QME TESTBANK QUESTIONS WITH
100% CORRECT ANSWERS
They Physician who signs the report must personally - Answer- Examine the Applicant,
Take a thorough history, review and summarize all the prior medical records, compose
and draft the conclusions of the report
Whose responsibility to arrange for a "certified" interpreter - Answer- Carrier
Who will decide disputed issues and determines conflicting histories or evaluations -
Answer- WCAB Judge
An attorney or a court reporter may NOT be present at ___ exams - Answer- Psychiatric
An injured worker may not be kept waiting for more than ___ after the scheduled
appointment time - Answer- one (1) hour
The Physician must inform the claims administrator of the new appointment time within
___ days of rescheduling the appointment - Answer- five (5) days
The Labor Code (L.C.) gives injured workers the right to choose their treating physician
(after the initial ___ days), unless they have opted to participate in an employer-offered
HCO or if there is an MPN - Answer- 30 days
Which of the following evaluators is not affected by Ex Parte violations - Answer- PTP
In panel QMEs, the evaluator is not allowed to communicate with either party outside
the evaluation exam, except in writing, and any written communication must be served
on the opposing party within ___ days - Answer- 20 days
In the case of Jones v Target Stores, because the referral was for physical therapy, the
referral was disallowed by the board because of the absence of preauthorization -
Answer- pre-authorization
Self-referral and cross referral violations are prospected by - Answer- District Attorney's
Office
Making a false or fraudulent workers' compensation claim is a felony subject to up to
____ years in prison or a fine of up to $______ or double the value of the fraud,
whichever is greater, or by both imprisonment and fine - Answer- five (5), $50,000
, The legislative reforms of 2012 required the physician fee schedule to be based on the
___ fee schedule, which is maintained by the Centers for Medicare and Medicaid
Services (CMS) - Answer- RBRVS
The conversion factor beginning in 2017 is calculated at ____% of Medicare (using the
conversion factor in effect in July 2012 as the base year), updated for inflation - Answer-
120%
The RBRVS fee schedule has three basic elements - Answer- RVUs, CF, GAF
Work comp PTP reports are billed using - Answer- California Specific Codes
For paper billing forms for health care providers, the physician must use - Answer- CMS
1500 forms
Electronic bills are paid within ___ days of receipt of the bill and supporting
documentation - Answer- 15 days
The provider is responsible for submitting a check or money order for the IBR fee and
any required or supporting documentation as part of the paper application within ___
days after receipt of the second=review decision - Answer- 30 days
Regulations require the QME to serve the medical-legal report and Summary Findings
Form 111 (if unrepresented) on the claims administrator, or if non the employer, and the
injured worker within ____ days from the commencement of the examination - Answer-
30 days
Treating physician reports and medical-legal evaluations are used to establish -
Answer- eligibility for benefits
Unrepresented worker - if the employee does not inform the employer of the selection
within ____ days of the assignment of a panel of qualified medical evaluators, then the
employer may select the physician from the panel - Answer- 10
SB-228 reforms of 2003 (Governor Davis) primarily addressed the following issues -
Answer- ACOEM Guidelines - 24 visit limit
For a QME evaluation for compensability only (AOE/COE), DO NOT send the QME
report to the following Part(ies)? - Answer- Local DEU
SB-899 reforms of 2004 (Governor Schwarzenegger) primarily addressed the following
issues? - Answer- AMA Impairment Guides and MPNs
Which of the following is not a term used in California as ratable "word of art"? -
Answer- Often
100% CORRECT ANSWERS
They Physician who signs the report must personally - Answer- Examine the Applicant,
Take a thorough history, review and summarize all the prior medical records, compose
and draft the conclusions of the report
Whose responsibility to arrange for a "certified" interpreter - Answer- Carrier
Who will decide disputed issues and determines conflicting histories or evaluations -
Answer- WCAB Judge
An attorney or a court reporter may NOT be present at ___ exams - Answer- Psychiatric
An injured worker may not be kept waiting for more than ___ after the scheduled
appointment time - Answer- one (1) hour
The Physician must inform the claims administrator of the new appointment time within
___ days of rescheduling the appointment - Answer- five (5) days
The Labor Code (L.C.) gives injured workers the right to choose their treating physician
(after the initial ___ days), unless they have opted to participate in an employer-offered
HCO or if there is an MPN - Answer- 30 days
Which of the following evaluators is not affected by Ex Parte violations - Answer- PTP
In panel QMEs, the evaluator is not allowed to communicate with either party outside
the evaluation exam, except in writing, and any written communication must be served
on the opposing party within ___ days - Answer- 20 days
In the case of Jones v Target Stores, because the referral was for physical therapy, the
referral was disallowed by the board because of the absence of preauthorization -
Answer- pre-authorization
Self-referral and cross referral violations are prospected by - Answer- District Attorney's
Office
Making a false or fraudulent workers' compensation claim is a felony subject to up to
____ years in prison or a fine of up to $______ or double the value of the fraud,
whichever is greater, or by both imprisonment and fine - Answer- five (5), $50,000
, The legislative reforms of 2012 required the physician fee schedule to be based on the
___ fee schedule, which is maintained by the Centers for Medicare and Medicaid
Services (CMS) - Answer- RBRVS
The conversion factor beginning in 2017 is calculated at ____% of Medicare (using the
conversion factor in effect in July 2012 as the base year), updated for inflation - Answer-
120%
The RBRVS fee schedule has three basic elements - Answer- RVUs, CF, GAF
Work comp PTP reports are billed using - Answer- California Specific Codes
For paper billing forms for health care providers, the physician must use - Answer- CMS
1500 forms
Electronic bills are paid within ___ days of receipt of the bill and supporting
documentation - Answer- 15 days
The provider is responsible for submitting a check or money order for the IBR fee and
any required or supporting documentation as part of the paper application within ___
days after receipt of the second=review decision - Answer- 30 days
Regulations require the QME to serve the medical-legal report and Summary Findings
Form 111 (if unrepresented) on the claims administrator, or if non the employer, and the
injured worker within ____ days from the commencement of the examination - Answer-
30 days
Treating physician reports and medical-legal evaluations are used to establish -
Answer- eligibility for benefits
Unrepresented worker - if the employee does not inform the employer of the selection
within ____ days of the assignment of a panel of qualified medical evaluators, then the
employer may select the physician from the panel - Answer- 10
SB-228 reforms of 2003 (Governor Davis) primarily addressed the following issues -
Answer- ACOEM Guidelines - 24 visit limit
For a QME evaluation for compensability only (AOE/COE), DO NOT send the QME
report to the following Part(ies)? - Answer- Local DEU
SB-899 reforms of 2004 (Governor Schwarzenegger) primarily addressed the following
issues? - Answer- AMA Impairment Guides and MPNs
Which of the following is not a term used in California as ratable "word of art"? -
Answer- Often
