Answers to Frequently Asked Questions about FCM
Have questions about field case management? From defining case management to defining the benefits to the injured employee, we’ve got you covered.
What is case management?
The most widely adopted definition for case management is “a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to facilitate an individual's and family's comprehensive health needs through communication and available resources to promote quality cost-effective outcomes.” Case Management Society of America (CMSA).
What types of case management services do you offer?
Genex offers field case management (FCM) and telephonic case management (TCM) services.
What is the difference between field case management and telephonic case management?
Both delivery systems can be effective but as a best practice, telephonic case management is used as an early intervention strategy, during the first 60 to 90 days post-injury or later in the claim to resolve a specific need. The idea being if you involve a TCM early in the claim they can help prevent it from becoming complex.
FCM is typically utilized on claims that are more complex in nature and need face-to-face intervention. Complex claims can be defined as a catastrophic injury/diagnosis or any claim that has complicating factors that may extend the disability duration or treatment beyond usual and customary guidelines.
Can a claim have both TCM and FCM services?
It is not unusual for a claim to have both TCM and FCM services.
Consider the following example: A telephonic case manager is having difficulty getting the treating provider to address return to work. The telephonic case manager sends a task assignment to the local field case manager to complete a job analysis (JA) of the employee’s regular job duties and associated physical demands. The field case manager completes JA and forwards it to the telephonic case manager. The telephonic case manager shares the job analysis with the provider and obtains a return-to-work release.
What are some common field case management services?
Field case management is typically either provided as a task-based or full assignment service. Common field case management services and their definitions are outlined in the following page.
How do I place a referral?
Genex offers several easy ways to place a field case management referral including phone, email, through Genex Case Connect, or by contacting your local Genex representative. Our central intake unit will take care of the rest. Check with your internal workflow for making referrals to FCM. Some clients have special portals or processes in place for making a referral.
How does case management benefit the injured employee?
- Facilitates timely and appropriate coordination of care, taking the burden off the injured employee and family
- Educates the injured employee on all aspects of their care so that they can make informed decisions
- Helps the injured employee set reasonable expectations around recovery
- Provides support and advocacy throughout the process
How does case management benefit the claims professional?
• Keeps the claims professional informed of all relevant medical and return-to-work plans and associated timeframes
• Decreases the dollars spent for both medical and indemnity payments
• Assists the claims professional in appropriate decision making
• Creates a positive working relationship between the claims professional, the injured employee, the employer, and the attorney (if involved)
• Provides an excellent resource for claim collaboration
How does case management benefit the medical provider?
- Expedites coordination of treatment plan
- Facilitates communication between all involved
- Provides support and education to the injured employee, supplementing the treating provider
How does case management benefit the employer?
- Communicates return-to-work (RTW) goals and timeframes
- Helps identify transitional or modified duty
- Communicates essential job duties and associated physical demands to the provider
- Coordinates RTW between the employer and injured employee
