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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Common Objections to Workers’ Comp Reports: Apportionment
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 claims adjusters. Welcome to the final in our series of posts about red flags in impairment reports, and how to ensure that your reports are not objected to by an insurance company. In our previous posts, we have covered incomplete history of symptoms, unchecked Activities of Daily Living (ADLs), accounting for prior injuries, incomplete examination, and complications with diagnostic tests. In a perfect Read More
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 Read More
Common Objections to Workers’ Comp Reports: Diagnostic Tests
This article is part of a series about why insurance carriers object to workers’ compensation reports and return them to the medical practice unpaid. This article is intended for medical providers, administrative staff, office managers, as well as insurance claims adjusters. If you’ve been following our series on objections to workers’ comp reports, you know about the importance of including a complete history of symptoms, activities of daily living (ADLs), prior injuries, and examination in your visit note. If you’re covering these bases, then you should be getting payment for your workers’ comp visits! Welcome to red flag #5 in Read More
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 Read More
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 Read More
Measuring the intangible: Apportionment
There’s a part of the workers’ compensation impairment report that is oft-ignored. The issue is apportionment, which means what part of the residual functional loss of the injury is industrial vs. other things. It’s confusing and hard to understand, and often left out of reports for this reason. As a result, many physicians don’t address it, or if they do it is incorrect and this delays claims. We are of course referring to apportionment. The AMA Guides to Evaluation of Permanent Impairment can be used to understand how multiple conditions are scored and weighted to make apportionment more relevant and Read More
RateFast Podcast: Data Reliability: The Chicken Price Index
This article is a transcription of an episode of the RateFast podcast, which you can listen to by searching “RateFast” in iTunes or the iOS podcast store. If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you! You might not think that they could be related, but there are actually a lot of similarities between the topics of the price of chicken and the price of insurance claims in workers’ comp. For starters, if there is no standard that sets the value of the price for either, then Read More
RateFast Podcast: Injury Mapping, Continued
This article is a transcription of an episode of the RateFast podcast, which you can listen to by searching “RateFast” in iTunes or the iOS podcast store. If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you! When it comes to injury mapping, there are four sets of data points that go into building a customized roadmap to recovery for each patient. These include the patient data set, the Activities of Daily Living, the biometric data set and work tolerance.
RateFast Podcast: Attorneys in Work Comp Pt. III: The AMA Guides
This article is a transcription of an episode of the RateFast podcast, which you can listen to by searching “RateFast” in iTunes or the iOS podcast store. If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you! The AMA Guides are the most commonly-used and influential workers’ compensation impairment calculation system in the United States, as well as in many other countries. In fact, they are the law when it comes to workers’ comp cases in California. Therefore, it is very important for anyone working in the workers’ Read More