QME Test Prep QME Test Prep
Study online at https://quizlet.com/_gubau5
How many CEU hours is a QME required to have over 2
12
years?
AD
The Administrative Director shall appoint qualified medical
Who appoints a physician to become a QME?
evaluators in each of the respective specialties as required
for the evaluation of medical-legal issues.
What are the maximum number of locations a QME is
10
allowed to register?
The fee is calculated by the number of QME exams in the
How is the QME reappointment fee calculated?
past 12 months and the number of locations
What guideline sets QME reimbursement rates? OMFS (Official Medical Fee Schedule governs fees)
California Code of Regulations (CCR)
What text governs treatment in the CA WC system?
Medical Treatment Utilization Schedule
ICD10
What system is used to code Diagnosis in California work-
International Classification of Diseases, same as clinical
ers' comp?
practice
How many days does Independent Bill Review (IBR) have
15 days to assign, 60 days for a decision
to assign a case?And how many days for a decision?
What does PTP stand for? Primary Treating Physician
A PR-2 is triggered when the claimant needs testing, has
a change in status or every 45 days.
What triggers a PR-2?
Progress Report must be submitted every 45 days, UN-
LESS there is a significant change in the claimant's status,
then it's 20 days.
DWC AD10133.36 Return to Work & Voucher Report
If a PR-4 indicates disability, what form must also be filed?
Note: this is not the same as a vocational rehabilitation
voucher
, QME Test Prep QME Test Prep
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No more than $1K for computer equipment, etc.
Vocational Rehab benefits have what limits?
No more than $600 for Vocational Counseling
What does RFA stand for? Request for Authorization
Fill in the blanks
DWC1 is filed by (whom) ____ within how many ____ DWC1 is filed by the employer within one day.
days?
Serious injury or death must be reported to whom within
Cal/OSHA, 24 hours (pesticides too)
what timeframe?
What degrees are considered to be a physician in CA WC? MD, DO, DC, LAc, PsyD, etcNOT Physical Therapist (PT)
Prior to 1/1/2005, what book was used to rate disability? Packard Thurber
AMA Guides to the Evaluation of Permanent Impairment,
After 1/1/2005, what book was used to rate disability?
5th Edition
What industrial incident led to massive Work Comp re-
Triangle Shirtwaist Factory Fire
form?
Fill in the blank n 1913, the California legislature enacted the first compul-
In 1913, the ____ Act established workers' comp in CA. sory workers' compensation law, known as the Boynton Act
Fill in the blank
In 1917, the Workman's Compensation Insurance and
In 1917, the ____ Act was added to and expanded on the
Safety Act was added to and expanded on the Boynton Act.
Boynton Act.
In 1951, the CA WC system added subjective factors into
Fill in the blank
disability ratings.
In 1951, the CA WC system added ____ factors into dis-
Subjective factors may include pain, numbness, weakness,
ability ratings.
tenderness, paresthesia and sensitivity
All of the above
The Historic Compromise consisted of no fault, exclusive
remedy and assured and fixed benefit
, QME Test Prep QME Test Prep
Study online at https://quizlet.com/_gubau5
No Fault Exceptions: Self-inflicted, serious, and willful mis-
The Historic Compromise consisted of which compo-
conduct of employee reduces payment 70%Self-inflicted,
nents?a. No faultb. Exclusive remedyc. Assured and fixed
serious, and willful misconduct of employer increases pay-
benefitsd. All of the above
ment 50%
What Labor Code governs all things QME? Labor Code §139.2 governs all things QME
In an unrepresented case, who helps advise the
claimant?
I & A Officer
a. DEU
I&A= Information and Assistance Officer
b. Medical Unit
c. I & A Officer
For how many years is a QME appointed? AD appoints QMEs for 2 years
A PT (Physical Therapist) is not considered a physician in
What licensure is not considered a physician in CA WC?
CA WC.
In order to apply for an appointment, a QME must do
which of the following?
a. Pass competancy exam
b. Complete 16-hour disability writing course All the above
c. dedicate 1/3 of their time to direct medical treatment or
be AME 8+ times in previous 12 months
d. All of the above
Yes, failure to complete accurate and complete reports
pursuant to Labor Code section 139.2(i) may be grounds
Can the AD suspend/terminate a QME for too many re-
for termination.
jected or late reports?
The AD may also suspend a QME if their license to practice
is suspended and/ or failure to pay fees.
A disability is considered at P&S when the condition is
When is a permanent disability considered at P&S (MMI)?
unlikely to change within the next year
Impairment ratings are converted into Disability rat-
ings using the Permanent Disability Rating Schedule
Study online at https://quizlet.com/_gubau5
How many CEU hours is a QME required to have over 2
12
years?
AD
The Administrative Director shall appoint qualified medical
Who appoints a physician to become a QME?
evaluators in each of the respective specialties as required
for the evaluation of medical-legal issues.
What are the maximum number of locations a QME is
10
allowed to register?
The fee is calculated by the number of QME exams in the
How is the QME reappointment fee calculated?
past 12 months and the number of locations
What guideline sets QME reimbursement rates? OMFS (Official Medical Fee Schedule governs fees)
California Code of Regulations (CCR)
What text governs treatment in the CA WC system?
Medical Treatment Utilization Schedule
ICD10
What system is used to code Diagnosis in California work-
International Classification of Diseases, same as clinical
ers' comp?
practice
How many days does Independent Bill Review (IBR) have
15 days to assign, 60 days for a decision
to assign a case?And how many days for a decision?
What does PTP stand for? Primary Treating Physician
A PR-2 is triggered when the claimant needs testing, has
a change in status or every 45 days.
What triggers a PR-2?
Progress Report must be submitted every 45 days, UN-
LESS there is a significant change in the claimant's status,
then it's 20 days.
DWC AD10133.36 Return to Work & Voucher Report
If a PR-4 indicates disability, what form must also be filed?
Note: this is not the same as a vocational rehabilitation
voucher
, QME Test Prep QME Test Prep
Study online at https://quizlet.com/_gubau5
No more than $1K for computer equipment, etc.
Vocational Rehab benefits have what limits?
No more than $600 for Vocational Counseling
What does RFA stand for? Request for Authorization
Fill in the blanks
DWC1 is filed by (whom) ____ within how many ____ DWC1 is filed by the employer within one day.
days?
Serious injury or death must be reported to whom within
Cal/OSHA, 24 hours (pesticides too)
what timeframe?
What degrees are considered to be a physician in CA WC? MD, DO, DC, LAc, PsyD, etcNOT Physical Therapist (PT)
Prior to 1/1/2005, what book was used to rate disability? Packard Thurber
AMA Guides to the Evaluation of Permanent Impairment,
After 1/1/2005, what book was used to rate disability?
5th Edition
What industrial incident led to massive Work Comp re-
Triangle Shirtwaist Factory Fire
form?
Fill in the blank n 1913, the California legislature enacted the first compul-
In 1913, the ____ Act established workers' comp in CA. sory workers' compensation law, known as the Boynton Act
Fill in the blank
In 1917, the Workman's Compensation Insurance and
In 1917, the ____ Act was added to and expanded on the
Safety Act was added to and expanded on the Boynton Act.
Boynton Act.
In 1951, the CA WC system added subjective factors into
Fill in the blank
disability ratings.
In 1951, the CA WC system added ____ factors into dis-
Subjective factors may include pain, numbness, weakness,
ability ratings.
tenderness, paresthesia and sensitivity
All of the above
The Historic Compromise consisted of no fault, exclusive
remedy and assured and fixed benefit
, QME Test Prep QME Test Prep
Study online at https://quizlet.com/_gubau5
No Fault Exceptions: Self-inflicted, serious, and willful mis-
The Historic Compromise consisted of which compo-
conduct of employee reduces payment 70%Self-inflicted,
nents?a. No faultb. Exclusive remedyc. Assured and fixed
serious, and willful misconduct of employer increases pay-
benefitsd. All of the above
ment 50%
What Labor Code governs all things QME? Labor Code §139.2 governs all things QME
In an unrepresented case, who helps advise the
claimant?
I & A Officer
a. DEU
I&A= Information and Assistance Officer
b. Medical Unit
c. I & A Officer
For how many years is a QME appointed? AD appoints QMEs for 2 years
A PT (Physical Therapist) is not considered a physician in
What licensure is not considered a physician in CA WC?
CA WC.
In order to apply for an appointment, a QME must do
which of the following?
a. Pass competancy exam
b. Complete 16-hour disability writing course All the above
c. dedicate 1/3 of their time to direct medical treatment or
be AME 8+ times in previous 12 months
d. All of the above
Yes, failure to complete accurate and complete reports
pursuant to Labor Code section 139.2(i) may be grounds
Can the AD suspend/terminate a QME for too many re-
for termination.
jected or late reports?
The AD may also suspend a QME if their license to practice
is suspended and/ or failure to pay fees.
A disability is considered at P&S when the condition is
When is a permanent disability considered at P&S (MMI)?
unlikely to change within the next year
Impairment ratings are converted into Disability rat-
ings using the Permanent Disability Rating Schedule
