Course Highlights

The Division of Workers' Compensation has adopted new regulations for standardized paper billing forms and electronic billing standards. California will now be one of the first states in the country to provide for ebilling in workers’ compensation,

These regulations encourage both workers’ comp insurers and medical providers to transition to e-billing. The new regulations will also streamline paper billing by standardizing billing forms and will make it easier to communicate through the use of standardized bill review messages.

By statute, claims administrators are required to accept electronic bills and may develop their own capacity to accept electronic bills or may contract with a vendor to perform the function. Participation in electronic billing is optional for medical providers.

Provisions relating to paper billing become effective on Oct. 15, 2011 and provisions relating to electronic billing become effective Oct. 18, 2012.

This comprehensive seminar will provide important information to help claims administrators, medical providers, and other professionals implement this new law.

Instructor

Suzanne Honor-Vangerov was the Manager of the DWC Medical Unit where she oversaw the Qualified Medical Evaluator, Spinal Surgery Second Opinion, Medical Provider Network, and Utilization Review programs. As Manager she was involved in the drafting process of the new E-Billing regulations. She is considered to be an expert in medical billing and fee schedule issues. She has served as a speaker for the annual DWC Educational Conference, has been an instructor with the Insurance Education Association (IEA), and for a variety of other organizations. She is now an attorney at law in private practice engaged in workers' compensation defense.

This course is $150.

This course has weekly news reports of new cases, pending legislation and other information in the California Workers' Compensation industry. This is an annual update course. Each week a podcast will be posted that will discuss new legal, medical, regulatory and other significant events that effect the workers' compensation claims process. This podcast is available on our website, or in the Apple iTunes store, however in order to receive professional credit you need to view the podcast within this online school environment where a record of attendance by way of our software logs can be maintained. Each podcast is between 15 to 25 minutes in length, and varies from week to week. At the end of the year, credit will be given for the total of time of the videos that are viewed during the year.

This 6 hour course was recorded during the live training in Los Angeles on July 31, 2009. Admission to this course is restricted to claims professionals who are members of the CIGA defense teams. The topics and list of presenters are as follows:

1. Pharmacy Trends and Clinical Management: Jim Andrews, R.Ph. Senior VP, Operations Cypress Care
2. Using Clinical Pharmacy Reviews to Mitigate Costs in Workers Compensation: Angie Hefner, Senior Account Executive – Cypress Care: Frank E. Carbonara, Esq., Guilford, Steiner, Sarvas and Carbonara LLP
3. Case Law Development and Statutory Defenses: Richard Guilford, Esq., Guilford, Steiner, Sarvas and Carbonara LLP
4. Medicare Secondary Payer Claims: Frank E. Carbonara, Esq., Guilford, Steiner, Sarvas and Carbonara LLP
5. Medical Provider Network Update - General Litigation Guidelines, Common Legal Issues and Adverse Awards: Barbara Hester, CIGA MPN and UR Manager, Frank E. Carbonara, Esq., Guilford, Steiner, Sarvas and Carbonara LLP

CE Credit

Attorneys may receive 6 hours of MCLE or Legal Specialization in Workers' Compensation credit, and Claims Professionals may obtain 6 hours of continuing education credit for taking this course online.

To enroll in this course please call Rene Thomas Folse, 805 907 6467.

This 6 hour course was recorded during the live training in Glendale on November 4, 2011. Admission to this course is restricted to claims professionals who are members of the CIGA defense teams. The topics and list of presenters are as follows:

1. INTRODUCTION/OVERVIEW - CIGA COURT REPORTING SERVICES BY ACCUTEXT - Presenter: Terri J. Harrison, CIGA Director of Workers’ Compensation
2. CYPRESS CARE – SUBSTANCE ABUSE, Presenter: Angie Hefner, Jim Andrews & Scott Phillips, Cypress Care
3. MSA PROTOCOLS, Presenter: Frank Carbonara, Esq., Guilford Steiner Sarvas & Carbonara
4. MEDICARE SECONDARY PAYOR (MSP) CLAIMS - UPDATE & REFRESHER, Presenter: Frank Carbonara, Esq., Guilford Steiner Sarvas & Carbonara
5. CIGA CASELAW DEVELOPMENT - (PRE JUDGMENT INTEREST/REIMBURSEMENT PROCEEDINGS/ASSIGNEES), Presenter: Richard Guilford, Esq., Guilford Steiner Sarvas & Carbonara
6. MPN & UR UPDATES/ISSUES & PREPARING CASES FOR UR TRIALS, Presenter: Frank Carbonara, Esq., Guilford Steiner Sarvas & Carbonara, Presenter: Barbara Hester, CIGA UR and MPN Program Manager
7. HOME HEALTH CARE & MEDICAL NECESSITY, Presenter: Frank Carbonara, Esq., Guilford Steiner Sarvas & Carbonara

CE Credit

Attorneys may receive 6 hours of MCLE or Legal Specialization in Workers' Compensation credit, and Claims Professionals may obtain 6 hours of continuing education credit for taking this course online.

To enroll in this course please call Rene Thomas Folse, 805 907 6467.

Claims of psychiatric injury are perhaps the most difficult and complex claim in California workers compensation. This five hour advanced course covers the topics in our basic two hour course in greater detail. The topics in this advanced course are as follows:

• Rating Psychiatric Claims
• Causation and Apportionment
• Basics of Psychological Testing
• Detection of Malingering
• Psychiatric Claim Investigation
• Evaluation & Cross-Ex of Experts
• Case examples

This 2 hour course is about the defense of Workers' Compensation psychiatric claims under California Law. It begins by discussing the latest cases defining injury, predominant cause, and apportionment using the causation standards of labor code section 3208.3 and the S.B. 899 apportionment rules, and concludes with a discussion of the Clinical Detection of Deception and Malingering using tools mandated by the DWC Psychiatric Protocols and the AMA Guides. It was recorded live on February 19, 2009 in Long Beach California during a presentation to claim professionals.

CE Credit. Rene Thomas Folse, JD, Ph.D. is approved by the American Psychological Association to sponsor continuing education for psychologists (#1948), and the California Bar Association (#11240) to sponsor MCLE programs for attorneys and the firm of Floyd, Skeren & Kelly is approved to give Legal Specialization Credit (#13169) and they maintain sole responsibility for this program and its content. Attorneys may receive 2 hours of MCLE or Legal Specialization in Workers' Compensation credit, and psychologists may obtain 2 hours of CE for taking this course online.

California has now mandated the use of the AMA Guides, 5th Edition. Physicians, attorneys and other claim professionals must now learn how to apply the hundreds of tables and charts contained in the Guides. This 5 hour course walks you through all of the chapters of the Guides, and simplifies the task of learning by finding just those sections that apply to common every day claims. In this way the task of learning is greatly simplified. This course has been given for four years to a variety of professional audiences, and has been praised for making learning the Guides straight forward and manageable.

CE Credit. Rene Thomas Folse, JD, Ph.D. is approved by the California Bar Association (#11240) to sponsor MCLE programs for attorneys and the firm of Floyd, Skeren & Kelly is approved to give Legal Specialization Credit (#13169) and they maintain sole responsibility for this program and its content. Attorneys may receive 5 hours of MCLE or Legal Specialization in Workers' Compensation credit for taking this course online.

The 2004 workers’ compensation reforms made conservative changes to all aspects of workers' compensation benefits. The mandated use of the American Medical Association Guides to the Evaluation of Permanent Impairment reduced permanent disability awards by more than 50%.

Attorneys for injured workers reacted by inventing what is now known as the "California Add-On's."This concept exploits chapters in the AMA Guides for seemingly non related impairment such as sleep disturbance, gastrointestinal distress, psychiatric injury and more.This presentation will cover how to deal with sleep disorder claims, one of the current California Add-On's.

• Introduction:Sleep disorder claims are also part of what is now called the “California Add-Ons” which applicant attorneys pursue to increase permanent impairment under the AMA Guides 5^th Edition.
  

• Industrial Causation and ApportionmentThe AMA Guides contemplates that a ratable sleep disorder be caused by problems with the nervous system, or mental and behavioral factors,or problems with the cardiovascular or hematopoietic system.Recent case law provides that causation of sleep disorders cannot be based solely on a consequence of pain which is often the theory of the claim. We will learn how to see the telltale signs of what is and is not industrial in origin.

• Dealing with Excessive Assessment Costs: Employers often are billed thousands of dollars for “sleep lab” studies that make assessment costs more serious than the potential cost of the permanent disability that is claimed. We will show how to minimize or avoid these costs by using recent assessment guidelines published by the AmericanAcademy of Sleep Medicine.
  

• Detection of Malingering:The sleep lab study known as polysomnography that is often obtained in a sleep disorder claim is not appropriate for forensic use.Instead, newer and cheaper tools known as actigraphy will help determine if a sleep disorder claim is authentic or exaggerated.We will discuss guidelines that can be used to obtain the correct forensic assessments at a much lower cost.

• Impairment:Assuming that a sleep disorder claim is not exaggerated and is industrially related, our final topic will discuss strategies that can minimize the level of permanent impairment that is claimed.

This is a comprehensive five hour course in Workers' Compensation Ethics. The theme is based upon a presentation made by Casey Young, former Administrator of the Division of Workers Compensation. Several decades ago, Mr. Young conducted a survey of all stakeholders in the Workers' Compensation Community, and discovered that each stakeholder had little or no trust in the ethics of the other stakeholders. In essence, each profession had failed to hold the public trust. His conclusion is that it is of utmost importance for each group of stakeholders to restore the public trust. The focus on this ethics course will be to enhance the public trust in your role in the California Workers Compensation System.

Topics include:

1. Introduction to Workers' Compensation Ethics
2. Aftermath of Harvey Levin Fraud Expose
3. Social Benefits of Ethic Standards
4. Ethical Standards for Workrs' Comp Attorneys
5. Ethical Standards for the Insurance Industry
6. Ethical Standards for Claim Administrators
7. Sanctions and Attorney Fees
8. Ethical Standards for Employers - Part I
9. Ethical Standards for Employers - Part II
10. Safety in the Workplace

This course qualifies for 5 hours of MCLE or Legal Specialization credit, or credit toward Claims Administrator Certification. Ethics is a mandatory subject.

Introduction - History and Principles of Workers’ Compensation – Landmark Political Reform Measures and the Historical “Stress Claim Stigma”. The “Perfect Storm”, Unicover and Stock Market Losses. Organization and Stake Holders. Current political socio-economic climate.

Threshold Issues of Compensability – Basic Concepts of Injuries, Employment and AOE-COE

Benefit Scheme
a) Medical Care and Benefits - Treatment Issues. UR and ACOEM Guidelines
b) Temporary Disability Benefits
C) VR, Supplemental Job Displacement Benefits, Return to Work Incentives
d) Permanent Disability Benefits, AMA Guides and Apportionment
e) Death Benefits – Suicide

Penalties, Extraordinary Remedies. Audits and Enforcement. Penalties for Delay. Serious and Willful Misconduct. 132a

Physician Duties and Responsibilities – Specialist Reporting Requirements, Medical Legal Benefits. Substantial Evidence Rule

Introduction to Worker’s Compensation Informal Dispute Resolution and Litigation. The AME/QME process. WCAB Litigation Process and Statutes of Limitations.

Once a claim has been made of an industrial injury by an employee, the employer or their carrier must conduct a thorough investigation to determine if the claim is authentic, and what benefits are payable. Investigation is therefore a required job skill for professional claims administrators and attorneys. The administrator may not restrict its investigation to preparing objections or defenses to a claim, but must fully and fairly gather the pertinent information, whether that information requires or excuses benefit payment. This course will discuss essential investigatory tools and methods used for basic AOE-COE investigations and more advanced topics including the SIU investigation of potentially fraudulent claims.

The California system of Workers' Compensation has its own adjudication system known as the WCAB. Although most litigation is accomplished by attorneys, the labor code allows non attorneys to litigate claims as well. Non attorneys are known as hearing representatives, and they are commonly used by some insurance companies. This is a basic course about litigation before the WCAB. It is appropriate for hearing representative and new attorneys who desire to litigate cases before an Administrative Law Judge of the WCAB. This course will cover the following topics.

• Preparation Process and The IRAC Framework
• Rules of Law – Legal Precedents
• Timeline Preparation and Issue Spotting
• Discovery & Investigation Methods and Tools
• Negotiation and Negotiation Strategy
• Rules of Evidence
• Trial Planning and Procedure
• Examination of Witnesses
• Reconsideration and Appeals

Essentially workers compensation benefits have statutory restrictions on assignment of benefits to any third parties. In instances where a third party claims some right to claim an injured workers' benefits, the person making such claim is called a lien claimant, and they document their position by filing a "lien" claim in the litigation case. The most common lien claimant is a medical treatment provider who has not been paid the fees to which they feel they are entitled. In this 4.5 hour course the following topics are discussed.

Introduction, Lien Definition and Types Limits on Benefit Assignment

Liens Against Compensation Attorney Fees. Inadequate Withholding. Fees during Subrogation. Reasonable Living Expenses. Neglected Family. ADFC and County Welfare. Child Support. Group and EDD Disability. Baird Formula
Victims of Violent Crimes.

Other (Conditional) Liens Medical Legal Liens. Non Medical Litigation Costs. Interpreter Fees. LC 5811 Costs.

Medical Treatment Liens. Non Medical Provider Liens (3d Party Payers). Gregory Formula. Direct Provider Liens. Threshold Issues. Failure to Object, Thomas Findings. Strategic Disadvantage of Liens. Medical Control. Qualifications of Provider. Corporate Status and FBN Statements. Kickbacks and Referral Fees. Medical Necessity. MTUS. Employer Dilemma. Reasonable Value. OMFS. Medical Transportation. Repackaged Pharmaceuticals. Interpreters. Housekeeping and Attendant Care.

Penalties and Sanctions Applicant. Treatment, Med-Legal, and Non Providers.

Lien Litigation Procedure. Time Limits. Filing and Service. Post Settlement Process.

This is a 2 hour course that offers information about medical issues that are part of the Workers Compensation claim process.

Stepan Kasimian, MD is an orthopaedic surgeon with specialty training in spinal reconstruction and minimally invasive spine surgery. His primary medical and research interests include degenerative spine disease and spinal deformity. He has extensive experience in treating multiple spine disorders including disc herniations, spinal stenosis, spondylolisthesis, kyphosis, scoliosis, tumors, and spinal trauma. His expertise in multiple complex spinal disorders allows him to choose the proper treatment modality for his patients. Dr. Kasimian received his undergraduate degrees in Microbiology & Molecular Genetics and History from the University of California, Los Angeles. He graduated from Meharry Medical College with Summa Cum Laude and was inducted into the Alpha Omega Alpha Honor Society in his junior year. He completed his internship and residency in orthopaedic surgery at the Los Angeles County - USC Medical Center. After residency, Dr. Kasimian obtained further training in complex spinal reconstruction surgery at Cedars-Sinai Medical Center, Institute for Spinal Disorders. He presents a 60 minute discussion on "How to Avoid Spinal Surgery."

Dr. Levi Harrison, MD has the fastest growing solo practice for hand, wrist, elbow, and shoulder injuries in the Los Angeles Area. His training and expertise have been lauded throughout Los Angeles, CA and internationally. His practice uses state-of-the-art treatment protocols and cutting edge surgical techniques. Patients vary from the pediatric population to notable athletes, musicians, and celebrities. He is involved extensively in volunteer efforts with the free Glendale healthy kids program and is a member of the Glendale Rotary Club. Dr. Harrison is Fellowship trained at the renowned Indiana Hand Center in Indianapolias, received his Medical Degree from the University of California at Davis, his Master’s Degree in Engineering focusing on Solid State Physics at Howard University, a Bachelor of Arts in French/Romance Languages from the University of Notre Dame, and a Bachelor of Science in Electrical Engineering from University of Notre Dame. His 25 minute presentation is about the "Effects of Diabetes on Orthpedic injuries".

Donald Abrams, P.A., President, CEO of Medical Equation Inc, is trained as a physician’s assistant, receiving his national certification in 1979. He practiced in the field of Orthopedics for 16 years prior to coming to Texas. Focusing on worker compensation assessment, his professional career turned towards the impairment rating process, experienced in contested case hearings and District Courts in Texas. He has lectured extensively in the impairment rating process and is certified as an instructor with the Designated Doctor program. His 45 minute presentation provides practical information about "Understanding the AMA Guides Impairment Rating."

Most industrial cases involve complex medical evidence. Physicians provide such evidence by way of narrative medical reports. The California WCAB disfavors the presentation of medical evidence by way of live testimony. There are standards that are used to determine if medical evidence is admissible, and persuasive and if the report is substantial evidence to support an award. This course will discuss the following topics.

Evidence - General Concepts Role of Claims. Burden of Proof. Admissibility vs Weight.

Statutory and Common Law Rules of Evidence. Rules Precluding Admission. MSC Statements, LC 4061/62 Objections. LC 4628 Objections. DWC Protocols, Face to Face Time. Service of Reports.

Scientific Evidence Standards Daubert and Fry Federal Standards, Weak and Strong science. Measurement of Strength of Science Standards in Utilization Review Issues.

Rules that Effect Weight Given to Medical Reports Substantial Evidence Rule. Single Reports and Range of Evidence. Lay Testimony Alone. Use of a Factual Timeline. Making “Sense” and People v Bassett. Expertise and Methodology. Probability vs Possibility. AMA Guide Standards and Rule 10606

Case Studies General Strategy When Reviewing Medical Evidence.

This brief course covers the new QME Regulations that were adopted by the California Division of Workers' Compensation in 2009 that became effective February 17, 2009. The new regulations made a number of changes to the QME process. This two hour course will discuss the most significant provisions of the new law. Some of the changes are as follows.

• New definition of the medical specialties that can be requested by the parties.
• New training requirements to become a QME
• New forms that requests additional data.
• Provisions for requesting replacement panels
• Provisions to obtain an additional panel in a different specialty
• Mandatory information that must be provided by a QME in the narrative report.
• Methods to distribute a psychiatric QME report that may be harmful to a claimant.

This course will give the students a basic understanding of these new provisions. Attorneys may receive two hours MCLE or Legal Specialization credit. Claims adjusters may receive two hours continuing education credit upon completion of this course.

The California legislature has created various penalties and sanctions to help ensure that parties will comply with the provisions of the labor code. When violations are alleged, then if proven, penalties and sanctions may apply. This course covers the more common claims for penalties, sanctions and other extraordinary remedies as follows:

• Serious and Willful Misconduct
• Penalties for Delay
• Bad Faith Claims
• Costs and Attorney Fees
• 132a Discrimination
• SIF Benefits
• Concluding Remarks

This 3 hour course will discuss the basics of each of these topics. This course is suitable for claims adjusters, hearing representatives or new attorneys who are building their knowledge base of information about workers' compensation.

An injured worker is entitled to receive a scheme of benefits if they suffer an industrial injury in the course and scope of their employment. At times, there may be a dispute between the injured worker and the employer or insurance carrier regarding what these benefits might be. If this dispute involves a medical issue, it is called a "medical-legal" dispute. Medical-Legal disputes are resolved in most instances by an examination and report done by a special physician known as a QME or Qualified Medical Evaluator. The QME process is specified in various provisions of the California Labor Code. The reasonable costs and expenses of this evaluation is paid for by the employer or the employers' industrial insurance carrier. To become a QME, a physician must take and pass the QME Competency Examination. The Division of Workers’ Compensation (DWC) will administer the next Qualified Medical
Evaluator (QME) Competency Examination on Saturday, April 28, 2012.

An application packet can be downloaded from the DWC website.
This course will help physicians prepare for this examination. The examination is based upon a 256 page Physician's Guide, Third Edition prepared in 2001, and supplemental materials published by the DWC that updates this Guide to conform with changes in the law. The Guide has eight chapters. This course has approximately 6 hours of lecture material that covers each of the eight chapters and includes the new law. This course covers the following topics:

1) The Workers' Compensation System.
2) Basic Concepts: Compensability
3) Basic Concepts: Disability
4) Vocational Rehabilitation
5) The Role of the Physician in the Workers' Compensation System
6) How to Conduct Medical Legal Examinations.
7) The Physicians' Conduct
8) Information for Office Staff

The course concludes with a practice examination and a final video that reviews the answers and a Last Minute Cram Sheet, that you can use to review before the examination.

This course is $200. Please call 805 341-2296 to enroll.

One of the several benefits paid by California workers' compensation is a permanent disability benefit. The calculation of the value of the benefits requires the use of the AMA Guides 5th Edition and the Schedule for Rating Permanent Disability. An estimate of this calculation is also required for reserving and negotiation prices. Topics in this class include the following.

Rating Permanent Disability Versions of PDRS. Which version to use. Rating Formula. FEC, Occupation and Age Adjustments. Combining and Adding. 15% Step Up/Down Examples and Exercises. Presumptions.

Introduction to the AMA Guides Historical Issues. Basic Concepts. General Overview. Introduction to the Quick Reference Guide. Spine Injury Examples.

Apportionment of PD Apportionment Rules Before and After S.B. 899. Pathology and Speculation. Calculation Using Formula A. Benson Case

Life Pensions Formula and Calculators

Commutation of Permanent Disability Authority, Grounds and Examples.

Reserving Rules for Insurance Companies and Self Insured. Use of Quick Reference Chart. Review and Adjustments.

Claim Evaluation and Negotiations Claim Evaluation Tangible and Intangible Factors. Types of Settlement. Intended Resolution Point. Negotiation Psychology. Transcending Impasse.

The Self Insured Examination will be given in November, 2009. If you intend to take this examination, you may wish to take a review course to help you prepare. This is a 12 hour course that covers the following topics.

1. Introduction to the SIA Examination and Test Taking Strategies
2. Mandatory Training Requirement for Claims Professionals
3. The Administration of Self Insured Programs
4. The Claim Process Workflow and Time Limits
5. Claim File Reserving Requirements
6. Subrogation
7. Audits and Compliance
8. Industrial Medicine Fundamentals
9. Death Benefits
10. Jurisdiction and Injury AOE-COE
11. Course of Employment
12. Earnings
13. Temporary Disability Benefits
14. Rating Permanent Disability
15. Utilization Review
16. Medical Provider Networks
17. SSSOP - Spinal Surgery Second Opinion Process
18. QME Process

This is a fast paced, advanced level course. It assumes that you have a basic understanding of the fundamentals of workers' compensation, and professional experience handling claims. The course will discuss advanced issues in each one of the above topics.

This is a course in basic workers' compensation subrogation. In the event an industrial injury is caused a third person who is not the employer or co-employee, the possibility exists for the employer and their industrial insurance carrier to pursue an action in civil court to recover their claim costs. These cases are based upon tort law. In order to recover in such a subrogation claim, the employer or carrier must show fault. This is a basic two hour course on subrogation fundamentals. The course will discuss some of the following topics.

• Introduction to tort law.
• Spotting the case
• Investigation techniques
• Civil discovery rules
• Civil litigation basics
• Rules for obtaining credit at the WCAB
• Formulas for computing comparative negligence

Attorneys may receive two hours of MCLE or Legal Specialization credit, and claims administrators may obtain two hours of continuing education credit for completing this course.

The Survival Skills for Claims Adjusters course is designed to help new, and seasoned claims adjusters survive and thrive as they engage in the profession of administering claims of industrial injuries. At times this occupation can be demanding and fatiguing, and even frustrating. Dennis Knotts, a seasoned claims professional and talented instructor shares his secrets of years of experience in the Workers' Compensation community. This 5 hour course covers the following topics:

1. Survival Skills (42 Minutes)
2. How Did We Get Where We Are? (23 Minutes)
3. Multi~Tasking in a Fast-Paced Environment (19 Minutes)
4. Professionalism (35 Minutes)
5. Goal Setting (9 Minutes)
6. Documentation (19 Minutes)
7. Diary (19 Minutes)
8. Important Labor Codes (43 Minutes)
9. Time Management (48 Minutes)
10. Mental Health (30 Minutes)

Claims administrators can obtain 5 hours of educational credit for taking this course.

The California workers compensation system is a no-fault system which means that the injured worker need not show fault such as negligence on the part of his employer in order to recover benefits. However, although fault is not required, the claimant must show that an "injury" occurred and that it "arose out of employment". The acronym for this is called AOE-COE or "Arising Out of Employment and Course of Employment. Thus, if an injury is found to be AOE-COE that means the threshold issues have been met and the claimant should recieve the scheme of benefits.

One of the major benefits provided by the California workers compensation system is medical care to cure or relieve from the effects of an industrial injury. Safeguards have been implemented to contain costs. One safeguard is called utilization review (UR) which provides a method for the review of a request for treatment requests to determine if they are medically necessary. UR applies standards called "evidence based medicine" which are published in various treatment guidelines such as the ACOEM (American College of Occupational and Environmental Medicine) Guideline which is incorporated into the California Medical Treatment Utilization Schedule (MTUS). This course will cover the following topics.

Medical Care - General Concepts Provision of Care. Escalation of Costs. Cost Drivers and Solutions. Access to Care Issues.

Price Controls – Fee Schedules OMFS. Payment Calculations. Abuses

Quantity Controls - Evidence Based Medicine EBM General Concepts. Next Step - Pay for Performance. Functional Restoration. Measurement Concepts.

Quantity Controls – ACOM/MTUS Implementation Transition to MTUS. Rebuttal of MTUS. Chapter 12-Low Back. Acupuncture. Pain Guideline.

Implementation of ACOEM/MTUS with Utilization Review Mandatory Plan. UR Reviewers. Time Limits. Types of Review. Penalty Regulations. Hard Caps. Recent Cases.

Quantity Controls- Spinal Surgery Second Opinion Process (SSSOP) Cost Drivers. CPT Codes. Voicing Objections. SSSOP Evaluations. Agreement and Disagreements.

Price and Quantity Controls – The MPN. Voluntary Implementation. 2nd and 3rd Opinion Process and IMR.

AME–QME Dispute Resolution Historical Provisions. QME Process for Represented and Unrepresented Workers. Proposed New Regulations.

This course covers a variety of special topics that are related to new developments in workers' compensation law. A variety of presenters will offer valuable information about practical problems that occur in the every day management of claims and litigation. Enrollment is limited and by invitation only.