2022 QME Test California Orthopaedic Association Disclaimer: The answers to these questions can be found in the audio recording, in the course handouts, and represent the opinion of the speakers. They do not necessarily represent COA’s opinion or policy on the issue. Question Title * 1. Contact Information Full Name and Title * Email Address * Phone Number Question Title * 2. Test Date Date Date Question Title * 3. How many district offices does the CA Workers' Compensation System have? A) 16 B) 24 C) 36 Question Title * 4. How many Workers’ Compensation hearings occur in CA each month? A) 5,000 - 6,000 B) 10,000 - 12,000 C) 16,000-18,000 D) 22,000-24,000 Question Title * 5. The total number of CA Workers’ Compensation claims in 2021 was approximately: A) 250,000 B) 660,000 C) 880,000 D) 1,000,000 Question Title * 6. Average medical payments per claim with more than 7 days of lost time has been approximately stable since 2015. A) True B) False Question Title * 7. The total number of Independent Medical Review (IMR) applications for treatment issues has declined almost ________ between 2019 and 2021. A) 25% B) 33% C) 50% D) 75% Question Title * 8. The % of IMR claims deemed ineligible remained fairly constant between 2019-2021. A) True B) False Question Title * 9. Reasons for ineligibility include: A) No signature B) Untimely filing C) No Utilization Review (UR) report attached D) A and B E) A, B and C Question Title * 10. The evaluator may use the COA Medical-Legal template as a checklist to help ensure completeness of their report. A) True B) False Question Title * 11. IMR upheld UR decisions regarding surgery approximately _____ of the time. A) 20% B) 50% C) 75% D) 90% Question Title * 12. The new Medical Legal Fee Schedule (MLFS) became effective: A) 1/1/2021 B) 2/1/2021 C) 4/1/2021 D) 6/1/2021 Question Title * 13. The new Medical-Legal Fee Schedule added several new complexity factors to the billing process. A) True B) False Question Title * 14. The Division of Workers' Compensation has developed an instructional course for QMEs. A) True B) False Question Title * 15. The new Medical-Legal Fee Schedule increased reimbursement for medical legal testimony in depositions. A) True B) False C) True but only for injuries after 6/1/21 Question Title * 16. The new Medical-Legal Fee Schedule created a new mediation system for disagreements about payment for missed appointments. A) True B) False C) True but only for injuries after 6/1/21 Question Title * 17. When reporting the number of pages reviewed for a ML 201 medical legal report, include in the count: A) Fax Cover Sheets B) Proof of Service C) Medical test results D) A and B Question Title * 18. What records can be provided to the QME? A) Records prepared or maintained by the treating physician B) Non-medical records that are relevant to determine a medical issue C) Records of prior injuries more than 20 years old D) A and B E) All of the above Question Title * 19. Are post-termination claims allowed under California's Workers' Compensation system? True False Question Title * 20. An AME musculoskeletal evaluation is billed at 25% more than a QME evaluation. A) True B) False C) True, but only for evaluations after 6/1/21 Question Title * 21. If a deposition is canceled less than 8 calendar days before it is to occur, the QME may still bill for a minimum of 2 hours. A) True B) False C) True for injuries after 6/1/21 Question Title * 22. Review of medical records is not important under the definition of substantial medical evidence. A) True B) False Question Title * 23. It is sufficient for the QME to only state the conclusions of their evaluation of the injured worker in their Medical-Legal report? A) True B) False Question Title * 24. An orthopaedic evaluator is required to spend at least 20 minutes in the evaluation of an injured worker. A) True B) False Question Title * 25. Can the evaluator contact the treating physician to receive missing medical records? If records are received, the evaluator must also provide the records to all parties. A) True B) False Question Title * 26. Can an attorney or their staff attend and record the evaluation? Their attendance must be documented in the Medical-Legal report. If this is the case, may the evaluator also record the session to avoid any discrepancies? A) True B) False Question Title * 27. Another health care provider can perform the hands-on evaluation of the injured worker? A) True B) False Question Title * 28. Substantial medical evidence means that conclusions are based on clinical judgements that are: A) Reasonable B) Credible C) Of solid value D) B & C E) All of the above Question Title * 29. Cumulative TraumaOne definition of a Cumulative Trauma (CT) injury date is the date: A) The case was filed with the DWC B) The date there was a concurrence of disability and knowledge C) Neither of the above D) Both A and B E) All of the above Question Title * 30. Under the Guzman cases there is no need to calculate the strict impairment under the AMA Guides 5th edition because it is inaccurate. A) True B) False C) Only for cases after 6/1/21 Question Title * 31. An objective diagnosis in the CA Workers’ Compensation system is one using metrics confirmed by: A) The Centers for Disease Control B) The California Department of Public Health C) Medical criteria accepted by national standards Question Title * 32. How many kinds of causation are there in CA Workers’ Compensation cases? A) 4 B) 6 C) 8 D) 10 E) 12 Question Title * 33. ApportionmentApportionment in CA Workers’ Compensation is focused on: A) Causation of the injury B) Causation of the impairment Both A & B Question Title * 34. Given that injured workers cannot choose their parents, can genetic factors be used to apportion impairment? A) Yes B) No Question Title * 35. In the Lindh case the Court of Appeals ruled that apportionment was valid for preexisting risk factors. A) True B) False Question Title * 36. The Justice case concluded that “directly caused” means that “indirect causes” cannot be used for analyzing causation. A) True B) False Question Title * 37. To maintain consistency, it is appropriate for orthopedic QMEs to use the same apportionment in their disability reports as was used by an internist regarding the same injured worker. A) True B) False Question Title * 38. BiasBias is defined as a tendency for a physician to favor one viewpoint over another without medical facts to back up the conclusion. A) True B) False Question Title * 39. Unconscious bias can be impacted by the order in which the medical information is presented in the patient's record. A) True B) False Question Title * 40. Other common types of bias in medical evaluations include anchoring bias, confirmation bias, and momentum bias. A) True B) False Question Title * 41. Assessment of impairment in the hand and upper limb requires the evaluating physician to confine his/her assessment to the tables and figures in Chapter 16 of the AMA Guides before considering the combination chart. A) True B) False Question Title * 42. Which other impairments can be combined with impairment for Carpal Tunnel Syndrome? A) Grip Loss B) Loss of wrist motion C) None of the above. Done