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Auditor: QME Shortage Delaying Claims; Some State Agencies Overpaying for Comp

  • State: California
  • Topic: Top
  • -  1217 views
  • - Average time spent on item: 79 minutes
  • - Popular with: Legal
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A lack of available medical evaluators resulted in the automatic denial of claims some state workers…

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Steven Chandler Nov 22, 2019 a 8:11 am PST

So it comes as no surprise to many in this industry as to the lack of qualified QMEs. Is it because of reimbursement rates? I think that may be a small issue but rather the bigger is this, its boring work! Physicians receive an incredible amount of education so that they can practice medicine (hands on practice). This is the majority. Why would we expect a large sum of physicians to come charging towards the QME program if it promised only very brief exam followed by the review of volumes of records. Unless youre a research physician, how is that in any way attractive? And then charging towards the premise of throwing more money will only attract two types, the grossly inexperienced looking for greater sums of money and the soon-to-be-retired (or should have already long ago) looking to make a few bucks and have a professional service review the records on their behalf. That's essentially how it is now no matter how you swallow it. I suggest before throwing more money, perhaps they should conduct a study to determine the actual problems and define a plan, other than just money, to move forward. Sure, money can be one item but why not look at the burdensome review of records and see if that can be changed too? We're moving into an electronic world quite rapidly. It's time to stop sending bankers boxes of paper and expecting a rapid return on the report.

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