TEST YOUR ACRONYM ACUMEN

The men and women who handle workers' comp claims speak in shorthand. If you've worked in the business, you know what I mean. 

AOE/COE is shorthand for "work-related." The EC is the employer-carrier, and the EE is the claimant/employee. Those are easy ones. 

Want to test yourself on workers' comp common acronyms? Try these: 


DOI: ______________________________________________

LC: _______________________________________________

MO: _______________________________________________

MMI: ______________________________________________

CT: _______________________________________________

PPD: ______________________________________________

TD: _______________________________________________

QIW: ______________________________________________

PRN: ______________________________________________

PBM: ______________________________________________

UR: _______________________________________________

ACOEM: ____________________________________________


ANSWERS: Date of Injury; Labor Code; Medical-Only (claim); Maximum Medical Improvement; Cumulative Trauma or Continuous Trauma; Permanent Partial Disability; Temporary Disability; Qualified Injured Worker; Return as Needed (when IW isreleased from active care); Pharmacy Benefit Manager; Utilization Review; American College of Occupational and Environmental Medicine (treatment guidelines).

If you got all 12 correct, you are a real pro. A bona fide WCP.

Claims Adjuster Survey Update

You received an email in early July inviting claims adjusters to take a survey and receive 75 for completing the questionnaire. That was a legitimate offer that came from us.

Nearly 70 people completed the questionnaire about speciality networks. That was a huge help! WorkCompCentral is selective and we haven't partnered with many companies on surveys like this one. However, it seemed like a good opportunity for adjusters to share their on-the-job experiences and make a little spending money in the process.

Wanted: Psyche Claims Speaker

Are you interested in speaking to a group about workers' comp psyche claims, either from a med-legal or a clinical perspective? If so, the California Association of Licensed Investigators needs you.

CALI District Governor Ryan Clocks is asking for "medical-legal and or attorney-related speakers to talk on how investigators can best assist them in doing their job. I would like a psychologist or psychiatrist to address evaluating/investigating psych or stress work comp claims."

You may email Ryan at rclock.precisionservices@gmail.com or by phone, (562) 502-7053. Ryan was a California work comp claims adjuster before becoming a full-time licensed investigator. 

Summer Live CE Series Continues

Three live continuing-education seminars are scheduled this summer for your consideration:

1)  SATURDAY, AUG. 4 
"Writing a Rateable Psyche Report" with Dr. Julie Armstrong, Psy.D9 a.m. to 3 p.m., Mills College, Oakland


CE CREDITS: 6 hour available for QMEs, attorneys and claims

Details: http://ww3.workcompcentral.com/Course/coursedetails/?category=42&id=727


2)  SATURDAY, AUG. 25 
Liens, the New Rules and the Coming Armageddon - Three Perspectives
9:00 a.m. - 4:00 p.m., National University, San Bernardino

CE CREDITS: 6 hour available for QMEs, attorneys and claims

Details: http://ww3.workcompcentral.com/Course/coursedetails/?category=42&id=731

3)  SATURDAY, SEPT. 15 Session III for Orange County 
"Writing a Rateable Psyche Report" with Dr. Julie Armstrong, Psy.D
9 a.m. to 3 p.m., National University, Costa Mesa

CE CREDITS: 6 hour available for QMEs, attorneys and claims

Call to be enrolled: 805-484-0333, ext. 113 or 133. 

Cost of all live summer seminars is $299 member price for qualifying WorkCompCentral paid subscribers; $329 for non-subscribers. You must call in a registration to receive the $299 special price. 

Registered Nurse Leads 8/10 Webinar

The next webinar in the monthly "One on One" series from WorkCompCentral deals with medical spending that delivers best results for the injured worker and his employer. 

Presenter Denise Gillen-Algire, RN, will offer claims payers tools and best practices to contain treatment and pharmacy costs and to achieve best outcomes for the injured worker. 

Denise is the program co-chair of the National Workers' Compensation & Disability Conference, being held Nov. 7-9 in Las Vegas. She is the Practice Leader for Risk Navigation Group's Integrated Health & Productivity Management practice. She holds an RN degree from the University of New Mexico and a Masters' in Business Administration degree from the University of Texas (Dallas). She is board certified in Occupational Health Nursing, and is a fellow of the American Association of Occupational Health Nurses. 

Continuing-education credit is available for participants. Go to https://ww3.workcompcentral.com/Course/coursedetails/?category=42&id=732 to learn more and to register. 

Go Where Everybody Knows Your Name

You probably noticed the gray bar across the top of the page if you visited WorkCompCentral.com anytime this month. It reads: "Community Coming Soon." 

What is Community? It is a new feature for WorkCompCentral subscribers to connect them with others in this industry. It's a cross between your Facebook profile and LinkedIn, only you control the privacy settings and manage your contact list. 

If you go to the WorkCompCentral.com home page, mouse over the gray "Community" bar. Point at the icons and see what happens. 

In Community, you are eligible to receive business referrals, make referrals, post testimonials about colleagues and much more. Also, you'll have an email in-box where messages from us about your account, live events or promotions (like the adjuster survey) will go. When you log into Community, you can see who messaged you. 

An official announcement is coming in August. We are excited to offer the workers' comp industry a place to call its own. Community!

                            =====>                                                                                <=====

Calif. Lien Training Now Online

There are two short courses available about the new regulations in California regarding workers' comp liens. Both sessions were given live for WorkCompCentral and recorded.

- "Will the New Regs Put the Zombie Liens to Rest?" with attorney and author Michael Sullivan. 90 minutes. 

- "What's New About Liens at the WCAB" with Presiding Judge Paige Levy." 3 hours.
Find them under "What's New" at http://ww3.workcompcentral.com/Course/pods

Industry News Briefs

Recent news headlines about workers' comp in your state:

CA - AD Moran Says Calif. Lien Backlog Eliminated: 7/2/12
UT - Judges Suspended as Comm. Reviews Destruction of Medical Reports: 7/3/12
CT - WCC Moving Forward with Price Cap on Repackaged Drugs: 7/3/12
IL - State Will Seek Liquidation Order for Movers Self-Insured Pool: 7/3/12
OK - Senators Request Comp Study‚ 'Opt-Out' Supporters to Plan Strategy: 7/5/12
FL - Court Clarifies Admissibility Standard for Medical Reports: 7/5/12
IL - Court Orders Rehab. for Lumbermens‚ American Manufacturers: 7/6/12
NATION - X-Mod Formula Change Could be Costly for Employers: 7/11/12
All news stories are available for viewing with a paid subscription or one-time purchase. 

Subscribe at https://ww3.workcompcentral.com/subscribe/index

Buy an article using the News search tool at https://ww3.workcompcentral.com/news/index. From this page, use the pulldown menu to see only stories about that particular state. 

Dana Point conference reminder

Executive Director Lanette Hanson of the California Workers' Compensation & Risk Conference issued a reminder this week to register before Aug. 15 for the three-day event Sept. 19-21.

An early registration saves employers up to $150 off the regular price. Pricing and program information is at www.cwcriskconference.org. 

Dr. Rupali Das, the new medical director of the California DWC, is a featured presenter. Her  topic is utilization review best practices. Other DWC officials, including Administrative Director Rosa Moran, are scheduled to present. 

With 60 expert speakers, the conference has a charity golf tournament, networking events, a "Monte Carlo" night, and keynote speaker Ken Baldwin, who hosts NBC Sport’s “Season on the Edge” and is a celebrity dance instructor. The nightly activities include a salsa dance lesson and a competition. 

Who Do You Trust Nowadays?

My first day in journalism school, our professor faced an auditorium full of wide-eyed and eager reporters. This was in a more innocent time before the World Wide Web, blogs, social media and smart phones. 

Professor Don Ranley was his name, and I will never forget a simple rule he laid down for us:  
           
"If your mother says she loves you, check it out!" 

Over the next two years, our professors constantly challenged us to verify the source of our information. Cub reporters had to call back their sources and read back portions of the story before the newspaper went to print. Sometimes, our editors "killed" a story figuring it was better to be a day late than flat wrong.

Fast forward to 2012. There are no less than 52 social media sites (probably double that number) that are considered mainstream. Email, texts, tweets, Facebook status updates, instant messages - they all deliver snippets of information in nanobursts. Sadly, alot of our friends, colleagues and bloggers aren't checking their facts closely.

I offer some suggestions about who you can trust for information, how I know, and why.

1. People you know personally are better bets than anonymous strangers you read on the web.

2. Bloggers are not trained journalists. Journalism (whether people like to admit it or not) is a serious profession. Bloggers, like Matt Drudge of the Drudge Report, do a fine job covering politics. However, for every Drudge Report, there are 50 web sites that re-post other people's content without fact-checking it, or they publish opinion as fact without a disclaimer.

3. Don't be afraid to listen to both sides. The truth is usually somewhere in the middle.

4. Keep in mind what your mother told you. If it sounds too good to be true, it probably is.

5. Don't be afraid to ask questions. Writers aren't smarter than you; they just come off that way.

6. OK, here's a biggie! Don't hesitate to ask someone where they got their information. Do it politely without it being a challenge. Since not all sources of information are created equal, this is a fair question.

Who can you trust nowadays? News organizations that aren't biased toward an agenda or party. Web sites that offer both sides of an issue, too. Friends and colleagues who aren't easily fooled. Public speakers who admit they don't have all the answers. Because finding answers starts with asking the right questions.

If you don't believe me, go ask your mother. 

- Rob McCarthy, Newsletter Editor  

Update on New Lien Rules for California Comp

The Workers' Compensation Appeals Board released a set of rule changes governing liens on June 1, about a week after you read it here first. (It's not often that this newsletter scoops our News Department.) I incorrectly reported in May that the WCAB would give lien claimants 360 days after a case settles to file a lien. The WCAB shortened that time to 180 days - half the time originally proposed. Rule 10582.5 under "Dismissal of Liens for Lack of Prosecution" is the rule section.

If you are a lien claimant of any sort, you definitely will want to read about the new rules here.

Can 'Zombie' Liens Be Stopped? Find out on June 25

What is a "zombie" lien anyway? It's a lien for payment that was satisfied, and the file was closed. Yet, someone is calling and sending demand letters for payment on the lien. It's come back ... to haunt you. 

Learn more about the problem of "zombie" liens when author Michael Sullivan and lien hearing rep JP Navarro answer the question, "Will the New Regs Put Zombie Liens to Rest?" on a June 25 webinar.

It will last about 90 minutes and offer 1.5 continuing-education credits. For the details, click here.

The webinar is free to Sullivan on Comp subscribers. Becoming a subscriber is easy! Free offer

Psyche Injury and Evaluation

Psyche injury isn't a topic that gets prime-time attention in continuing education or on the workers' comp conference circuit. WorkCompCentral is proud to partner with Dr. Julie Armstrong, Psy.D, to deliver a seminar about psyche that has something for the psyche treater and the attorneys alike. 

"Writing a Rateable Psyche Report" takes place this Saturday here in Camarillo and on Aug. 4 at Mills College in Oakland. The cost is $329, and QME and MCLE credit is available. 

Psychiatrists and psychologists: This report-writing skills course will cover the applicable workers' comp law, what type of mental trauma is compensable and why, and what a report must contain to be substantial evidence at trial. 

Attorneys: You'll know what constitutes a good psyche report vs. a poorly written one. 

Need more info or to talk with a school adviser? Call 805-484-0333, ext. 113 or 133. 

Ellen Flynn Appointed Associate CJ 

Judge Ellen Flynn is replacing Mark Kahn as the associate chief justice of the Southern California offices of the Division of Workers' Compensation. Judge Kahn announced his retirement and will stay on as a retired judge through August, according to the DWC. 

Ellen Flynn has been the presiding judge at the Anaheim board for 21 years, and started her workers' comp legal career at State Fund. In 1991, she was chosen Judge of the Year. 

“I am deeply honored to have been chosen for this position,” said Judge Flynn. “I look forward to working with everyone in the Southern California offices and with the administration.”

News Digest

N.Y.: Comptroller Rejects $61M in Overpayments by SWCB. Link

CA: Valdez Decision Published. Link

N.Y.: Bill Expands NY Workers' Choice. Link

MO:  High Court Revives Widow's Tort Suit Against Statutory Employer. Read it.

Nation: Master Complaint Filed in NFL Concussion Litigation Suit. Read about it.

NCCI: Narcotics Costs on the Rise. Link

IL: Lawmakers Order That Claims Administration Be Contracted Out. Who's affected

Read them with a subscription or buy the individual article.  

May 2012 Issue 

WHAT'S WITH THE SANCTIONS?

Volley of Cases Draws Fresh Attention to Labor Code 5813 

Sanctions have been in the news lately, which signals an good opportunity to review the issue of sanctions and who and what actions trigger them in proceedings at the California Division of Workers' Compensation district offices.

On May 9, WorkCompCentral published a news story titled, "4th DCA Asked to Review Sanctions Against Interpreter." In that case, a corporate officer at an interpreting firm is appealing a $2,500 sanction imposed by Workers' Compensation Administrative Law Judge. WCJ Agnes Barling ruled against the interpreter, who was accused of soliciting an injured worker to lie in court that he required the interpreter's services. The interpreter's appellate attorney said the issue being raised on appeal is whether the judge met the appropriate legal standard to impose sanctions.

On May 15, WorkCompCentral published a news article, titled, "2nd DCA Considering Sanctions against Beverly Hills Attorney." The facts of the case are unusual, but here goes:  The 2nd District Court of Appeal is reportedly considering sanctions against a Southern California attorney for filing a frivolous petition for review of three administrative decisions denying his requests for the discovery of privileged materials and imposing monetary penalties against him. The 2nd DCA dismissed the attorney's petition seeking review of a case in which he unsuccessfully attempted to prove that a claimant and her attorney participated in a fraud in order to collect workers' comp benefits for the claimant. The appellate court  denied review this month, saying it was "frivolous." The DCA remanded the matter to the WCAB to make a supplemental award of attorney fees for services rendered in connection with the appeal.

The granddaddy of late has to be this one, though. "WCAB Imposes Sanctions on Carrier, Adjuster and Defense Attorney," published April 16 on our web site. The California Workers' Compensation Appeals Board ordered $16,510 in sanctions and against the carrier, for engaging in bad-faith and frivolous actions in a benefits dispute. On review by A WCAP panel, the commissioners concluded that the monetary penalty was warranted based on their attempts to compel an applicant to submit to a deposition. The applicant was deposed the first time in 2006, four years after the carrier and adjuster stipulated to a cumulative trauma injury to various body parts. Workers' Compensation Administrative Law Judge Craig Glass ruled that only one deposition was permitted under Code of Civil Procedure Section 2025 (renumbered 2025.610). The applicant sought sanctions and attorney fees, and WCJ Glass ordered the insurer and adjuster to pay the applicant's attorney costs of $15,610 and a penalty of $2,500 – the statutory maximum allowable under Labor Code Section 5813.

The applicable California Labor Code Section is 5813 (Sanctions for bad faith actions / tactics):

(a) The workers' compensation referee or appeals board may order a party, the party's attorney, or both, to pay any reasonable expenses, including attorney's fees and costs, incurred by another party as a result of bad-faith actions or tactics that are frivolous or solely intended to cause unnecessary delay. In addition, a workers' compensation referee or the appeals board, in its sole discretion, may order additional sanctions not to exceed two thousand five hundred dollars ($2,500) to be transmitted to the General Fund.
(b) The determination of sanctions shall be made after written application by the party seeking sanctions or upon the appeal board's own motion.
(c) This section shall apply to all applications for adjudication that are filed on or after Jan. 1, 1994.

Judges admittedly don't order sanctions very often in California workers' comp proceedings, however, they are within their authority to do so. A sanction amounts to potential loss of revenue, loss of reputation and filing for writs of review by the WCAB and an appellate-level court. Your case also could get written up in a legal publication, generating mostly unwanted attention unless you did the asking for sanctions against the opposing party. In that case, the attention is good for business.

Google "workers' comp sanctions" and up come reported sanction cases in Virginia, Connecticut, North Carolina, Montana, Texas, Oregon and in the federal court system. The intent of sanctions is to identify and punish delay tactics, either in paying benefits or deliberately wasting the court's time.

Retired Judge Pam Foust, who has written the definitive guide for liens and lien litigation in California, briefly covers sanctions in Chapter 4 of her book, "California Lien Claims in Workers' Compenstion Cases." If you have Pam Foust's book (the new edition is due out in August), refer to it, too.

If you are a party to workers' comp claims or an attorney representing the injured worker or the payer, make it your business to understand Labor Code section 5813. There is an excellent class online about sanctions and attorney fees, interest, costs and penalties taught by a Judge Myrle Petty and lien attorney Jon Brissman. Both instructors talk from experience about this monetary issue and its implications for your practice and your wallet. Jon Brissman also penned an article about interest on medical liens, which is attached to the course.

View the course: Click

Links:

Labor Code 5813: Lookup

4th DCA Asked to Review Sanctions Against Interpreter … Read It or Buy the Article.

2nd DCA Considering Sanctions against Beverly Hills Attorney ... Read It or Buy Now

WCAB Imposes Sanctions on Carrier, Adjuster and Defense Attorney ... Read It or Buy Article.

Lien guide for California by (ret.) Judge Pam Foust ... By James Publishing

WCAB Lien Rules Have the Green Light!

Now we know in California what became of the proposed rule changes about liens. WorkCompCentral  learned this week that the amendments went into effect on Monday, May 21. The DWC has not issued a formal announcement yet, and judges are under advisement to use discretion in applying the new rules immediately since the approval and release flew below everybody's radar, even the judges. 

The proposal to give lien claimants one year from the date of filing a lien to set a trial date did make the final package of rule changes. However, the tolling of this regulation won't begin until Aug. 1. 

There is a Southern California judges' training this week, and the lien regulations will be part of that training. Presiding Judge Paige Levy of Marina del Rey has agreed to discuss the lien rule changes at a previously scheduled seminar for WorkCompCentral on June 2 in Anaheim. Seats remain. Check it out. 

Mills College a Pleasant Experience

We learn something from every seminar that WorkCompCentral presents, and last Saturday was no different. We traveled to Oakland to the campus at Mills College, where nearly 50 workers' comp professionals listened to presenters Judge Colleen Casey and Robert Rassp and keynoter Judge Lilla Rados. The topic was rating permanent disability and tricks of the trade. People liked the class. 

That much we expected. 

What we didn't see coming were the reviews about Mills College itself. A few took the time to comment about how much they enjoyed spending time on the peaceful, green campus. "More Bay area seminars at Mills College," one person requested. "Mills College is a very good and quiet and pleasant campus," another opined. As they say in the real-estate business. location, location, location. 

More live seminars are in development for late summer and fall in the Bay area. Watch your email in-box for announcements about the topics and dates of these continuing-education events at Mills College, as long the administration keeps inviting us back for slow Saturdays on the Oakland campus.

Last Saturday's seminar, "Rating PD: Tricks of the Trade," will be available in a couple of weeks as a distance-learning course. Call Sam or Jake at 805-484-0333, ext. 113 or 133 about getting enrolled. 

The Doctor Who Paid Us a House Call

It was a treat listening to Dr. Gunnar Anderssen, the senior editor of the AMA Guides 5th Edition last month. His dry wit had the audience in Studio City chuckling with lines such as this one, "When the Devil reads the Bible, his interpretation is different." Someone asked him what is the purpose of the AMA Guides, to which he replied, "To read them."

One person left a comment that Gunnar's devil-may-care observations about California comp disability law (i.e., Almaraz-Guzman) led one attendee to joke that he was packing up practice and moving to Illinois, where Anderssen has an orthopedics practice at Rush University Medical Center in the heart of Chicago. Illinois uses the latest edition of the Guides, the Sixth, to evaluate permanent disability. 

On the drive from LAX to Studio City, I got into a conversation with him about back pain and what type of activities to avoid. Dr. Anderssen revealed that astronauts coming back from long missions aboard NASA space vehicles experienced back pain once they returned to Earth. The time in weighless space was the culprit, Dr. Anderssen concluded after studying the problem for NASA. As a result, astronauts now have exercise equipment that puts downward pressure on their spinal column, mimicking what happens naturally on Earth. The spine needs compressing to stay healthy. 

Also, you're taller in the morning than you are late in the day. The disc material between our vertebrae dehydrates during our waking hours and shrinks. This causes a person to shrink in height, too. While we sleep at night, our bodies naturally rehydrate the disc material, so we regain our lost height overnight.

NY Board Intends to Adopt Use of ICD-10 Next Year

The New York Workers' Compensation Board has announced that it will require use of the ICD-10 codes (International Classification of Diseases, 10th Edition for diagnosis and procedures) on Oct. 1, 2013. New York is taking this action to promote "consistency between medical systems and to avoid imposing significant costs to support two diagnostic coding systems,"Chairman Robert Beloten said. 

The Board expects to require use of ICD-10 on a timetable consistent with Medicare and Medicaid. The Center for Medicaire and Medicaid Services (CMS) has information on its website. Questions about ICD-10 and its impact on New York's workers' compensation system should be emailed to ide10@wcb.ny.gov.

Summer Class Schedule 

Registration is open for all of the following:

JUNE 2, BUSINESS EXPO CENTER IN ANAHEIM

"Your Liens - When to Hold 'Em, Fold 'Em and How to Settle."

With Jon Brissman, Judge Paige Levy and attorney Sean Hermanson. Focus is on evaluating liens, preparing to litigate liens and going to trial or settlement conference.

Registration and CE Credit Details: View

========>

JUNE 23, WORKCOMPCENTRAL IN CAMARILLO

"How to Write a Rateable Psyche Report"

Led by Dr. Julie Armstrong, PsyD. She will talk about the medical-legal system for workers' comp, the psyche component of a claim, and what a rateable report must contain.

Dr. Julie Armstrong, Psy.D, is a QME who performs psychology evaluations regularly as a panel or agreed evaluator. Julie is also a registered nurse and clinical nurse specialist, and worked for 13 years at UCLA's Neuropsychiatric Hospital. She also is interviewed on TV news and the Discovery Channel crime series, "Wicked Attractions."

Registration and CE Credit Details: View

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WEBINAR - BURN INJURIES IN THE WORKPLACE

Friday, June 1 at 1 p.m. presented by Dr. Peter Grossman of the Grossman Burn Centers. 

This is a free continuing-education program from WorkCompCentral, part of the monthly "One on One at 1" series. Risk managers, nurse case managers, comp program managers, claims supervisors, underwriters, insurance brokers, claims consultants and managed-care representatives are strongly encouraged to participate. 

Registration and CE Credit Details: Register

========>

WEBINAR - A SURVIVAL GUIDE FOR DOCTORS IN CALIF. WORK COMP

Tuesday, June 19 at 1 p.m. (RESCHEDULED TO MID-JULY - TO BE ANNOUNCED)

Led by managed-care and workers' comp specialist Maureen Bennington. This webinar offers a list of do's and dont's for treaters that practice workers' comp medicine in California. Target group includes: treating physicians, specialists. orthopedic surgeons, physical rehab/chiropractic, medical practice groups, medical office managers, medical
billers and anyone who treats or see patients in Calif. comp. 

Call 805-484-0333, ext. 1 for more information. (Registration for this webinar is pending).

<========

April 2012 Issue

 

Taking the Fear Out of Workers' Comp Reform

Today is Friday, the 13th and that fact makes alot of people nervous. Fear of Friday the 13th has a name, too. The scientific name is friggatriskaidekaphobia (pronounced frig-u-trisk-eye-deck-uh-pho-bee-uh). 

The most common fears people share are probably no secret to anyone. I looked up the most common fears online and found the top 10 listed at About.com. In order they are:

1. Spiders                                                          
2. Snakes
3. Heights
4. Being trapped 
5. Dogs
6. Thunder and lightning
7. Injections
8. Social situations
9. Flying
10. Germs 

One noticeable exception missing from the 10 list was fear of change. 

There's been talk recently in California about another event that makes people nervous: workers' comp reform. It's not a matter of "if" reform is coming to California. Business and labor are in agreement that reform can be accomplished, giving injured workers higher benefits and employers some cost savings.

WorkCompCentral Western Bureau Editor Greg Jones is covering the pre-reform activity in Sacramento and around the state, where the Division of Workers' Compensation is on a fact-finding tour to hear from stakeholders what parts of comp need legislative fixing. Nine meetings are scheduled around California, and the first one was held this week in West Sacramento. So, yes, reform is just around the corner. 

Whatever the DWC, labor and business, and the politicians decide to fix, you'll hear about it as it happens by reading WorkCompCentral's Daily Newsletter and email announcements, like this one. 

Dale Carnegie, the author of "How to Win Friends and Influence People," offers this advice for facing whatever fear bothers you: "If you want to conquer fear, do not sit home and think about. Go out and get busy." Need a place to start? How about attending a DWC public forum to listen to the administration and public comments, upon which the DWC might base the reform legislation. 

P.S. April marks the 8th anniversary of SB 899, the last major renovation done on California comp law.

- Rob McCarthy  

MAY 1: HELPING DOCTORS FRUSTRATED BY UR

Medical treaters of all types are encouraged to participate in a free webinar on May 1 at 1 p.m. Pacific time. The title is "The Key To Winning the UR Battle ... Understanding URO Requirements."

This is designed for help providers serving the workers' compensation industry and dealing with utilization reviews. This overview of the requirements of the URO (utilization review organization) clarifies what drives the system. Providers will learn how to submit a request for treatment that results in authorization. The options available when a denial of your treatment request is received will be addressed as well as the challenges encountered throughout the UR process.                                                
                                                                                                                                                                                                                                                                             
Led by Maureen Bennington, a 20-year veteran of workers' compensation. She has a Master's of Science degree in Rehabilitation Administration and is credentialed in Utilization Review, Case Management, Disability Management and Vocational Counseling. Maureen has extensive knowledge related to all managed care products. She has been responsible for the development of case management, medical bill review and utilization review programs, file review and audit procedures, return-to-work programs and disability management product development and implementation          procedures.                    

Read more about the webinar here.

Register now: Yes!

LIVE SEMINAR SCHEDULE FOR APRIL, MAY AND JUNE

There is alot of live training available about rating, lien litigation and writing a psyche report that meets the legal standard for substantial evidence.

APRIL 

April 28, Studio City - "Straight Talk About Using the Guides: An Open Forum Featuring Dr. Gunnar Anderssen, Senior Orthopedics Editor of the AMA 5th." An expert panel will assemble with Dr. Anderssen to discuss Guides issues and controversies.

Six MCLE, Legal Specialization, Rating and Calif. Claims Professional credits available. (QME credit pending)

$299 for WorkCompCentral qualifying subscribers. $329 regular price.

Register: https://ww3.workcompcentral.com/Course/coursedetails/?category=42&id=719


MAY


May, 19, Mills College in Oakland - "Rating PD - The Tricks of the Trade." Led by Colleen Casey and Robert Rassp. Judge Lilla Rados is the keynote speaker. Digs deeper into the most common rating issues and traps in workers' compensation cases. Includes a session about how to depose doctors for the "why's and "how's."

Six MCLE, Rating and Calif. Claims Professional credits available. (QME credit pending)

$299 for WorkCompCentral qualifying members. $329 regular price.

Register: https://ww3.workcompcentral.com/Course/coursedetails/?                  category=42&id=721                                                                                      Judge Lilla Rados 


JUNE

June 2, Orange County Expo Center - "Your Liens - When to Hold 'Em, Fold 'Em and How to Settle." With Jon Brissman, Judge Paige Levy and attorney Sean Hermanson. Focus is on evaluating liens, preparing to litigate liens and going to trial or settlement conference.

Six MCLE, Legal Specialization and California Claims Professional hours.
$299 for WorkCompCentral qualifying members. $329 regular price.

Register: https://ww3.workcompcentral.com/Course/coursedetails/?category=42&id=718

$299 for WorkCompCentral qualifying members. $329 regular price.


June 23, WorkCompCentral Learning Facility, Camarillo - "How to Write a Rateable Psyche Report," led by Dr. Julie Armstrong. Julie will talk about the medical-legal system for workers' comp, the psyche component of a claim, and what a rateable report must contain.

Six MCLE, Legal Specialization hours. QME credit for this seminar is pending.

Registration is being taken by phone, 805-484-0333.

RX BILLING FORM DOESN'T ACTUALLY EXIST - OOPS!

The DWC today sent out a Newsline in which it alerted medical billers for pharmacy and carriers to a billing regulation error. Here's what the DWC said:

"DWC has received inquiries regarding the paper billing form adopted for pharmacy billing. The billing regulation adopts the National Council on Prescription Drug Programs (NCPDP) Workers’ Compensation/Property & Casualty Universal Claim Form and specifies version 1.0 – 05/2008. However, the NCPDP has informed the division that version 1.0 was a draft that was never put into production. The NCPDP form that is available is version 1.1 – 05/2009. DWC intends to revise the regulations to specify the correct version number for the form. In the meantime, it would appear to be reasonable for pharmacies to use version 1.1 and for claims administrators to process bills submitted on that form."

ARIZ. PASSING TREATMENT GUIDELINES  

A bill to implement workers' compensation treatment guidelines is moving in the Arizona statehouse. HB 2368 is an omnibus bill that directs the Industrial Commission to implement treatment guidelines. It also modifies how monthly benefits are calculated, and expand insurer subrogation rights. The Senate has approved the measure, which is now awaiting debate and action in the lower House.

TWO STATES ADOPT OPIODS MEASURES 

IAIABC announced this week that Oklahoma and Massachusetts have adopted new treatment guidelines to deal with opiods abuse. A national RX Drug Abuse Summit also took place this week, ratcheting up the pressure on states to clamp down on prescription practices of narcotics by treating physicians. Joe Paduda, who covers the workers' comp industry on his blog www.managedcarematters.com, attended and filed dispatches from the event. I recommend you check out Joe's blogs. Managed Care Matters

SOMETHING FOR MEDICAL BILLERS AND CODERS

The U.S. Department of Health and Human Services has issued a proposal that will postpone the compliance date for ICD-10, currently scheduled for October 1, 2013, for one full year.

BROWSE TOPICS, ANYTHING THAT'S NEW

We're proud of our continuing-education catalog, and we work hard to line up speakers and topics that are a cut above the rest. So, do us a favor. Bookmark our CE home page and check it regularly for "What's New"and "Weekly Deals" It's a good way to keep informed about us and this industry.

        Staying Informed Doesn't Happen by Accident

March 2012 Issue

        

Cab Drivers Fare Well in Brain Study

Findings Can Be Applied to Head Injuries 

A recent study of London cab drivers offers evidence that learning new tasks is healthy for the adult brain. This is especially good news for rehabilitation after a brain injury.

The study included people training to become licensed taxi drivers in London, with its complicated grid of 25,000 streets and 20,000 landmarks. The researchers gathered brain images of the taxi trainees over the three- to four-year period it takes to learn to navigate the city, and tested their memory.  

At the start of the study, there were no differences between groups of new taxi drivers and non-drivers. After three to four years, however, successful taxi trainees showed an increased in gray matter in the back part of the hippocampus. The hippocampus is important in spatial navigation and memory.

These changes did not occur in trainees who failed or in people in the non-driving control group. The findings show that the human brain remains "plastic" even in adult life, enabling it to adapt when people learn new tasks and skills, said University College Londonm researchers Eleanor Maguire and Katherine Woollett.

But, why does learning new streets and destinations change brain activity in cabbies? The simple answer is that learning new things may also strengthen connections between existing neurons. The challenge the London cabbies face also may increase the production of new neurons in the brain, the researchers theorized. 

The findings also offer incentive for adults to be lifelong learners. More information about brain health can be found at The Society of Neuroscience web site.

New Name for Florida Workers' Comp Conference 

The Florida Workers' Compensation Educational Conference has a new name that reflects the growth in attendance and national interest in the show, the organizers announced. 

"Today, I am proud to announce that we are a truly national conference, and a name change and other initiatives in 2012 will reflect that. While FWCI will continue as a state-specific organization, we have created the National Workers‟ Compensation Institute (NWCI) as an umbrella organization, and have formally renamed the conference the National Workers' Compensation Educational Conference," said James McConnaughhay,  the general chair.

Information About April 28 QME Exam 

The California Qualified Medical Evaluator examination will be administered on April 28 at locations in Southern and Northern California. The test sites and start times are:

SOUTHERN CALIFORNIA
Embassy Suites Garden Grove
11767 Harbor Blvd
Garden Grove, CA 92840
714-539-3300

NORTHERN CALIFORNIA
South San Francisco Conference Center
255 South Airport Blvd
South San Francisco, CA 94080
650-877-8787

Registration begins at 9:30 am. The exam begins at approximately 10 am. After instruction is given, candidates have three hours to complete the 200 multiple choice exam. 

Call the DWC at 510-628-2004 for more assistance or visit their web site.  For details about preparing for the exam, go here.

Topics Added to the Online Catalog 

Three webinars recorded in 2012 are available this month in the online catalog:

1) EDEX, EAMS and the Public Search Tool: Unlocking California Claims Information. 

Presented by Susan Gard. 1 CE Credit for California Claims Professionals, Attorneys

Cost: $24.19

Registration

Summary: Susan Gard, who oversees workers' compensation process and automation for the City and County of San Francisco, explains how EAMS, EDEX and the new Public Search tool differ and complement one another. She also will demonstrate EAMS and the new public search tool, while addressing whether EDEX is obsolete because of the rollout of the DWC public search tool. 

2) Demystifying Workers' Comp Claims in California.

Presented by attorney Michael Sullivan, author of Sullivan on Comp. 

2 CE Credits for California Claims Professionals and Attorneys/Legal Specialists. 

Cost: $41.09

Registration

Summary: Attendees will gain an understanding of the legal and med-legal processes, medical treatment, litigation and substantive issues that arise in the administration of a workers' comp claim. Two resources form the basis of this instruction by experienced attorney, speaker and author Michael Sullivan - the California Workers' Compensation Flowchart 2012 and the legal practice book series, "Sullivan on Comp."

3) Medicare Set-Aside Update - What You Don't Know Can Hurt You.

Presented by MSA compliance expert Kim Wiswell of CompProjections.

1 CE Credit for Calif. Claims Professionals and Attorneys/Legal Specialists. 

Registration

Summary: The latest trends from the Centers for Medicare and Medicaid Services (CMS), including the most frequent reasons your submitted allocations are delayed in the approval process, and how you can avoid these delays. Plus, suggestions for ensuring your cases are "submission ready" prior to even requesting an MSA.

Whole-Person Approach to Treating Addiction

                PRIUM's Medical Director Speaking on Next Free Webinar, April 2

PRIUM Senior Vice President of Business Development Mark Pew will interview PRIUM’s Medical Director, Sankar Pemmaraju, DO, about “whole-person” treatments for claimants who are dependent on opioids or addicted to them. The free webinar will be Monday, April 2 at 1 p.m. (Pacific), 4 p.m. (Eastern).  

The hour-long webinar focuses on strategies to help claimants regain control of their lives, return to work and establish healthy lifestyles.  These include:   to work and establish healthy lifestyles.  These include:  

• Physical medicine
• Functional capacity evaluations
• Alternative therapies, such as acupuncture
• Occupational therapy and retraining claimants when job duties exacerbate pain
• Psychological counseling
• Personal trainers and nutritional counselors

Produced by WorkCompCentral.com, the webinar offers one continuing education credit to California claims professionals and attorneys.  There is no charge to attend, but space is limited to the first 100 registrants. Call 866-975-2667 or enroll online.

PRIUM Medical Director Sankar Pemmaraju, D.O. works with physicians to incorporate the latest scientific literature and evidence-based medical guidelines into their treatment of workers’ compensation patients.  He maintains an active practice in his functional restoration clinic in Southlake, Texas. His board certifications include a Diplomate of the National Board of Osteopathic Medical Examiners and Diplomate and Fellow of the American Board of Physical Medicine and Rehabilitation, and a Consultant of the National Board of Osteopathic Medical Examiners.  

Rating Event Features Guides Sr. Orthopedic Editor 

Dr. Gunnar Anderssen Joins Expert Panel on April 28 in Studio City 

Dr. Gunnar Anderssen, the senior editor of the orthopedics chapters of the AMA Guides Fifth Edition, will make a rare speaking engagement in California on April 28 to discuss controversies with the Guides, and answer audience questions. It marks his return to California since 2004 when SB 899 was adopted. 

Dr. Anderssen heads a distinguished speaker panel about Guides rating, issues and case law. Applicant and defense perspectives are represented, plus conflicting rating opinions by doctors who evaluate injured workers. A full list of topics for discussion is found here.

He will be joined by presenters from the medical, legal and rating professions. Ken Kingdon is moderator of the seminar at The Sportsmen's Lodge Empire Room, 12825 Ventura Blvd., Studio City, CA 91604. Ken writes "KIngdon Rating Newsletter" and has written three books about Guides rating, including the AMA publication, "A Medical-Legal Companion to the AMA Guides Fifth." 

Call 805-484-0333, ext. 1 to learn more. Online registration here. 

California Requirements for Adjusters, Bill Review 

To legally perform the duties of a Claims Adjuster, the California Claims Professional Designation (CCPD) must be earned. This verifies he or she has completed at least 120 hours of training as set forth in Section 11761 of the California Insurance Code. 

To legally handle medical billing or review for an insurer or medical billing entity, an agent must earn a Medical Bill Reviewer Designation Form that verifies he or she has completed at least 40 hours of training as set forth in the regulations (Title 10, Section 2592.04).

If you are handling claims or reviewing medical bills and need to be certified, contact us. We have credential programs that can be taken online, which meet California requirements. 

To speak with a California credential adviser, call 805-484-0333, ext. 113 or 133. 

For a summary of the training and requirements, look under Credentials on our web site. Or visit the California Department of Insurance web page about adjuster and bill reviewers.