Effects of Medication and Impairment Rating

Posted , updated on

How the AMA Guides 5th Edition approaches impairment is complex, and accurate impairment ratings are tricky as a result.

For example, many medical providers don’t realize that the effects that medication has on an injured worker can actually change the worker’s impairment rating. This is defined on page 600 of the AMA Guides.

With page after page of definitions and tables, little details like these can easily be glossed over. We designed RateFast so that you don’t need to spend your time reading and re-reading the Guides. If you use RateFast to write your California PR-4 reports, then our software will prompt you with easy-to-answer questions about the effects that medication has on your patient.

But it’s still important to understand how the effects of mediation impact a worker’s whole person impairment. Here are a few key facts:

  1. “Effects of medication” are defined on page 600 of the AMA Guides, 5th Edition: “Medications may impact the individual signs, symptoms, and ability to function.”
  2. If an injured worker is affected by the medication he or she takes for the work-related injury, then the physician may choose to increase the impairment by small amount—between 1% and 3%. (Frustratingly, the AMA Guides do not give specific instructions on how to do this.)

So imagine that your patient has reached MMI for an injury to the low back. Let’s say that she is assigned a DRE category II and given a 5% WPI.

Now, imagine that the muscle relaxant she has been prescribed causes excessive drowsiness and limits her ability to drive. Is she eligible for an increased whole person impairment rating? Yes. The muscle relaxant has affected her life by limiting her ability to drive.

The moral of the story: if you’re a medical provider, make sure to ask your patients if their medications cause any side effect. It could make a real change in their impairment rating.

If you need help remembering to ask if medications are affecting your patients symptoms, try RateFast today for free. This question is built into our patient history questionnaire and our impairment calculations.

Increase Your Impairment Rating Accuracy

Posted , updated on

Understanding impairment is essential to workers’ compensation cases. Without a working definition of how the AMA Guides approaches impairment, accurate impairment ratings are impossible to assign or review. If you are working in the world of California workers’ compensation then you understand how complex impairment rating can be.

If you don’t have a thorough knowledge of how ratings are assigned in accordance with the AMA Guides then the accuracy of your permanent and stationary reports may be suffering. This leads to delays in patient care as well as extra work for you and your staff. 

Impairment severity, functional limitations and regional impairments… there’s a lot to wade through. Fortunately there’s a simple explanation for all of these moving parts. To learn more about the whole body approach to impairment simply follow RateFast’s easy walkthrough. How does the AMA guides fifth edition approach impairment? There are only 6 facts to keep in mind:

  1. The impairment severity reflects resulting in functional limitations.
  2. Most chapters report impairment as a whole person impairment units.
  3. Upper and lower extremity chapters have a regional impairments to assign additional weighted value to the specific areas of the arms and legs.
  4. Chapter 16, the upper extremities report sub impairment at the levels of digits, hand, and upper extremity.
  5. Chapter 17 the lower extremities report sub impairment at the levels of foot and lower extremity.
  6. Regional impairments of the spine are weighted accordingly to contribution of function.

So let’s say there’s a 52-year-old right-hand dominant labor worker sustained an amputation to his right thumb at the MP joint (40% HI), and the right small finger at the MP joint (10% HI).

Why is there such a big difference in impairment values? Using the organ system and whole body approach to impairment, the thumb is given four times the value as the little finger for functionality importance. Remember, The Guides 5th edition gives relative weights to organs and body systems. A keen understanding is critical to creating and reviewing accurate and reproducible impairment reports

Try RateFast Express today!

How to Request Authorization for Treatment

Posted , updated on

If you are a medical professional working in California workers’ compensation, then you will probably need to prescribe treatment or diagnostic testing for your patients.

When you’re working in California work comp, all treatment, testing, and other medical services must be authorized by the employer’s insurance administrator. To request authorization, you need to submit a Request for Authorization (or RFA). The RFA is a written request for treatment, diagnostic testing or other medical services for the injured worker.

Anybody can fill out a form. But it takes a true professional to complete an RFA form with all the information that insurance administrators need.

If you don’t complete an RFA form correctly, then your treatment authorization may be delayed, or not approved at all.

But you can easily submit a RFA that will give insurance administrators all of the information they need. You just need to cover all the bases by following a few simple steps.

How to Correctly Submit a Complete RFA in 8 Easy Steps

  1. Get the correct RFA form from the DWC website, here: https://www.dir.ca.gov/dwc/DWCPropRegs/IMR/IMRFormRFAClean.pdf

  2. In the top box of the form, check the reason for the RFA.

    • Check “New Request” for all treatment that you have not previously requested.
    • Check “Resubmission – Change in Material Facts” if new information is available about the employee’s medical condition.
    • Check “Expedited Review: Check box if employee faces an imminent and serious threat to his or her health” if the request is urgent–but not life threatening. (If the request is life threatening, and the employee requires hospitalization or emergency surgery, then submit a concurrent RFA.)
    • Check the “Check box if request is a written confirmation of a prior oral request.” if you have spoken with the claims adjuster, and you have agreed that the employee needs care and that the treatment will be approved. For example, if the employee requires immediate surgery or medication, and the adjuster verbally approves the treatment, you will still need to submit an RFA.

     

  3. Complete the rest of the form by providing basic information about the injured worker.

  4. In the “Requested Treatment” section, ensure that you give all details about the treatment you’re requesting in the “Other” column. For example, if you’re requesting physical therapy, then make sure that you indicate the amount of treatments; if you’re prescribing medication, then specify the dosage and refills.

  1. If you’re the treating physician, then sign the RFA. If you’re not the treating physician, make sure you get his or her signature.

  2. Submit the Request For Authorization form with the visit report (the Doctor’s First Report, PR-2 report, etc.) via fax or email. If you don’t submit the RFA with the visit report, then the RFA will likely be returned to you.

  3. You should receive your approved or denied RFA within 14 calendar days after you submit it. If you don’t, then contact the insurance administrator.

Try RateFast Express today!