{"id":465,"date":"2013-03-12T11:30:00","date_gmt":"2013-03-12T11:30:00","guid":{"rendered":"https:\/\/jhwlawoffice.com\/nevada-workers-comp-law-blog\/?p=465"},"modified":"2020-01-29T15:35:45","modified_gmt":"2020-01-29T15:35:45","slug":"cost-of-rating-exams-up-again-get-it-right-the-first-time","status":"publish","type":"post","link":"https:\/\/jhwlawoffice.com\/nevada-workers-comp-law-blog\/2013\/03\/articles\/benefits\/permanent-partial-disability-awards\/cost-of-rating-exams-up-again-get-it-right-the-first-time\/","title":{"rendered":"Cost of Rating  Exams Up Again:  Get It Right the First Time"},"content":{"rendered":"<p>&nbsp;&nbsp;&nbsp;&nbsp; Effective February 1, 2013, the <a href=\"http:\/\/dirweb.state.nv.us\/WCS\/mfs\/2013_MedicalFeeSchedule.pdf\">Nevada fee schedule <\/a>that governs health care providers under the Nevada workers&#8217; compensation system, raised the PPD (permanent partial disability) reimbursement to $718.96.&nbsp; &nbsp; If the rating physician is rating more than two body parts, he or she can charge an additional $240.11 for each additional body part.&nbsp; For example, the fee schedule states that the cervical spine constitutes one body part, the thoracic spine another body part, and the lumbar spine constitutes a separate body part for rating and billing purposes.&nbsp; If an injured worker has injuries to the neck, the low back, and to the right wrist, the rating physician&#8217;s bill will be $959.07.<\/p>\n<p>&nbsp;&nbsp;&nbsp;&nbsp; Injured workers who disagree with the first rating&nbsp;or the percentage offered by the industrial insurer must pay these same rates when they obtain a second rating by following the procedure in NRS&nbsp;616C. 100.&nbsp; With these high costs, it is essential that the injured worker gets a fair and accurate rating the first time around when the insurer must pay for it.&nbsp; Although the law allows a hearings or an appeals officer to order an insurer to reimburse an injured worker for a second rating&nbsp;if the second rating is found to be more accurate, there are no guarantees that a second rating will result in a higher percentage, or that a hearing or appeals officer will agree that the higher percentage is correct.&nbsp;<\/p>\n<p>&nbsp;&nbsp;&nbsp;&nbsp; It is difficult for Injured workers to find an extra $718.96 to pay for a second exam,&nbsp; even if they are likely to be reimbursed.&nbsp; Also, it takes time to file appeals and contest the first rating, and the injured worker cannot accept the disputed first percentage in a lump sum while litigating the first percentage.<\/p>\n<p>&nbsp;&nbsp;&nbsp;&nbsp; Here are&nbsp;a few things I may do&nbsp;representing an injured worker do to get the first rating correct:<\/p>\n<ul>\n<li>Ask the adjuster to agree with me on which of the 145 doctors on the DIR&#8217;s rating list will evaluate the client.<\/li>\n<li>Make sure that the rating physician is rating all accepted body parts.&nbsp;<\/li>\n<li>I go with the client to the rating with a copy of the medical records, so that if the doctor is missing an important record, like an operative report, I have a copy ready.<\/li>\n<li>I know the AMA&nbsp;Guides and am prepared to discuss complex issues such as apportionment of pre-existing conditions or how a particular body part should be rated.<\/li>\n<li>I obtain a copy of the rating evaluation as soon as it is done so that I can resolve any problems by writing to the rating doctor before the adjuster sends a determination letter.<\/li>\n<li>I may have the rating report reviewed by a rating doctor at a cost less than the full cost of an exam to confirm a suspected error and then ask the rating doctor for an addendum.<\/li>\n<li>I prepare a persuasive argument for the hearing officer after filing an appeal that the first rating is wrong under the AMA&nbsp;Guides, and ask that the insurer be required to pay for a second rating.<\/li>\n<li>Finally, if I think the first rating is incorrect and that the second rating phsycian who is assigned by the DIR is likely to find a higher percentage, I file an appeal and schedule a second exam.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp;&nbsp;&nbsp;&nbsp; Effective February 1, 2013, the Nevada fee schedule that governs health care providers under the Nevada workers&#8217; compensation system, raised the PPD (permanent partial disability) reimbursement to $718.96.&nbsp; &nbsp; If the rating physician is rating more than two body parts, he or she can charge an additional $240.11 for each additional body part.&nbsp; For &hellip; <a href=\"https:\/\/jhwlawoffice.com\/nevada-workers-comp-law-blog\/2013\/03\/articles\/benefits\/permanent-partial-disability-awards\/cost-of-rating-exams-up-again-get-it-right-the-first-time\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Cost of Rating  Exams Up Again:  Get It Right the First Time<\/span> <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[75],"tags":[171,197,227,342,367,29,376,387,411,436,504,505],"class_list":["post-465","post","type-post","status-publish","format-standard","hentry","category-permanent-partial-disability-awards","tag-compensaiton","tag-disability","tag-fee","tag-nevada","tag-partial","tag-permanent","tag-permanent-partial-disability-awards","tag-ppd","tag-rating","tag-schedule","tag-worker","tag-workers"],"acf":[],"aioseo_notices":[],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/jhwlawoffice.com\/nevada-workers-comp-law-blog\/wp-json\/wp\/v2\/posts\/465","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jhwlawoffice.com\/nevada-workers-comp-law-blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jhwlawoffice.com\/nevada-workers-comp-law-blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jhwlawoffice.com\/nevada-workers-comp-law-blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/jhwlawoffice.com\/nevada-workers-comp-law-blog\/wp-json\/wp\/v2\/comments?post=465"}],"version-history":[{"count":4,"href":"https:\/\/jhwlawoffice.com\/nevada-workers-comp-law-blog\/wp-json\/wp\/v2\/posts\/465\/revisions"}],"predecessor-version":[{"id":1625,"href":"https:\/\/jhwlawoffice.com\/nevada-workers-comp-law-blog\/wp-json\/wp\/v2\/posts\/465\/revisions\/1625"}],"wp:attachment":[{"href":"https:\/\/jhwlawoffice.com\/nevada-workers-comp-law-blog\/wp-json\/wp\/v2\/media?parent=465"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jhwlawoffice.com\/nevada-workers-comp-law-blog\/wp-json\/wp\/v2\/categories?post=465"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jhwlawoffice.com\/nevada-workers-comp-law-blog\/wp-json\/wp\/v2\/tags?post=465"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}