Dr. Mary Kneiser, the AANEM’s State Liaison for Michigan, has been educating claims adjusters since 2003. While the sources of fraudulent studies may change over the years, Kneiser’s message hasn’t: “It is important that we as physicians have open lines of communication with adjusters,” she explained. “Adjusters have a variety of experience levels and backgrounds, and when we are dealing with them we have to recognize that.” Kneiser hopes her audiences learn a sense of how to tell a quality study from a poor one. “We have to take the time to educate adjusters so they continue to value EDX studies in diagnosing patients,” she said. “In the workers’ compensation and automobile insurance areas, the current system puts adjusters in the key role of determining payment for services, and if we ignore that, it is at our patients’ peril.” Willing to venture into the evolving world of educational technology, Kneiser spoke with adjusters from AAA of Michigan last year through its first webcast. Participants tuned in from several states. She also recently spoke with the Michigan Academy of PMR and will be speaking at the Michigan Occupational Medicine Annual meeting this fall. Kneiser has served as a State Liaison since 2009, when the program began. She finds that the State Liaison Program provides a network of physicians focused on challenges in their state and that meeting allows them to problem solve together. “To be able to network with physicians with similar interests regarding quality issues is a piece that has been long overdue,” she said. “Our practices are so widely varied, but we have similar problems that allow us to help each other.” 06/10

Through the efforts of the AANEM’s State Liaison in New Jersey, Dr. Alexander Pendino, Highmark Medicare Services has corrected the Maximum Number of Studies Table included within its local coverage determination. Highmark was notified during the comment period in February that the table it included was not accurate and should be modified. The modifications were not included when the new policy was released earlier this year. Pendino spoke with Dr. Eileen Moynihan, Medical Director at Highmark Medicare, and discussed the inaccuracy. Ultimately, Pendino’s persistence resulted in a recent correction of the table. 12/09

Oklahoma State Liaison Dr. Tim Pettingell’s greatest concern in Oklahoma is “fraud and overutilization.” Pettingell, a physiatrist in Broken Arrow, kicked off a speaking tour that will end later this summer, educating case managers and adjusters about the value of quality EDX medicine. Pettingell reviews EDX medicine, the types of providers that should be performing and interpreting these studies, requirements of good quality studies, and parameters to identify fraudulent studies. He is targeting multiple insurers with the series, including the Case Management Society of America -- both the Tulsa and Oklahoma City chapters -- CompChoice, CompSource, WorkNET, Gemani, and AIG. His first engagement was with case managers at CBR Insurance, an Oklahoma workers’ compensation insurer. 06/10

In addition to Pettingell’s work educating case managers, he also has focused his efforts on the US Department of Labor. Initially, he was approached to provide a permanent impairment rating, and he conducted a full review of the injured workers’ records. Over the course of the review, Pettingell was frustrated by the degree of overutilization and the lack of scrutiny by the Department.
“Injured workers within the US Postal Service are a large share of the population that is overseen by the Department, but it seems that once a provider is approved, there is no further oversight as to the quality of the services,” Pettingell said. He continues working to make inroads into the Department of Labor and its EDX policies. Pettingell feels the State Liaison Program is necessary and valuable. “Physicians must protect their patients and ensure that the community and payers only accept quality studies,” he affirmed.