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Flashcards in Medical Services Deck (26)
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1
Q

Which types of medical providers can be AP

A

Type A
Med Doctors, Doctor of Osteopathic Med, Oral and
Maxillofacial surgeons, Podiatric physicians and
surgeons
Type B
Chiropractors, naturopathic physicians and physician assistants (PA)

*** Nurse Practitioner can be used as an AP even though not listed

2
Q

How many days of TL or office visits can a Type B provide for medical services

A

Medical Services - 60 days or 18 visits from first visit or date on initial claim

Time Loss (TL) - 30 days from date of office visit on initial claim

3
Q

Which Type B provider can also rate impairment

A

Chiropractors

4
Q

Can an ER Dr. authorize TL? For how long?

A

Yes, for up to 14 days from ER visit

5
Q

Time period for medical provider to submit the 827 form to the insurer when initiating a claim for workers’ comp benefits

A

72 hours from office visit

6
Q

Time period to notify insurer of change of Attending Physician (AP)

A

5 days from first treatment of new AP

7
Q

How many days does insurer have to respond to a written request for diagnostic preauthorization

A

Within 14 days of receiving request from provider

8
Q

How many days does a medical provider have to send medical records to the insurer

A

Within 14 days of request from insurer

9
Q

How many days can a ANP provide medical services and/or authorize TL benefits

A

180 days from initial claim

10
Q

How many AP can an IW have during the life of a claim

A

3

11
Q

How many days do insurers have to pay medical bills on an accepted claim

A

45 from receipt of bill

12
Q

How many days do insurers have to pay medical bills which were prior to the claim being accepted

A

14 days from acceptance

13
Q

How many days do insurers have to pay worker reimbursements

A

30 days from receipt

14
Q

What can a worker request for reimbursement

A

Meals

Lodging

use of public transportation

use of private vehicle

Prescriptions

Other out of pocket, claim related expenses

15
Q

Time frame to request reimbursement

A

Two years from date of claim or when determined to be compensable

16
Q

Purpose of an Managed Care Organizations (MCO)

A

To help manage medical services in a claim, ensure treatment is reasonable and necessary, assist with return to work (RTW) information and facilitate claim closure

17
Q

Who does SAIF currently contract with for MCO

A

CareMark Comp (CMC)

Kaiser-on-the-job

Majoris Health Systems

18
Q

What factors to consider for MCO

A

Disabling claim

Services offered by MCO

AP currently belongs to MCO

Complexity of medical conditions

IW location and access to medical services

19
Q

Who approves the MCO and services certified

A

DCBS approves the MCO and all services are certified by Geographical Service Areas (GSA)

20
Q

What is the purpose of a MCO treatment review

A

To review current and past course of medical treatment and provide the AP with recommendations with timelines and goals

21
Q

When to consider a MCO treatment review

A

No clear diagnosis for ongoing complaints

No treatment plan

IW is not released to appropriate level of work

Treatment is ongoing without resolution

Excessive medication use (Opioid use)

IW may be delaying or stalling recovery

22
Q

How many days notice does insurer give IW for an Independent Medical Exam (IME)

A

10 prior to appointment

23
Q

Minimum days to send cover letter and medical records to IME physician

A

7 days prior to appointment

24
Q

If IME has multiple examiners it must be completed within ___ hours to be considered one IME

A

72 hours

25
Q

If an IW does not attend the IME what can you NOT do

A

Stop paying TL

Deny the claim

26
Q

If an IW does not attend the IME what CAN you do

A

Request suspension of benefits from WCD or request a penalty