Greater Than or Equal To: Percentiles and RateFast

A percentile is a value below which a percentage of data falls.

This means that if you are in a group of 10 people, and you are the 9th tallest at 6 foot 5 inches, then 6′ 5″ is the 80th percentile height in your group. Note that the value falls below your point in the data set.

It is difficult to dispute the numbers when they are on paper, but what happens when there is a dispute about how that data is organized?
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Common Objections to Workers’ Comp Reports: Examination

This article is part of a series on the top reasons why insurance carriers object to a workers’ compensation report and return it to the medical practice unpaid. This article is intended for medical providers, administrative staff, office managers, as well as insurance claims adjusters.

This is now the fourth in our series of Common Objections to Workers’ Comp Reports. If you haven’t already, read the previous articles on History of Symptoms, Activities of Daily Living (ADLs), and Prior Injuries.

Not everybody can do the splits, but your injured worker used to be able to get pretty close. Maybe they can’t go as far now because their range of motion in their left hip has been limited due to an injury at work. In fact, the key to measuring how much they can do the splits now lies in how far the injured leg moves from the hip as compared to the uninjured leg. This gives a crude idea of the examination in workers’ comp.

Failing to perform the examination according to the rules laid down in the AMA Guides 5th Edition gives the insurance carrier a great reason to object to your report, and the impairment rating that’s based on. Even if the insurance carrier accepts a report with an incomplete exam, the impairment rating is likely to be either too high or too low, which is bad news for at least one of the stakeholders.

Failure to document an exam correct on the report is setting yourself up to have a QME called. Take it from us: it’s better for everybody if the primary treating physician gets the exam right the first time.

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Locked Out? How to Unblock Your RateFast Account

This post is intended for RateFast users who have been blocked out of their user account. If you are a RateFast admin and want to know how to unblock somebody else’s account, read this other article. Last updated on August 17th, 2017.

Introduction

Were you happily going about your day, minding your own business, logging into RateFast—and then you got hit with this message?

Your account has been blocked. Please call practice account administrator for further assistance.

account blocked

Argh!

But not to worry. This message may be scary and red, but this blog post is here to help.

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How to Reset Somebody’s RateFast Password If They’ve Been Blocked

This post is intended for RateFast admin users who want to reset passwords for other users. Last updated on July 28th, 2017.

Introduction

People forget passwords.

If somebody in your organization forgets their RateFast password, hopefully they can reset it themselves by clicking the “Forgot Password?” button on the login screen and answering their security questions.

…but, of course, people forget the answers to their security questions too.

Life sure is complicated—but don’t worry: as a RateFast admin, you have the power to reset your colleague’s password so they can get on with their day.
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Common Objections to Workers’ Comp Reports: Prior Injuries

This article is part of a series on the top reasons why insurance carriers object to a workers’ compensation report and return it to the medical practice unpaid. This article is intended for medical providers, administrative staff, office managers, as well as insurance claims adjusters.

We have now covered two reasons that an insurance claims adjuster may object to your impairment PR-4 report: First, due to an incomplete history of symptoms, and second, because of an incomplete activities of daily living (ADLs).

It is the intention of the claims adjuster to be skeptical about any and all things that can set off red flags in the review process of your reports. Should they find any documentation regarding a previous claim, the insurance company will go through the worker’s history of injuries in the workplace with a fine tooth comb to ensure that the current injury is not a result of symptoms of a prior injury.

Reason #3: Prior Injuries

If an employee gets hurt at work, the patient’s previous medical history may be relevant to the claim.

For example, imagine that someone has had back pain for a long time due to a childhood injury. Then she gets a job. One day while at work, she falls off a ladder and hurts her back even more.

The physician’s work comp report should include information not just about the current injury—the falling off the ladder incident—but also about the previous injury.

Why?

Well, the patient has symptoms—back pain, inability to sit for long periods of time, difficulty dressing—but it’s possible that some or all of these symptoms existed before the work-related injury. The question becomes—which symptoms were caused by the work-related injury? Which symptoms existed previously, but are now worse due to the work-injury? Make sure to listen very carefully when taking your patient’s history.

These questions are all oriented around the one central question: what was the patient’s life like prior to the injury?

When it comes time to write the impairment report and calculate the impairment rating for the injury, information about all previous conditions will be critical for calculating apportionment—but that’s a different story.

For now, the important thing to remember is that the history of any injuries affecting a body part that has been injured at work should be included in workers’ comp reports. If the claim’s adjuster is reviewing a report on an employee’s spine injury, and the adjuster knows that the patient’s spine had been previously injured but doesn’t see any information about that prior injury in the report, it will raise a question: how much of the symptoms are caused by the work injury?

The goal is to answer that question before the adjuster can ask it. This way, there will be no reason for the insurance carrier to deem your report incomplete.

Note that the prior injury is only applicable to the specific body part injured in the current impairment report, e.g., a prior injury to the left arm is not applicable to an injury in the right leg.

In your workers’ comp report, include a section for each prior injury that is relevant to the claim. In RateFast, information about prior injuries is automatically presented under a “Medical History” heading, and organized by each body part. Information should include how any prior injuries affected the patient’s ADLs, whether there was surgery, medications currently being taken for the prior injury, and so forth.

Here’s an example of a decent description of a prior injury:

Employee reports that her cervical spine was injured in a car accident when she was 12 years old. Symptoms included limited mobility (range of motion unknown) and pain. Prior to work-injury, took 300 mg ibuprofen daily. ADLs impacted: sleeping (caused patient to wake up) and driving (difficulty turning neck).

Here’s a poor description of a prior injury that is likely to raise questions in the insurance adjuster’s mind:

Employee reports that her cervical spine was injured.

But the worst description of all is no description. Always ask about prior injuries, and take detailed notes.

In Conclusion

In an impairment report, the description of prior injuries should be like a miniature report in-and-of itself. The physician must work with what he/she has in order to ensure that the prior injuries are thoroughly and accurately described. It may be difficult to obtain a detailed record of an injury from many years ago, but if the information about prior injuries doesn’t satisfy the claim’s adjuster, then the report may be returned—unpaid and with questions.

How to Make a Correction or Add an Addendum to a RateFast Report

This post is for RateFast users who want to make a correction, fix a typo, or add additional content to a RateFast report that has been closed and signed.

Picture this: a provider has reviewed and signed the RateFast report. The report is now closed and can no longer be edited.

But wait. There’s a typo.

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Common Objections to Workers’ Comp Reports: Incomplete Activities of Daily Living (ADLs)

This article is part of a series on the top reasons why insurance carriers object to a workers’ compensation report and return it to the medical practice unpaid. This article is intended for medical providers, administrative staff, office managers, as well as insurance claims adjusters.

In our previous post of this series, we discussed the history of symptoms in the doctor’s impairment PR-4 report. The following section covers the next step in the subjective complaints category.

You are facing the possibility that your report could be returned, possibly for the second time, and it is very important to you and your patient that you cross your t’s and dot your i’s so that you make this as timely of a process as possible. Like anything else, taking a few moments to take extra care can save your hours or even days of trouble in the future.

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Common Objections to Workers’ Comp Reports: Incomplete History of Symptoms

This article is part of a series on the top reasons why insurance carriers object to a workers’ compensation report and return it to the medical practice unpaid. This article is intended for medical providers, administrative staff, office managers, as well as insurance claims adjusters.

You’re at the clinic and you receive a fax or a letter from an insurance carrier related to an impairment PR-4 visit with a workers’ comp patient

Payment for the visit? Not quite.

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Automation Is Coming to Workers’ Compensation: Could Your Job Be Done by a Robot?

“We are coming closer to the point where not only cashiers but surgeons might be at least partially replaced by A.I.,” said former Federal Reserve Chairman Ben Bernanke in a recent interview.

The rapid integration of automation in all industries is undeniable. The surprising news is that there are many jobs that have traditionally required an expert—a highly trained human professional—that can be better performed by robots, at least in part.

Workers’ compensation is no exception. As the sun sets on the age of the expert and rises on the age of the machine, workman’s comp is a critical example of a field that will benefit from automation.

Continue reading Automation Is Coming to Workers’ Compensation: Could Your Job Be Done by a Robot?