What Are The AMA Guides? A Brief History and Explanation

It is important that physicians have a framework that they can use to show stakeholders the results of their examinations of a worker’s injury. The framework the physician uses is the standard used by the entire state so that they can agree or dispute the results within the language of the framework.

This framework is the AMA Guidelines, a book divided into several editions that is used in most states to measure permanent impairment as a result of injuries. This is a quick primer intended to give a little information to those unfamiliar with the Guides.
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RateFast Podcast: How Spinal Injuries in Stack Up in Work Comp

This article is a transcriptions of an episode of the RateFast podcast, which you can listen to by searching “RateFast” in iTunes or the iOS podcast store.

Physicians have a number of different diagnostic tests requiring special machines, that they use to determine the severity of an injury. It’s not always necessary to throw a patient into an MRI machine when they come in complaining about back pain, however. Sometimes an effective treatment plan is enough to ensure that a potential injury gets better, instead of getting much worse.

We talked to Dr. Christian Athanassious regarding the intricate details about, and differences between, bulging and herniated discs. In our podcast, Dr. Athanassious helped to shed light on the steps that a spine specialist takes to determine the severity and treatment of discs in the spine.
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Gender Bias, Lawmakers, Semantics, and Workers’ Comp

In October, governor Jerry Brown vetoed the bill AB 570. This bill would have made an amendment to Labor Code Section 4663, saying “No percentage of an apportionment in the case of a physical injury occurring on or after January 1, 2018, shall be based on pregnancy, childbirth, or other medical conditions related to pregnancy or childbirth.”

This is the third year in a row that a bill rolling back apportionment laws when considering pregnancy and childbirth has been written, and then vetoed.

The amendment that AB 570 proposes is simple enough, but the politics surrounding the decision to veto the bill are more complex. Bear with us, it’s not all black and white.

This story begins in the early 2000s.
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RateFast Podcast: How Bad Is It, Doc? First Aid vs. Recordable Injuries

This article is a transcriptions of an episode of the RateFast podcast, which you can listen to by searching “RateFast” in iTunes or the iOS podcast store.

Not all work-related injuries require a workers’ compensation claim. The severity of an injury marks the difference between a recordable injury (opening formal claim that involves follow-up visits and an impairment rating), and the simple application of first aid.

Most first aid injuries can be recognized and treated on the spot, but the doctor always has the full authority to determine whether or not to open an injury claim. Read on to learn about how this decision is made.
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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 world, the long road of a workers’ compensation claim would end in a healthy patient with a 0% WPI, an fairly compensated primary treating physician, a satisfied claims adjuster, and no involvement with an attorney. But it’s rarely this simple.

Apportionment is an attempt to objectify something that cannot be measured with tools, which opens up the possibility for disagreement. As we’ve learned from our other blog posts in this series, disagreements between PTPs and the employers’ insurance can cause slowed claims, delayed treatment, and could result in the need for an attorney.
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RateFast Podcast: Institutional Bias and What You Can Do to Prevent It

People have the tendency to cut corners sometimes. This might come as a surprise to some, but in some cases doctors are no exception.

That said, cutting corners doesn’t necessarily mean that the job is done lazily. For a doctor this can happen because they are pressed for time, they are making an inference based off of prior experience, even outside forces could be pressuring them to fill in a number here and there.

When cutting corners like this becomes routine, we get institutional bias.

Our interview with Dr. John Alchemy covers institutional bias, why it happens, and what doctors could do to avoid dragging out their claims by letting their bias get the better of them. Listen to the podcast on iTunes here.

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RateFast Podcast: Came for surgery, left with some antidepressants?

After they ask themselves the 3 questions before referring a patient to a spine specialist, your provider may follow through, and when a primary treating physician refers an injured worker to the specialist for diagnostic tests, the worker might suspect that there is surgery ahead. This is not always the case.

In fact, there’s a chance that they might even leave the specialist’s office with a prescription for antidepressants, among other possibly unexpected treatments.

RateFast’s own Dr. John Alchemy and Claire Williams interview orthopedic surgeon Dr. Athanassious about the circumstances surrounding complications with spinal injuries in injured workers, and where the primary treating physician may direct them when more specific care is needed. Click here to listen to the podcast on iTunes.

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RateFast Podcast: Understanding the RFA

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.

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RateFast Podcast: What are The Chances? Probability and RateFast

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.

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