Limit "Double Dipping" to Ice Cream

Limit "Double Dipping" to Ice Cream
by Don Barthel, Esq.
Bradford & Barthel believes "double dipping" should be limited to visits to Baskin-Robbins!

Unfortunately many QMEs, PTPs, and even AMEs are attempting to get applicants "a little something extra" when applying the DRE method to the spine!

3+4=5: A Rating Example

3+4=5: A Rating Example
by Mark Fletcher, Esq.
Did you know that 3 + 4 = 5 when applying the DRE (Diagnosis Related Estimate) method to the lumbar and thoracic spine? It's strange, but true.

If an applicant qualifies for a DRE Category III ("significant signs of radiculopathy"), but also qualifies for Category IV ("alteration of motion segment integrity"), this qualifies the individual for Category V (25% to 28%). (See Table 15-3, page 384, for the lumbar spine; see page 389, Table 15-4, for the thoracic spine).

Medical Provider Network Let the Games Begin...

Medical Provider Network Let the Games Begin...
by Sherri Dozier
Change is the name of the game in 2005. It appears that the legislative intent was much more than putting California on a "diet" to reduce its ever growing workers' compensation waistline. The intent was to create a "life-style change." Like any "life-style change" it's usually met with skepticism and resistance.

We knew the MPN was coming, yet many of our employers and carriers are still struggling to implement this valuable program. The advantages are clear. Keeping medical control for the life of a claim. Sounds great, but is it really that simple? Probably not. The advantages, however, may far outweigh the disadvantages. Keep in mind, every new program goes through years of trial, errors, and interpretations. This was evident with the Health Care Organization (HCO). The HCO was a part of the 1993-1994 reform. It was not really utilized or understood until the late 1990s.

How can we assure success through the MPN?