4.Timely services and retention of reports 3 Flashcards
What is the purpose of reimbursing the physician for one office visit in a disputed claim?
The reimbursement is for the office visit used to review and discuss the evaluator’s report with the injured worker.
Which regulation governs the applicable rate for the reimbursed office visit?
The applicable rate under section 9789.11 Physician Services Rendered on or After July 1 2004 of Title 8 of the California Code of Regulations governs the reimbursement rate for the office visit.
What types of services might be included in the reimbursement for the office visit?
The reimbursement may include record review any necessary face-to-face time during the visit in excess of that specified in the applicable CPT office visit code as well as the standard elements of the office visit.
What are the QME Forms mentioned in the document?
The QME Forms are: QME Form 121 which pertains to the protection of mental health records and QME Form 120 which relates to the voluntary directive for alternate service of medical-legal evaluation reports on disputed injuries to the psyche.
What does CPT stand for in the context of office visit coding?
CPT stands for Current Procedural Terminology. It is a set of medical codes used to report procedures and services provided by healthcare practitioners.
What types of reports may require preparation time and charges during an office visit?
Charges may apply for the time required to prepare a treatment report pertaining to the office visit.
What is the purpose of the QME Form 120?
The QME Form 120 labeled as the Voluntary Directive for Alternate Service of Medical-Legal Report on Disputed Injury to the Psyche is used when serving a comprehensive medical-legal report by the evaluator on a physician.
What two copies of the medical-legal report are served under subdivision 36.5f?
One of the two copies of the medical-legal report must be served on the physician pursuant to subdivision 36.5f along with the QME Form 120.
What does ‘Electronic service’ mean in the context of medical-legal reports?
Electronic service refers to the service of the medical-legal report and all required documents by either electronic transmission or electronic notification.
Who can perform electronic service of medical-legal reports?
Electronic service may be performed directly by the physician or by an agent of the physician.
What section outlines the electronic service of medical-legal reports?
The electronic service of medical-legal reports is outlined in section 36.7.
What types of evaluations are included under the electronic service of reports?
A Qualified Medical Evaluation (QME) Agreed Medical Evaluation (AME) reports and other medical-legal reports may be served electronically.
What are the key elements required when serving medical-legal reports electronically?
The service must include the medical-legal report and all documents required by section 36.
What happens if a comprehensive medical-legal report is served incorrectly?
If served incorrectly it may lead to disputes regarding the accuracy or validity of the medical-legal report potentially complicating associated legal proceedings.
What are the implications of having a comprehensive medical-legal report prepared?
The preparation of a comprehensive medical-legal report may involve additional charges and require thorough documentation affecting both the patient and the evaluator’s responsibilities.
What does ‘Electronic transmission’ refer to?
‘Electronic transmission’ refers to the transmission of a document by electronic means to the electronic service address at or through which a party or other person has authorized electronic service.
Define ‘Electronic notification’.
‘Electronic notification’ is the process of notifying the party or other person that a document has been served by sending an electronic message to the electronic address at or through which the party or other person has authorized electronic service with details included.
What conditions must be met for electronic service to be permitted?
Electronic service shall be permitted only when the parties agree to it and a written confirmation of that agreement is made.
What must a party provide at the time of consenting to electronic service?
At the time of giving consent to electronic service a party or entity must provide their electronic address for the purpose of receiving electronic service.
To whom must medical-legal reports or other papers be transmitted for electronic service?
For electronic service the medical-legal report or other papers must be transmitted to the electronic address that is the most recent electronic address provided by the party to the physician.
What is the significance of having a written confirmation for electronic service consent?
A written confirmation of the agreement for electronic service serves as a record and proof that both parties consented to use electronic means for document transmission.
What is the impact of providing an outdated electronic address?
If a party provides an outdated electronic address they may not receive important documents or notifications as the transmission would go to a location that is no longer valid.
Why is it important for parties to agree on electronic service?
It is important for parties to agree on electronic service to ensure that both understand and consent to the method of communication which helps in maintaining clarity and avoiding disputes over service methods.
What role does the term ‘most recent electronic address’ play in electronic service?
The term ‘most recent electronic address’ is crucial as it indicates that the documents must be sent to the latest address provided by the party to ensure successful delivery and receipt.
What is the obligation of a party whose electronic address has changed?
The party must file a notice of change of address with the physician and all parties.
What is the moment when service is considered complete when using electronic means?
Service is complete at the time of transmission.
How does the period of notice change after service of a document through electronic means?
Any period of notice and any right or duty to act or make a response shall be extended by two business days.
What terms apply to the electronic service of medical-legal reports in claims of injury to the psyche?
All of the terms of section 36.5 apply except that the service requirements in section 36.5b6 may be accomplished by electronic service as per this regulation.
What is the relevance of section 36 regarding electronic service of medical-legal reports?
For purposes of all medical-legal reports all of the terms of section 36 apply to electronic service but the manner of service can be accomplished through electronic transmission when appropriate.
What is the implication of electronic service for medical-legal reports?
Electronic service for medical-legal reports allows for quicker and possibly more efficient communication while still adhering to legal requirements outlined in relevant sections.
What is the purpose of the mandatory form 122 AME or QME Declaration of Service of Medical-Legal Report?
This form is used to certify the electronic service of all medical-legal reports in compliance with 8 Cal. Code Regs. 122.
What can replace the mandatory form 122 AME or QME Declaration of Service of Medical-Legal Report?
An Affidavit of Proof of Electronic Service can replace the mandatory form.
What must the Affidavit of Proof of Electronic Service include regarding the document served?
It must set forth the exact title of the document served in the action.
What are the five requirements that must be shown in the Affidavit of Proof of Electronic Service?
A) The name and residence or business address of the person making the service. B) That he or she is a resident of or employed in the county where the electronic service occurs. C) That he or she is over the age of 18 years. D) That he or she is readily familiar with the business’ practice for serving electronically. E) That the document would be electronically served that same day in the ordinary course of business.
What legal consequence does the Affidavit of Proof of Electronic Service carry when it is signed?
It is signed under penalty of perjury under the laws of the State of California.
What other details must be included in the Affidavit of Proof of Electronic Service?
The specific details that must be included were not provided in the text but typically it would include the date of service and the method of electronic communication used.
What is the age requirement for a person making electronic service as per the affidavit?
The person making the service must be over the age of 18 years.
What does it mean to be readily familiar with the business’ practice for serving electronically?
It means that the individual is knowledgeable about the procedures and protocols of the business concerning how documents are typically served electronically.
What is the significance of the statement that the document would be served the same day?
This statement assures compliance with business practices and the promptness of service which is crucial in legal proceedings.
How is electronic service of documents in California regulated?
It is regulated by the California Code of Regulations specifically under 8 Cal. Code Regs. 122.
What information must be included in the electronic service of documents?
- The electronic service address and the residence or business address of the person making the electronic service. 2. The date of electronic service. 3. The name and electronic service address of the person or entity served. 4. A statement that the document was served electronically.
What is the time frame for an unrepresented employee or claims administrator to request a factual correction of a comprehensive medical-legal report from a panel QME?
An unrepresented employee or the claims administrator may request a factual correction within 30 days of the receipt of a comprehensive medical-legal report from a panel Qualified Medical Evaluator.
What are the requirements for requesting a factual correction of a medical-legal report from a panel Qualified Medical Evaluator (QME)?
A request for factual correction must be served on: 1. The panel Qualified Medical Evaluator who examined the injured worker. 2. The party who did not file the request. 3. The Disability Evaluation Unit office where the comprehensive report was filed.
Under which Labor Code section is the filing of comprehensive medical-legal reports with the DEU required?
Labor Code section 4061e.
Who can request a factual correction of a comprehensive medical-legal report?
An unrepresented employee or the claims administrator.
What is the purpose of a request for factual correction of a comprehensive medical-legal report?
To address errors or inaccuracies in the report prepared by a panel Qualified Medical Evaluator.
What is a Qualified Medical Evaluator (QME)?
A Qualified Medical Evaluator is a physician certified by the state to conduct independent medical evaluations and issue medical-legal reports concerning workers’ compensation cases.
What is the consequence of not serving the request for factual correction appropriately?
Failure to serve the request appropriately may result in rejection of the request or failing to address the error in the medical-legal report.
What document format should be used for the request for factual correction?
The request for factual correction should be made using the specific form as outlined in subdivision f.
What is the time frame for the injured worker to respond to a request for factual correction served by the claims administrator?
The injured worker has five (5) days after the service of the request for factual correction to respond to the corrections mentioned in the request.
Who must the injured worker serve their response to after receiving the request for factual correction?
The injured worker’s response must be served on both the panel Qualified Medical Evaluator and the claims administrator.
If the request for factual correction is filed by the injured worker how long does the panel Qualified Medical Evaluator have to review the request?
The panel Qualified Medical Evaluator has ten (10) days after service of the request to review the requested corrections.
What is the purpose of the panel Qualified Medical Evaluator’s review of the request for factual correction?
The purpose is to determine if factual corrections are necessary to ensure the factual accuracy of the comprehensive medical-legal report.
How long does the panel Qualified Medical Evaluator have to review a request for correction if the request is filed by the claims administrator or both parties?
If the request for correction is filed by the claims administrator or by both parties the time to review the request for correction is extended to fifteen (15) days after the service of the request.
What happens at the end of the period given for responding to a request for factual correction?
The text does not provide specific information about what happens at the end of the period but typically after the review period the Qualified Medical Evaluator may issue an amended report if corrections are deemed necessary.
What must the panel QME do in response to a request for factual correction in subdivision c?
The panel QME shall file a supplemental report with the DEU office where the original comprehensive medical-legal report was filed indicating whether the factual correction of the comprehensive medical-legal report is necessary to ensure its factual accuracy. If factual corrections are necessary the report should also specify whether these corrections change the opinions stated by the panel QME.
What is the role of the DEU office in the factual correction process?
The DEU office is where the original comprehensive medical-legal report was filed and it receives the supplemental report from the panel QME regarding the necessity and impact of factual corrections.
What limitations are placed on parties regarding documents filed with the panel QME?
No party shall file any documents with the panel QME other than the form indicating the facts that should be corrected nor shall the panel QME review any documents not previously filed with them pursuant to Section 35 of the rules.
