RateFast Podcast: Understanding the RFA

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In workers’ comp, providers must fill out a Request for Authorization form (RFA) when requesting a service, treatment, or tests for a patient. The RFA must be filled out correctly in order to receive approval from the employer’s insurance.

This excerpt from our podcast on How To Submit an RFA features RateFast’s founder Dr. John Alchemy in conversation with Arun Croll and Claire Williams about the intricacies and limitations of the Request for Authorization process.

There are certain steps that providers can take to make an RFA likely to be accepted, such as making sure that appropriate ICD-10 codes are included on the form. Insurance carriers may deny an RFA for all kinds of reasons, so it’s imperative to be as thorough as possible.

If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you!

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RateFast Podcast: What are The Chances? Probability and RateFast

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An educated prediction is a critical element in decision-making when face to face with the future. This is because the future is always uncertain.

Whether you’re making bets, conducting a weather forecast, or working in medicine, knowing the probability that something will or will not happen can have a huge impact on which action to take next.

Making observations to measure the probability of an event happening involves collecting data from past events in order to compare them to the expected outcome. This is why we can have a sense of confidence as to when we should bring an umbrella, buy buy buy, or sell sell sell.

Check out our podcast titled Probability in Workers’ Compensation with RateFast intern Marten Thompson, where we discuss probabilities, Sherlock Holmes, and more.

If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you!

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Greater Than or Equal To: Percentiles and RateFast

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If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you!

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: Incomplete Activities of Daily Living (ADLs)

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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

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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.

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

Top 5 Articles of 2016

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From how to use an inclinometer correctly to understanding why a panel QME gets involved in a work injury, read up on the best workers’ compensation content of the past year.

  1. What’s A QME?
  2. Muscle Atrophy
  3.  Exacerbation vs. Aggravation
  4. Activities of Daily Living
  5. How to use an Inclinometer

Do you have a workers’ compensation topic you’d like to see covered? Email us and we’ll put our best people on it!

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The Art of the Qualified Medical Exam

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A QME is a medical professional who is credentialed by the state to perform qualified medical examinations required for certain workers’ compensation cases. For a more detailed look at what a QME is, take a look at this article.

Recently on the RateFast Work Comp Report podcast we interviewed Dr. Nissen about being a Qualified Medical Examiner (QME). Dr. Nissen discussed what he called “the art of the QME”—a skillset that involves using creativity and critical thinking to overcome several unique challenges.

A few of these challenges are described below.

Understanding the American Medical Association Guide to Impairment Rating and Evaluation.

Using the huge tome commonly known as the AMA Guides demands a depth-of-knowledge that few physicians take the time to develop. In order to serve as an effective impartial examiner, the QME is responsible for knowing the Guides back-to-front. This knowledge directly informs all other aspects of QME’s work with the claim, from performing the physical exam to determining impairment.

Assessing previous medical charts.

Medical charts for a single patient are often hundreds of pages long, and the ability to review them for relevant information takes practice, insight, and real-time analysis.

Performing an accurate physical evaluation.

The QME evaluates the patient according to the Guides, reviewing all thirty-four activities of daily living, and taking repeated measurements depending on the type of injury. A correct evaluation requires extensive knowledge of the Guides and rigorous attention to detail.

Creating a precise and correct impairment rating.

All of the relevant medical charts and all new information generated by the QME’s physical exam must be collected into the QME’s report. This data must be accurate; after all, the QME’s role is to bring objectivity to the claim, so reproducibility of results is key.

Conclusion

Dr. Nissen argues that in order for QME reports to truly benefit injured workers, physicians need a system for collecting consistent data. Accurate and meaningful data results in less legation, and ultimately the speedy close of the workers’ compensation claim.

Fortunately, such a system has been developed. RateFast is a total workers’ compensation solution that helps providers perform perfect exams, document patient medical histories, format and organize reports, and determine impairment ratings according to the AMA Guides. We urge medical providers, QMEs, and anyone who is interested in improving workers’ compensation to join RateFast for free.

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Sub Rosas in Workers’ Comp

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This article is for medical providers, insurance adjusters, and attorneys who want to better understand the process of a Sub Rosa within the context of a workers’ compensation case.

What is a Sub Rosa?

Sub Rosa is a fancy latin term that literally means “Under the Rose.” In workers’ compensation, however, it means secret investigation—surveillance. During a Sub Rosa investigation, usually an investigator is sent out to survey the injured worker. The investigator attempts to observe what level of physical activity the injured worker can or cannot perform. The second, and less common use of Sub Rosa in work comp is to investigate a doctor, an employer, work sites, and/or working conditions. 

What are the stakeholders looking for in a Sub Rosa?

When insurance adjusters, employers, or medical providers require a Sub Rosa investigation, they are normally looking evidence that an employee can perform observable physical activities that are in excess of what they claim they can do.

 For instance, an injured worker may report that they can’t lift anything, or can’t bend over, or can’t walk without a cane. The fundamental purpose of this surveillance is to verify or disprove the validity of what the person is claiming in regards to their physical or psychological conditions. 

Sometimes a patient may claim that they have good days and bad days. In these cases, their limitations ambiguous. It’s very important, therefore, that Sub Rosas span several, separate days, to provide an accurate view of the patient’s conditions.

What should the doctor do while viewing surveillance footage of a patient?

Most surveillance tapes are dead-boring. It is advisable for the doctor to dictate what she observes the patient doing while she watches the tape. It’s also important for the doctor to state whether she can clearly identify that the person being filmed is the patient in question, or whether she knows it is certainly not the patient, or whether she can’t tell.

When should an attorney consider requesting a Sub Rosa?

An attorney may consider a Sub Rosa to be useful if one or more of the following are present:

  • Is the patient off from work for a much longer time than is typical for their condition?
  • Does the patient have a history of workers’ comp cases where this has been a trend?
  • Do physical findings corroborate with the patient’s description of their symptoms?

Should a doctor confront the patient with apparent discrepancies before recommending a Sub Rosa?

Yes. There is a lot that can be gained from a frank discussion with the patient about their symptoms and physical findings. Here at RateFast, we are committed to remaining non-partisan—we believe the ultimate goal of a workers’ compensation claim should be to get patients safely back to work. Therefore, we recommend an open and honest discussion with the injured worker before considering surveillance.

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