appreciate”
“Excellent all around”
“In the past 18 months, the SEAK Medical File Review Directory has generated over 300 referrals, which has resulted in $100,000 in business. Thank you!”
“From your Directory, I have been contacted by about 5 companies, each company has requested between 200 – 600 chart reviews”
“I was listed in the SEAK File Review Directory for a year, and in addition to offers for “prn” case review work, a company called about a job which, full time, would pay $200,000 plus benefits, and part time, 3 days per week, $120,000 plus benefits.”
“I have gained at least four new business clients from the directory. Two of which are using my services frequently! I wish I would have listed with SEAK years ago when I was developing my consulting business. Thank you!”
“I am now doing a fairly brisk file review business, thanks in part to your course and Directory. I have cut down my clinical practice to about 50%, and no longer do inpatient work…whew!!!”
Additional Supplemental Income Courses from SEAK
Contact SEAK, Inc.: 508-457-1111 [email protected] PO Box 729 Falmouth, MA 02541 www.seak.com