Disclaimer: The answers to these questions can be found in the audio recording and in the course handouts and represent the opinion of the speakers.  They do not necessarily represent COA’s opinion or policy on the issue.

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1. Contact Information (Required.)

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2. Test Date (Required.)

Date

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3. SB 863 requires Medical Provider Networks (MPNs) to confirm with their network providers that they are willing to continue to participate in the MPN by January 1, 2016. (Required.)

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4. Carriers/self-insured employers have the exclusive right to choose providers for their MPN.  (Required.)

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5. Liens filed by providers who are criminally charged with Workers’ Compensation fraud, are automatically stayed pending the disposition of the criminal case. (Required.)

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6. The Division of Workers’ Compensation (DWC) doesn’t require the use of the MTUS Treatment Guidelines and Drug Formulary or any other guidelines for physicians treating Workers’ Compensation cases. (Required.)

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7. Only the Qualified Medical Evaluator (QME) or Agreed Medical Evaluator (AME) may examine the injured employee, and prepare and sign the report.  This includes:  a) taking a complete history, b) reviewing prior medical records, and  c) writing the report. (Required.)

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8. Causation of a disability is NOT a “complexity factor” under the Medical-Legal Fee Schedule. (Required.)

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9. The QME/AME should ONLY address causation of injury, if injury is denied AND if the parties have requested an AOE/COE evaluation. (Required.)

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10. An injured worker is entitled to a certified interpreter, if necessary, at defendant’s expense. (Required.)

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11. For any evaluation performed on or after July 1, 2013, regardless of the date of injury, a QME/AME shall not provide an opinion on any disputed medical treatment issue, but shall provide an opinion about whether the injured worker will need future medical care to cure or relieve the effects of an industrial injury. (Required.)

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12. QMEs must send in their report within 30 days of the Medical-Legal examination or the parties may request a replacement QME. (Required.)

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13. Supplementary Reports must be sent in within 30 days of request.  Parties may agree to 30 day extension. (Required.)

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14. A QME can effectively rebut the Combined Values Chart (CVC) by explaining how it was more accurate to use the Whole Person Impairment. (Required.)

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15. Disability duration is: (Required.)

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16. Return-to-work is dependent on: (Required.)

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17. Outcome measures include: (Required.)

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18. In a Medical-Legal evaluation, what does FACE to FACE time include? (Required.)

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19. According to the DWC’s most recent interpretation of the Medical-Legal laws, how does the QME/QME know if Causation is “in dispute?” (Required.)

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20. What factors may be considered in performing a Medical-Legal evaluation under the AMA Guides - 5th Edition? (Required.)

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21. If there is only one probable cause of injury, the QME/AME should not apportion an injury? (Required.)

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22. When a QME/AME determines the percent of the total causation, they must consider:  a) events of employment, b) past medical history, and c) family conditions. (Required.)

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23. If a physician opines that 50% of an employee’s back disability is caused by degenerative disc disease, the physician must explain:
  • The nature of the degenerative disc disease
  • How it is causing permanent disability at the time of the evaluation
  • Why it is causing permanent disability at the time of the evaluation
  • How it is responsible for approximately 50% of the disability, and
  • Why it is responsible for approximately 50% of the disability
(Required.)

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24. An exacerbation of an injury is a temporary worsening of a pre-existing condition with an increase in symptoms, signs, disability, and/or impairment. (Required.)

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25. An aggravation of an injury is a permanent worsening of a pre-existing condition with an increase in symptoms, signs, disability, and/or impairment. (Required.)

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26. Apportionment is not used as a complexity factor in a Medical-Legal report unless the patient is permanent and stationary. (Required.)

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27. To avoid problems should the DWC decide to audit the level of your Medical-Legal reports billed, it is advisable to get the parties to agree that the evaluation will be billed as a ML-104 prior to rendering the service. (Required.)

 

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