HCC QME Exam: Questions With 100%
Complete Solutions 2025|2026 Latest
Update
What is the RBRVS (Resource Based Relative Value Scale) - correct
answer-national fee system used to calculate the approved amount for
Medicare payments
value assigned to each CPT code based on work involved, cost, and
malpractice expenses
Unlawful discrimination for reporting a work injury is protected under
_____? - correct answer-LC 132a
What events may cause a request for an Independent Medical Review
(IMR)? - correct answer-If there is a dispute over medical treatment,
either the injured worker or the claims administrator can request an
IMR.
This request must be made in writing.
,What events may cause a request for an Utilization Review (UR)? -
correct answer-If the claims administrator believes that the
recommended treatment may not be medically necessary or
appropriate.
How many days before an examination can a QME reschedule the
examination? - correct answer-6 days
When is an AME used over a QME? - correct answer-If the injured
worker is represented by an attorney, both the attorney and the
insurance company might agree to use an AME instead of a QME. An
AME a physician that both parties trust to conduct the evaluation and
provide a fair report.
When is a QME used over an AME? - correct answer-If the injured
worker is unrepresented, they and the insurance company will use a
QME to resolve disputes over what is medically necessary. If the worker
is represented and the parties cannot agree on an AME, then they will
use a QME.
,The MTUS gets many of its practices from what guidelines? - correct
answer-American College of Occupational and Environmental
Guidelines (ACOEM)
What is Subrosa? - correct answer-An investigation done in secret.
The MTUS is considered the.....? - correct answer-Standard of medical
care for work related illness and injury.
The MTUS is presumed to be.....? - correct answer-Correct on the issue
of medical treatment and diagnostic services it addresses.
When was the MTUS adopted by the DWC? - correct answer-
01/01/2004
What is the goal of the MTUS? - correct answer-To achieve Functional
Improvement; meaning improvement in ADL's, reduce work
restrictions, reduce medical care
, At every visit the QME is expected to assess and clearly document
which 2 things that is addressed by the MTUS? - correct answer-1.
Functional improvement
2. Work Status including restrictions
The MTUS adopted the _____ model as apposed to the biomedical
model to better understand Chronic Pain (CP)? - correct answer-
BioPsychoSocial Model
The MTUS uses _____ to identify IW's with an increased risk for Chronic
Pain (CP) and Delayed Recovery (DR) - correct answer-Validated
questionaries
The MTUS created the _____ to insure IW's have access to effective and
appropriate treatment? - correct answer-Medical Evidence Evaluation
Advisory Committee (MEEAC)
Complete Solutions 2025|2026 Latest
Update
What is the RBRVS (Resource Based Relative Value Scale) - correct
answer-national fee system used to calculate the approved amount for
Medicare payments
value assigned to each CPT code based on work involved, cost, and
malpractice expenses
Unlawful discrimination for reporting a work injury is protected under
_____? - correct answer-LC 132a
What events may cause a request for an Independent Medical Review
(IMR)? - correct answer-If there is a dispute over medical treatment,
either the injured worker or the claims administrator can request an
IMR.
This request must be made in writing.
,What events may cause a request for an Utilization Review (UR)? -
correct answer-If the claims administrator believes that the
recommended treatment may not be medically necessary or
appropriate.
How many days before an examination can a QME reschedule the
examination? - correct answer-6 days
When is an AME used over a QME? - correct answer-If the injured
worker is represented by an attorney, both the attorney and the
insurance company might agree to use an AME instead of a QME. An
AME a physician that both parties trust to conduct the evaluation and
provide a fair report.
When is a QME used over an AME? - correct answer-If the injured
worker is unrepresented, they and the insurance company will use a
QME to resolve disputes over what is medically necessary. If the worker
is represented and the parties cannot agree on an AME, then they will
use a QME.
,The MTUS gets many of its practices from what guidelines? - correct
answer-American College of Occupational and Environmental
Guidelines (ACOEM)
What is Subrosa? - correct answer-An investigation done in secret.
The MTUS is considered the.....? - correct answer-Standard of medical
care for work related illness and injury.
The MTUS is presumed to be.....? - correct answer-Correct on the issue
of medical treatment and diagnostic services it addresses.
When was the MTUS adopted by the DWC? - correct answer-
01/01/2004
What is the goal of the MTUS? - correct answer-To achieve Functional
Improvement; meaning improvement in ADL's, reduce work
restrictions, reduce medical care
, At every visit the QME is expected to assess and clearly document
which 2 things that is addressed by the MTUS? - correct answer-1.
Functional improvement
2. Work Status including restrictions
The MTUS adopted the _____ model as apposed to the biomedical
model to better understand Chronic Pain (CP)? - correct answer-
BioPsychoSocial Model
The MTUS uses _____ to identify IW's with an increased risk for Chronic
Pain (CP) and Delayed Recovery (DR) - correct answer-Validated
questionaries
The MTUS created the _____ to insure IW's have access to effective and
appropriate treatment? - correct answer-Medical Evidence Evaluation
Advisory Committee (MEEAC)
