Untangling the PR-2 Report: 6 Tips For Faster, Better Treatment

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You’re in the middle of a complex work injury claim. You, whether you’re a doctor, patient, or adjuster, are under a lot of time pressure. You want to get back to work, or to close the claim, or see your patient healed. This is where the  PR-2 Report comes into play.

What is it? Before the patient has reached permanent and stationary status, it’s a report which summarizes the active management of the claim. It helps the provider communicate to the insurance company how the patient is responding to their treatment. After the claim has closed, PR-2 reports are used to describe future care necessary for the continual functional rehabilitation of the injured worker.

We’ve got six simple tips to help you understand the PR-2 Report better, and avoid common mistakes which can cause major delays.

  1. Don’t try to do too much in one single PR-2 Report. Time is short in any doctor’s visit.
  2. Select a focus for the visit and stick with it. Listen to how the patient is doing and select a plan of care which addresses the most debilitating parts of their injury first.
  3. Remember to keep all injured body parts on the radar. Injured body parts can get left off of the claim because the pain has seemingly fizzled out, only to flare back up again. If dealing with a multiple body part case it’s vital (literally!) to continue providing care for each aspect of the injury.
  4. Clear next steps. Future care should be a major priority of the PR-2 Report. For example, if you exam only the neck of an injured worker in one visit, be sure to plan to assess the functionality of the fingers in the next.
  5. Review the charts of fellow providers on the case.
  6. Remember to see the patient every 45 days (6 weeks) until the patient reaches MMI. Longer time between visits creates a lapse in care which can lead to delayed recovery and return to work.

If you’re confused about new RBRVS questions and how they change billing for the PR-2 report, check out question two in this helpful post from our friends at DaisyBill.

Listen in on the conversation at our new Podcast, CA WorkComp Report, here.

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AMA Guides 5ed Glossary Definitions (Pages 599-603)

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AMA Guides 5ed Glossary Definitions (Pages 599-603)

Below is a common list of terms that help RateFast users better understand the basics definitions used for impairment ratings. You will find many of these terms used in RateFast to provide more consistent and reproducible reports.

Aggravation

A factor(s) (eg, physical, chemical, biological or medical condition) that adversely alters the course or progression of the medical impairment. Worsening of a preexisting medical condition or impairment.

Ankylosis

Fixation of a joint in a specific position by disease, injury or surgery. When surgically created, the aim is to fuse the joint in that position, which is best for improved function.

Apportionment

A distribution or allocation of causation among multiple factors that caused or significantly contributed to the injury or disease and existing impairment.

Assistive devices

Devices that help individuals with a functional loss increase function. Examples include reachers, extended grabbers, hearing aids, and telephone amplifiers.

Causation

An identifiable factor (eg. accident or exposure to hazards or disease) that results in a medically identifiable condition.

Chronic pain

Pain that extends beyond the expected period of healing or is related to a progressive disease. It is usually elicited by an injury or disease but may be perpetuated by factors that are both pathogenically and physically remote from the original cause. Because the pain persists, it is likely that environmental and psychological factors interact with the tissue damage, contributing to the persistence of pain and illness behavior.

Combined Values Chart

A method used to combine multiple impairments, derived from the formula A+ B(1-A) w combined values of A and B, which ensures that the summary value will not exceed 100% of the whole person.

Contracture

A permanent shortening (as of muscle, tendon, or scar tissue) producing loss of motion, deformity, or distortion.

Desirable weight

A range of optimal weight given an individual’s sex, age, height and body habitus.

Disability

Alteration of an individual’s capacity to meet personal, social, or occupational demands or statutory or regulatory requirements because of an impairment. Disability is a relational outcome, contingent on the environmental conditions in which activities are performed.

Effects of medication

Medication may impact the individual’s sign, symptoms, and ability to function. They physician may choose to increase the impairment estimate by a small percentage (1% to 3%) to account for effects of treatment.

Functional limitations

The inability to completely perform a task due to an impairment. In some instances, functional limitations may be overcome through modifications in the individual’s personal or environmental accommodations.

Handicap

A historical term used to describe disability or a person living with a disability or disabilities. A handicapped individual has been considered to be someone with a physical or mental disability that substantially limits activity, especially in relation to employment or education.

Impairment

A loss, loss of use, or derangement of any body part, organ system, or organ function.

Impairment evaluation

A medical evaluation performed by a physician, using a standard method as outlined in the Guides, to determine permanent impairment associated with a medical condition.

Impairment percentages or ratings

Consensus derived estimates that reflect the severity of the impairment and the degree to which the impairment decreases an individual’s ability to perform common activities of daily living as listed in Table 1-2.

Malingering

A conscious and willful feigning or exaggeration of a disease or effect of an injury in order to obtain specific external gain. It is usually motivated by external incentives, such as receiving financial compensation, obtaining drugs, or avoiding work or other responsibilities.

Maximum medical improvement (MMI)

A condition or state that is well stabilized and unlikely to change substantially in the next year, with or without medical treatment. Over time, there may be some change, however, further recovery or deterioration is not anticipated.

Normal

A range or zone that represents healthy functioning and varies with age, gender, and other factors, such as environmental conditions.

Pain

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

Paresthesias

A sensation of prickling, tingling, or creeping on the skin, usually associated with injury or irritation of a sensory nerve or nerve root.

Permanent impairment

An impairment that has reached maximal medical improvement.

Prosthesis

An artificial device to replace a missing part of the body.

Radiculopathy

Any pathological condition of the nerve roots.

Recurrence

A return of the disorder or disease after a remission.

Reproducibility

Synonymous with reliability. Consistency in results when examinations (tests) are repeated.

Sciatica

Pain along the course of a sciatic verve, especially in the back of the thigh, caused by compression, inflammation, or reflex mechanisms.

Teleroentgenography

A radiographic method used to determine actual limb length.

Treatment

The action or manner of treating an individual, medically or surgically. Medical treatment is the action or manner of treating an individual, medically or surgically by a physician. Treatment may include modalities recommended by a health care provider.

Validity

An accurate measurement apart from random errors. Validity refers to the extent to which a test measures what it is intended to measure.

Whole person impairment

Percentages that estimate the impact of the impairment on the individual’s overall ability to perform activities of daily living, excluding work.

Workers’ compensation

A compensation program designed to provide medical and economic support to workers who have been injured or become ill from an incident arising out of and in the course of their employment.

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How to write a good Doctor’s First Report (DFR)

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Somewhere in California, a workers’ compensation injury is about to occur. The initial steps in a work comp claim are some of the most important, as they can determine the complexity and timeliness of an injured workers’ case. The Doctor’s First Report (or DFR) is the first step in determining care. What are these first steps?

          1. After a worker is injured on the job, the worker reports the incident to the employer.
          2. A medical provider examines the injured worker.
          3. The medical provider completes a Doctor’s First Report (DFR) that includes information about the patient and the history of the injury.

A DFR must be filled out for all on-the-job injuries according to the California Department of Industrial Relations.

Errors in the DFR can delay the patient’s ability to return to work or to receive treatment. Unfortunately, these errors are far too common.

How to make your Doctor’s First Report count

Here are some tips to keep in mind to ensure that your Doctor’s First Reports are as effective as possible.

  • The DFR should include a detailed description of the injury according to the injured worker. Get all the facts in the patient’s own words.
  • The physical exam taken for the DFR should be supported by the patient’s own story about the injury. The more consistent the patient’s account is with measurable findings, then there will be fewer complications further down the line.
  • List all injured body parts. Each individual body part will receive different types of treatment, and, ultimately, a different impairment rating.

So, if a patient comes in after injuring her cervical spine after falling off a ladder, but she also complains about a sore wrist, then you should make a note of both body parts in the Doctor’s First Report. This way, medical treatment for all aspects of the injured worker’s claim will be addressed. Further steps for reproducing the Doctor’s First Report are listed on the Division of Workers’ Compensation website, here.

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