WCAB court cases and ever changing California law ensure that the medical
legal landscape is always shifting! We continually update our courses to add
relevant and new information.
DWC Audit by the California State Auditor
you may recall, the DWC has been audited for the first time in its history by
the California State Auditors Office. The results of the audit are now
published. You may read the summary and full report here: https://www.auditor.ca.gov/reports/2019-102/index.html
Auditor's Office did an excellent job of summarizing the QME's functions and the
DWC Medical Unit's oversight of the QME system. There are some key findings,
many of which we in the QME community were already aware of:
The DWC has not adequately ensured that there are enough
QMEs to keep up with the demand for their services, noting that from fiscal
years 2013–14 through 2017–18, the total number of QMEs decreased by 12 percent
while requests for QMEs increased 37 percent.
- By not ensuring an adequate number of QME’s, the DWC may be causing delays to
the injured workers’ access to benefits while increasing costs to employers.
- The DWC inappropriately used its own QME reappointment process to discipline
some QMEs the Division alleged to have committed overbilling violations, which
raises due process concerns. The DWC lacks sufficiently detailed, written
policies and procedures for investigating and resolving complaints.
- The DWC has not continuously reviewed QME reports for
quality and has not tracked when workers’ compensation judges have rejected QME
reports that failed to meet minimum standards. “Low-quality QME reports can
delay injured workers’ receipts of benefits and add expenses for employers
involved in disputes.”
Recommendations within the Auditors Report:
- To address the decrease in the number of appointed
QMEs the Legislature should amend state law to specify that the DWC review and,
if necessary, update the fee schedule for compensating QMEs at least every
two years based on inflation. Implement a plan for recruitment for needed
specialists QMEs by 2020.
- Revise state law to increase the number of QMEs on the panels DWC provides.
- DWC should, by April 2020, develop and implement separate written policies and
procedures that define and specify its internal processes for disciplining and
- Implement a plan to continuously review QME reports for quality and report its
findings to its administrative director annually.
DWC Response and Auditor's Reply:
The DWC has responded officially to the Auditor's report and the Auditor's
Office has replied to that response. You may read these comments here: https://www.auditor.ca.gov/reports/2019-102/response.html#comments
At this point there is no news in regard to needed
revision of the MLFS. AB 1832 appears to be stalled, while the DWC's last
proposal was not well received by the QME community. The Auditor's report
clearly restates the need for adjustment to the MLFS, but does not articulate
how just an adjustment be made. The debate will no doubt continue into 2020, at
which point the MLFS will not have been adjusted for inflation in 14 years!
As Always: The issues
regarding the MLFS Complexity Factors remains concerning and QME's are urged to
fully document the complexity factors involved in billing. Your descriptions of
the complexity factors should be rock solid to avoid any conflict with the
Medical Unit. If you have any questions regarding
a specific case or complexity factor issue, please contact the Medical
Unit personally before issuing your report.
- California AB 1832
has stalled in the State Legislature
Salas and Eloise Gomez-Reyes have introduced AB 1832. Effectively AB 1832 would
constitute an increase in the MLFS which has not been adjusted since
2006. Since its introduction, there has been no action taken by the Assembly
and the bill has effectively stalled. To read the
full text of the bill and to track its progress, click
are urged to contact your State representatives regarding their needed support
of AB 1832.
Another New Proposed Fee Schedule.
responded to the introduction of AB 1832 with a proposed new Medlegal Fee
Schedule. A forum was opened and hundreds of pages of public comments were made.
the DWC Proposal and the Forum Contents
is proposing a flat rate type schedule which would sadly reduce payments to
QME's for most reports. This proposal stands in direct contrast to AB 1832,
proposing in effect a pay cut to QME's when a pay increase is needed to stem the
exodus of QME's from the system.
- New Course Approval - AMA Guides Examples
We are happy to announce that our new course covering AMA Guides 5th Edition
text examples has been approved by the DWC Medical Unit. The course discusses AMA Guides 5th Edition examples for the Upper and Lower
Extremities and the Spine.
of our courses have been re-compiled using the latest HTML5 website code. These
latest improvements will make our courses play smoothly on a wide array of PC's and
mobile devices. Check out our Sample videos which are also compiled
using this same code!
Course 1 Sample
Our 12 Hour Report Writing Course was approved by the DWC Medical Unit and
has been well received.
This course satisfies the DWC Medical Unit report writing
course requirement for New QME appointment.
All course are approved by the DWC
Medical Unit to 5/22/2021
DWC Medical Unit Report Writing
Course Provider #18
DWC Report Writing Course Approval to 8/20/20
All of our 6
hour courses have been re-approved by the DWC Medical Unit until 5/6/21.
- The DWC Medical Unit has released
a new version of the Physician's Guide to Medical Practice in the California
Workers' Compensation System
you would like to take any of our current courses in preparation for sitting the
Examination, please email us! We offer a discount for using our courses for
QME Regulations 2013
DWC Request for Independent Medical Bill Review
Complete EAMS Report Filing
Instructions from the DWC
2016 DWC Physicians Guide
DWC Medical Unit
Medical Unit QME Forms
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EAMS - Serving
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