• Specialty Consultations and Chart Reviews

    13 August 2012 / Chart Reviews / Comments Off on Specialty Consultations and Chart Reviews

    When reviewing other provider consultations, be sure to include the specialty, board certification, the name of the doctor, and any commonality or discrepancies between their evaluation and yours.

    Is a consultant performing any different or unusual physical exam testing that you have not considered?

    Not sure what a Yergason's test is? Look it up.

    Finally, make sure that you can follow the logic of the consultant. Are the conclusions of the report a surprise? If so, why?

    Take careful note to include the specifics of the consultant notes that appear to support conclusions.

    Opinions that are overly vague or unsubstantiated may need to be discussed in greater detail in the discussion section of your report.

  • NEWSFLASH:  90% of AME Reports are Incorrect

    09 August 2012 / Impairment Rating Specialists / Comments Off on NEWSFLASH:  90% of AME Reports are Incorrect

    NEWSFLASH:  90% of AME reports are incorrect; 72% of QME reports are incorrect; the average overpayment is $17,500 per report.

    My Team and I have reviewed over 2,500 reports from California physicians under the AMA Guides.  On average, those reports provide PD $17,500 more than the law specifies.  AME's are the worst, with 90% of their reports incorrect.  QME's are second worst, with 72% of their reports incorrect.

    What does that mean?  It means you will be overpaying $17,500 in most of your cases, unless you use Achem's Razor.

    Achem's Razor means finding the simplest solution to a problem.  Identify the right problem, then apply the simplest, most effective solution.

    1.  What is the problem?  Using the wrong doctors.

    2.  Solution:  Use the right doctors.

    3.  How can I find out who they are?

    a.  First, use doctors associated with Impairment Rating Specialists.  I have hand-trained each of those doctors on the AMA Guides.  They do correct ratings.

    Think of it.  If you use a doctor who does the rating correctly, then there is no need to write the doctor to get a corrected rating, no need to depose him, nothing the DEU can do to screw up the rating, and you have a report on which you can settle the case.

    Using the right doctor saves you time, money, and effort.  That is Achem's Razor--the simplest, most effective solution for the problem.

  • Clinical Office Visits and Medical Chart Reviews

    06 August 2012 / Chart Reviews / Comments Off on Clinical Office Visits and Medical Chart Reviews

    I will search for pain scale reports, compliance with medications, listed medications, and essential physical exam findings pertinent to injured body part.

    Will try to find the doctor’s thought process and reasoning for the management of the claim. I will look for response to treatment, and any indication as evidence in “objective” improvement.

    Objective improvement has both “soft” and “hard” findings.

    The soft side is the report of improvement in the activities of daily living, or the ability to tolerate symptoms better. Hard objective improvement is the exam measurements. Is range of motion, improving, stable, or deteriorating?

    I collect all of these findings for my chart entries.

  • Don't Forget the Cover Letter

    02 August 2012 / Chart Reviews / Comments Off on Don't Forget the Cover Letter

    There is usually some sort of cover letter. The letter comes in two basic flavors.

    The first is the standard form letter printed asking the doctor to please review the attached medical records and render a supplemental opinion. Fairly standard.

    The second type of letter is a much more spirited document. Typically it will introduce you to the documents in a specific manner, "From Dr. O'Hara's November 6, 2010 office visit note you will be interested to find that the employee actually reported seven prior industrial injuries and had disability well in advance of working for ACME Business".

    Take a quick mental note of which cover letter flavor you receive, because clearly the two present very different expectations on the chart review.

  • Taking the Medical Impairment History from the Employee

    31 July 2012 / Medical History / Comments Off on Taking the Medical Impairment History from the Employee

    Let the first sentence put a picture in the mind of the reader: name, age, handedness, employer and number of days, months or years with the employer.

    Let the worker tell you what they do, remember, details make your history memorable and fun to read. Listen to the first task they list and try to get a sense of the working conditions, the hours and tools they use.

    • Include both the physical and administrative functions of the workers.
    • What do they offer as their first and primary function on the job? What tools or objects do they use during the shift? Who do they report to, who do they supervise?
    • Work attendance history and disciplines/promotions
    • How much work has the employee missed, not just for this injury, but also in the past? Have they been promoted? Demoted or placed on a performance improvement program at any time?
  • What if the Employee Brings Their Own Records?

    24 July 2012 / Medical History / Comments Off on What if the Employee Brings Their Own Records?

    Be careful about this one. This begs the question directly of “What is a medical record”.

    In general, I will review medical documents brought by the employee if they are clinic chart notes, laboratory testing, imaging or consultations. I will make a photo copy of theses record to keep with the “formal” medical file. I will not accept into the chart review a summary document written by the patient, the spouse, or well intending family member.

    I will create a specific section for “employee provided documentation” so it is clear what has been provided on behalf of the parties, and what is being brought directly from the employee.

    Remember, these may be documents never seen before in the claim.

    Keep it separated, and keep it clear. You won’t go wrong.

  • Taking the Medical Impairment History

    23 July 2012 / Medical History / Comments Off on Taking the Medical Impairment History

    Lay the ground rules for the exam before you start the interview:

    1. The answers are to only be provided by the employee.
    1. The interviewer is not a treating provider and there is no doctor patient relationship. Make sure the patient understands this before you begin, otherwise they will continue to ask you questions as a primary treator.
    1. Information shared in the interview will be included in the report and communicated with all parties. If the employee chooses not to answer a question they need to state so, and the interviewer will move on to the next question.
    1. At any time in the interview or exam, if the employee experiences pain they are to stop any painful activity immediately and notify the examiner.


  • Tell Them What You Have

    19 July 2012 / Chart Reviews / Comments Off on Tell Them What You Have

    I provide a brief description of the chart prior to delving into the matter at hand.

    A description of the “Medical documents relied upon” is a nice way to make your report different than everyone else. Start by describing the number of pages, or a close estimation. I use inches to the nearest 1/8 inch. I will next weight the documents to the nearest tenth of a pound.

    This one really drives home the scope of work. My personal record is 46 pounds. You may comment on the date the chart was received, or if it was received in several shipments.

    Then move on to the quality of the notes.

    Are they good quality? Are they hand written? Are they in electronic or paper form? (Is there any food stuck to them?).

    Describe the physical organization. Example, are they in five binders? What are the titles of the binders? Who provided them? Attorney, carrier, employer? Are the chart notes out of chronological order (indicating you had to invest extra time in organizing them yourself)?


  • Paper vs. CD Rom Medical Records?

    16 July 2012 / Medical History / Comments Off on Paper vs. CD Rom Medical Records?

    This is really a personal preference.

    My preference is always the electronic scan. Some people feel cheated without the ability to hold and move papers. I never consider myself deprived BUT there is a downside (like so many things in life).

    If you are going to do a successful and efficient review of electronic medical records, you need to have a solid foundation in Acrobat Adobe. I also STRONGLY recommend obtaining the full Acrobat Adobe program.

    Trying to review a large amount of medical documents without the full Adobe program is like trying to mow your lawn with a pair of scissors. It can be done, but you will simply not like it.

    The Adobe full program will allow you to convert most decent quality chart notes to “Optical Character Recognition” (OCR)documents. This means you can cut and paste sections of notes directly from the electronic chart into your review document. Proper use of the program will give you incredible leverage and time savings. OCR will also allow you to search the electronic documents for key words or phrases. There are many good books currently available to short cut the learning process on Adobe. Find one, read it, and keep it close to your computer.

    It is also very green to use the electronic form of records. Think about all the time and energy invested in copying, packaging, and mailing the chart for the third, fourth and fifth time in the claim.

    Invest the several hours in learning Acrobat Adobe, and in no time you will be slicing and dicing the chart like nobody’s business. Hence I always call for the chart in electronic form. I think Phil’s term for this level of mastery is “The Jedi Knight Master”

  • How Many Pages Did You Say

    12 July 2012 / Chart Reviews / Comments Off on How Many Pages Did You Say

    The chart arrives. I want to discuss the “arrival” of the chart, because this can add to the drama of the medical legal evaluation. The arrival of a Fed Ex package or mailer pouch is the typical presentation of the chart.

    I personally enjoy custom packaging. Boxes have potential for “personality”. My personal favorites include the Nike shoe box, a cereal box, and my all time favorite…a cut down Jack Daniels cardboard box.

    Nothing, however, matches the UPS truck pulling up at the curb with the banker’s boxes. It is usually at this point the evaluator may experience a sense of fear, or all out terror. A single banker box holds exactly 5,000 sheets of 8 ½ x 11” paper. Electronic medical records can be a sleeper. A CD rom can hold up to 20,000 letter sized white and black letter pages. That’s four banker boxes. Remember what I said earlier about checking your emotion. Fortunately you have this blog

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