One Simple Tip to Improve How Your Practice Organizes Work Comp Claims

Currently when patients come into a clinic, whether the clinic uses an EMR or paper charts, a chart is created. Notes are written- that works fine, as long as there’s only one injury being managed. The real problem comes up when patients get a second injury.

What can easily happen is that the notes for the two different dates of injury get shuffled together. Incorrect documents given to the provider can then further confuse the patient’s examination, and delay the claim being closed.

This is the problem with administering multiple claims in the clinic. So what’s the solution?

Patient’s injuries need to be organized around the date of the event. Unfortunately that’s not the way that we’ve created healthcare records. Traditionally you have a chart that is organized chronologically.

To solve this problem we have to re-organize the way we write and create our EMRs for Work Comp. Because in Workers’ Comp, each claim has it’s own universe, it’s own set of unique information. These need to be the drivers of the organization in the chart. All you really need to know is what date of injury is this patient here for? Once you know that then you know what the injured body parts are, and you can put your finger on the last, correct, and appropriate notes.

Once you’re working in a system that’s correctly organized by date of injury, it now presents an opportunity for everyone in the clinic to start contributing to the creation of the correct visit note. Now the front office has the opportunity to prepare the patient for an exam based on that specific date of injury. A medical assistant can open the EMR, verify the date of injury, and check-in about pending actions and RFAs.

This allows the doctor to focus on making medical decisions instead of doing clerical research. The patient’s visit goes really smoothly and the patient feels that the doctors are informed and the clinic cares about moving their claim forward.

Take a good look at how different members of the clinical team are helping as injured workers come into the office. It says a lot about the quality of care perceived by the injured worker.

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Digitization of Workers’ Compensation

The process of digitization is taking information from  the real world and overlaying it with a set of digital perimeters, which allows that information to be put into a system.

This allows for meaningful content to be created for consistent conclusions across large numbers of users.

Electronic Medical Records (EMRs) have gained wide popularity over recent years, but to what extent have Workers’ Compensation reports been digitized in a similar way?

There really hasn’t been a concerted effort to digitize WorkComp by any one group or entity.

There are some impairment reporting softwares out there that will give you the header of the section of the report you’re supposed to fill out. But in these cases, the user is left with a blinking cursor to ask the questions and perform their own physical exam, at their current level of understanding.

We’re talking about guiding the patient and medical provider through a very specific process to make sure reports are as complete and compliant with the law as possible.

Digitization of Workers’ Comp means getting every part of the WorkComp reporting process standardized, using computer technology.

With the rise of cloud computing and centralized and data repositories, the time is now to start this process.

This benefits everyone in the workers’ comp process, but most importantly, it benefits the injured worker. Injured workers get caught in a spiral of inefficiency and errors which draws their cases out much longer than they need to be.

Digitization means faster and more accurate reports; there is currently no penalty for turning in wildly inaccurate reports. Once this process does get digitized any missing information will become blatantly clear.

Has this happened elsewhere? Yes- take a look at the automobile industry. As soon as cars appeared on the market, both new and used, there needed to be a system for determining their value. This guy Les Kelley showed up, of Kelley’s Blue Book– he didn’t have a computer, but he used a specific set of questions that determined how much a car’s value was worth and how much its resell value was. Within a couple of years he took over, his system was an industry standard.

So what does this look like in an Impairment Exam? Let’s have an example:

A QME is doing an exam for a right shoulder injury. The QME took two measurements with the goniometer in all planes of motion. This report gets submitted, and the report is digitized, meaning that someone takes the information and places it into a standardized format to confirm the opinion of the QME. However, what the QME either forgot or wasn’t aware of, is that in upper extremity injuries, you need to measure both the injured and uninjured parts of the body. Therefore half of the functional measurement set is missing, as no measurements were taken on the left shoulder. With digitization the data that’s missing is made extremely clear. This will improve accuracy and consistency in monetizing work injuries.

A study from 2006 found as much as 79% of reviewed reports for the low back were incorrect. Hopefully with the process of digitization this number will significantly decrease. Questions or comments on digitization? Write us at

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

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

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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