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Thread Title: Error with new QME regulation? I'm confused...
Created On Monday February 16, 2009 6:16 PM


ChiroGeek
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Monday February 16, 2009 6:16 PM

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Hi again,

I thought an "Agreed panel QME" was the last one surviving the strike off process? If so, then this "final verbiage" is erroneous:

Agreed Panel QME means the Qualified Medical Evaluator described in Labor Code section 4062.2(c), that the claims administrator, or if none the employer, and a represented employee agree upon and select from a QME panel list issued by the Medical Director without using the striking process. An Agreed Panel QME shall be entitled to be paid at the same rate as an Agreed Medical Evaluator under section 9795 of Title 8 of the California Code of Regulations for medical/legal evaluation procedures and medical testimony.

If this is so, then how in the world will you be able to tell if your agreed upon or a product of the strike off? This is ridiculous!!!


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gaiassoul1@yahoo.com
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Monday February 16, 2009 8:37 PM

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it is so, once you get the panel -- you are required to call and see if you can agree....only after an effort has been made to agree, do you then start the striking process.

Figuring out which fee is due you should be pretty simple...the question should be asked during the scheduling process..did you agree to us from a panel or was I the last name left after striking, if I was agreed, we will be sending a fax to both parties to sign so that I have no issues with my billing, so who would sign for the defense and who would sign for the applicant....pretty simple form to draw up to get AME rates.....

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ChiroGeek
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Monday February 16, 2009 9:20 PM

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But isn't agreeing on one doc on the list the same as striking / not choosing the other two? Seems silly to me and I can see we might as well kiss the AME upcoding gift good by, extra clerical work not withstanding. A very disappointing regulation.

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gaiassoul1@yahoo.com
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Tuesday February 17, 2009 6:54 AM

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not really, when you strike you have the risk of getting one doctor you don't like....have had multiple panels with two known app docs and one def...struck the lesser of the two app docs but still stood the chance of getting a crap report, so would rather attempt to agree to the best reporter on the panel.

So how else would you have proposed they do it?

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ChiroGeek
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Tuesday February 17, 2009 11:29 AM

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Respectfully, in your scenario, the fair doctor wins anyway: AA strikes the defense doc and you strike the more severely applicant doc. So, you still get the more neutral doc, only you don't have to pay the extra AME fees. Where is my thinking wrong? It still seems like good AME quality docs are going to get short-changed out of their deserved extra fees.

Edit: I think I get it now: the CA must strike first? no? Then it makes sense.

Edited: Tuesday February 17, 2009 at 12:22 PM by ChiroGeek

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postscript2
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Tuesday February 17, 2009 12:30 PM

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Hi Chirog:

Why don't you check out the Medical Forum and contact appliedpsyche or 7-day. One of them went to a seminar on this very issue.

I agree with you that it's a crap shoot, and honestly-who can you trust to tell the truth?

LCS

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gaiassoul1@yahoo.com
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Tuesday February 17, 2009 2:50 PM

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there is no rule who strikes first.....but let me tell you the percentage of agreed medical examiners off of panels in my experience is less than 2% so there are not many fees to get cheated out of...it will be the exception not the rule.

when I work defense it is rare there would be a doctor I would agree to as an AME on any panel I have seen.

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appliedpsych
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Wednesday February 18, 2009 8:30 AM

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gaiassoul1: re your post and payment rate issues.... Figuring out which fee is due you should be pretty simple...the question should be asked during the scheduling process..did you agree to us from a panel or was I the last name left after striking, if I was agreed, we will be sending a fax to both parties to sign so that I have no issues with my billing, so who would sign for the defense and who would sign for the applicant....pretty simple form to draw up to get AME rates.....

I am having trouble finding in the new Regs anything that talks about increase payment rate for an Agreed Panel QME - which I heard slight mention of at a CSIMS CE class - but nothing clear.

All I see is a reference that an APQME can get paid the same rate as any other QME or AME. The rate has been $250.00 per hour for some time now, and I do not see anything in the new regs that clearly spells out this increase for the APQME, which seems to be the implication I have heard from some.

Any insight to clear this up ?

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gaiassoul1@yahoo.com
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Wednesday February 18, 2009 5:50 PM

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is it not the reg the OP posted?? If not, then I will do the research....let me know.

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ChiroGeek
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Wednesday February 18, 2009 6:32 PM

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The verbiage is listed under Article 1, Section 1 (Definition), subsection (d):

"...An Agreed Panel QME shall be entitled to be paid at the same rate as an Agreed Medical Evaluator under section 9795 of Title 8 of the California Code of Regulations for medical/legal evaluation procedures and medical testimony."

Was that what you were looking for?

If memory serves me, that means, as I'm sure you know, you get a 1.25% increase on top of the $250 per hour for ML104 and ML106 (i.e., $312.50 per hour) or on top of the fee for ML102, and ML103. If an interpreters needed, then you get 1.35% increase above ML102 and ML103.

I still don't get why the distinction was necessary, since no adjusters are ever going admit to a doc being a Agreed QME. Why would they? There's nothing for the insurer to gain and only money to lost.

So, I guess I'm sore because it was touted that we (chiros that frequently survive the strike out procedure) were going to be rewarded for being good, fair, and neutral docs. But it was all BS. And don't tell me, "If you were really good, you would be an AME without the necessity of a panel." That just don't happen in this day and age. Only MDs or DOs are used (for the most part) as AMEs--at least in the north. If I'm wrong, I'd love to know a chiro who regularly enjoys a good AME business these days. Even the QME Chiro instructor's have lost that business. Sorry for the rant.... I still don't feel better.

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appliedpsych
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Wednesday February 18, 2009 8:42 PM

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Chirogeek -- RE: If memory serves me, that means, as I'm sure you know, you get a 1.25% increase on top of the $250 per hour for ML104 and ML106 (i.e., $312.50 per hour) or on top of the fee for ML102, and ML103. If an interpreters needed, then you get 1.35% increase above ML102 and ML103.

gaiassoul1 -- RE: is it not the reg the OP posted?? If not, then I will do the research....let me know.

I cannot find that 1.25% increase listed in the new regs. Can you pinpoint for me if you have the reference? All I find is a reference to the payment regs, and I do not see the addition listed in the versions I found online.


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