Managing Medical Claims

Training Manual Table of Contents

Section One: Medical Terminology
Prefixes 2
Exhibit 1.1 – Prefixes 2
Root Words 

2

Exhibit 1.2 – Root Words 3
Suffixes 5
Exhibit 1.3 – Suffixes 5
Aspects or Positions on the Body 6
Exhibit 1.4 – Aspects or Positions on the Body 6
Medical Abbreviations and Emergency Room Symbols 6
Exhibit 1.5 – Symbols/Abbreviations 6
Medical Professional  8
Exhibit 1.6 – Medical Professionals 9
Abbreviations Used With/For Medical Professional 9
Exhibit 1.7 – Medical Professional Abbreviations  10
Strains and Sprains  10
Exhibit 1.8 – Sprains and Strains 11
Workshop 1.1 – What’s It Mean?  12
Section Two: Fractures and Their Treatment
Types of Fractures 16
Exhibit 2.1 – Types of Fractures  17
Exhibit 2.2 – Common Fractures  18
Symptoms of Fractures  18
Complications 19
Exhibit 2.3 – Fracture Complications  19
Treatment  20
Exhibit 2.4 – Treatment of Fractures  20
Disability Periods  21
Workshop 2.1 – Fractures and Their Treatment 23
Sections Three: Injuries to the Head
Fractures 25
Exhibit 3.1 – Head Injuries Disability Chart 26
Exhibit 3.2 – The Skull 27
Skull Injuries  27
Exhibit 3.2 – Level of Cognitive Functioning Scale  29
Workshop 3.1 – Head Injuries  31
Section Four: Injuries to the Upper Extremities
Exhibit 4.1 – The Upper Extremities 33
The Hand 33
Exhibit 4.2 – The Hand  34
Carpal Tunnel Syndrome 34
The Shoulder  36
Exhibit 4.3 – Anterior View of the Shoulder 37
Chest and Rib Injuries  37
Thoracic Outlet Syndrome 38
Workshop 4.1 – The Upper Extremities 40
Section Five: Injuries to the Spine
Terminology 42
Exhibit 5.1 – Spinal Terminology 42
The Spinal Column 43
Exhibit 5.2 – Regions of the Spine 43
Exhibit 5.3 – Lateral View of the Spine 44
The Cervical Spine 44
The Dorsal/Thoracic Spine 44
The Lumbar Spine 45
Exhibit 5.4 – Superior and Lateral Views of a Lumbar Vertabra  45
The Dermatone Chart 45
Exhibit 5.5 – Dermatone Chart 46
Other Spinal Injuries  47
Exhibit 5.6 – Spinal Fractures  47
Severe Injuries to the Spine  48
Treatment for Spinal Cord Injuries  49
Reflex Sympathetic Dystrophy Syndrome (RSDS) 50
The Nervous System  51
Workshop 5.1 – Back Injuries 52
Section Six: Injuries to the Lower Extremities
Exhibit 6.1 – The Lower Extremities 60
The Femur 60
The Ankle 60
Exhibit 6.2 – Posterior View of the Knee 62
The Knee  62
Exhibit 6.3 – Common Knee Injuries  62
Exhibit 6.4 – Treatment of Knee Injuries  63
Exhibit 6.5 – Anterior View of the Knee 64
Exhibit 6.6 – Cartilage of the Knee 64
Exhibit 6.7 – Ligaments of the Knee 65
Workshop 6.1 – Injuries to the Lower Extremities 66
Section Seven: Scarring
Anatomy of the Skin 67
Exhibit 7.1 – Cross Section of the Skin  68
Injuries that Produce Scarring 69
Exhibit 7.2 – Injuries that Produce Scarring 69
Types of Scars 70
Treatment for Scars 71
Exhibit 7.3 – Treatment for Scars 71
Treating Scars 71
Exhibit 7.4 – Scar Revision Techniques  72
Evaluation Scar Cases 72
Scars and Revision Techniques 75
Section Eight: Diagnostic Testing
Common Lab Tests and Clinical Procedures 78
Exhibit 8.1 – Common Tests and Clinical Procedures 78
Tests for Head Injuries 79
Exhibit 8.2 – Tests for Head Injuries 79
Other Tests/Procedures 80
Exhibit 8.3 – MRI and CAT Scan Comparison 82
Workshop 8.1 – Performance Tests 85
Section Nine: Temporomandibular Joint Injuries
Exhibit 9.1 – The Jaw Joint 91
What Is TMJ? 91
What Causes TMJ? 92
Symptoms of TMJ 92
Treatment  93
Reviewing TMJ Claims 94
Length and Cost of Treatment  95
Workshop 9.1 – TMJ 97
Section Ten: The Teeth
Deciduous and Permanent Teeth 98
Exhibit 10.1 – Anatomy of a Tooth 99
Exhibit 10.2 – Deciduous Teeth 99
Workshop 10.1 – The Teeth  102
Section Eleven: Independent Medical Exams
What Is An IME?  103
How Are IME’s Used? 104
Before You Consider an IME: Some Considerations 104
Timing  105
Suggested Guidelines for Ordering an IME 105
Workshop 11.1 – IME’s  107

Workshop 11.2 – Critical Review of an IME 

109
Section Twelve: Rehabilitation
A Three Component Process 112