Achieving the Zen State: The Art & Mastery of theAchieving the Zen State: The Art & Mastery of the...

Nicole Cushman, Program DirectorCOHE Alliance of Western Washington

Achieving the Zen State: The Art & Mastery of the

L&I Workers’ Comp Form Trifecta (ROA,APF,PIR)

Clarity. Communication. Continuity. 1

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• Brief COHE Overview• Claim Initiation

Discussion • Worker’s

Compensation Initiation Forms

• Case Study #1 Exercise– ROA– APF– Discussion– Tips and Tricks

• Case Study #2 Exercise– ROA– APF– Discussion – Tips and Tricks

• Transfer of Care• Questions and Answers

2Clarity. Communication. Continuity.

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Outline

What is COHE?

* Definition from www.lni.wa.gov


• Improve medical outcomes, reduce claim costs, reduce permanent disability

Goal

• Occupational Health Best Practices in 1st 12 weeks of a claim, with possible extension to 6 months, if neededFocus

• Center of Occupational Health & Education (COHE)s work with medical providers, employers, and injured workers in a community-based program. COHEs improve injured worker outcomes and reduce disability by training providers and coordinating cases*

Foundation3

Road Map to Zen State


Workflow for Initiation of Claim


Follow-Up Care

Injured Worker seeks treatment for Injury

SELF-INSURED: Fax Provider’s Initial Report (PIR) to Self-

Insured Carrier within first 48 hours

STATE-INSURED:Fax Report of

Accident (ROA) to L&I within first 48

hours

Activity Prescription Form (APF) faxed to L&I within first 48

hours

Will a Transfer of Care need to occur

NO: Provide Medical Care Consistent with COHE Best

Practices

YES: Transfer of Care postcard sent to L&I

ORTransfer of Care online process

YES

NO

* If Self-Insured, fax to Self Insured Carrier

*

Claim Initiation FormsReport of Accident Provider’s Initial Report

Clarity. Communication. Continuity.

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Claim Initiation FormsActivity Prescription Form


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• You have seen the forms needed to initialize a claim.

• Now lets put them to use.

Case Study Exercise


• Worker states he was lifting a 50lb box of canned food when his back locked up. This injury occurred at work at 3pm on September 18, 2015.

• On exam, patient only able to flex forward lower spine 20°. Pain to palpation for lumbar spine. Pain 6/10 but able to ambulate. Lifting more than 10# hurts.

• Patient states no light duty is available at work. • Diagnosis made of Lumbar Sprain (847.2)

Case Study #1


• Case Study #1– Lumbar Sprain

Review Report of Accident (ROA)




• Case Study #1- Lumbar Sprain

• Fax ROA to LNI within 2 business days to receive full reimbursement (COHE Best Practice #1)

• Pain is NOT an objective finding – Box 1

• Box 7:– Yes: 100%– Probably: 51% or more– Possibly: less than 50%– No: 0%

Fill in L&I Provider Number – Box 14

Tips and Tricks – Report of Accident (ROA)


• Remind Injured Worker to obtain the Claim Number from the Self-Insured Carrier

• Submit completed form to the Self-Insured Carrier via fax. L&I notification is not necessary.

Tips and Tricks – Provider’s Initial Report (PIR)


Review Activity Prescription Form (APF)


What’s wrong with this APF?

• Must list objective clinical findings that support the diagnosis

• Capacities apply, all day, every day of the week, at home as well as at work

•Provider encouraged to contact the Employer and document in Activity Prescription Form

•Fax APF within 2 business days (to L&I or Self Insured) receive full reimbursement

Tips and Tricks – Activity Prescription Form (APF)


• Worker states he fell off a ladder and grabbed the shelf, right shoulder popped and now he has pain with movement and increased pain when arm is above shoulder. Injury occurred at work at 3pm on September 18, 2015.

• On exam, supraspinatus test positive. Pain level 4/10, but 8/10 when arm is above shoulder. Lifting anything with right side painful.

• Worker reports prior right shoulder injury. • Worker states no other work available. • Diagnosis of Right Rotator Cuff Tear (840.4)

Case Study #2


• Case Study #2– Rotator Cuff





• Case Study #2- Rotator Cuff

• Case Study #2– Rotator Cuff



Transfer of Care (TOC)

Clarity. Communication. Continuity.

Online

Postcard

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OR

Returning to the Zen State


COHE Alliance of Western WashingtonAdministration Contact Page

Thank you for your time!

COHE Alliance of Western Washington Administration Team:

• Paul Darby, MD, Medical Director– Email: [email protected] – Phone: 253-274-5521

• Louis Lim, MD, Associate Medical Director– Email: [email protected] – Phone: 253-539-6064

• John L. Hart, DO, Associate Medical Director Southwest Region – Email: [email protected] – Phone: 503-504-8206

• Nicole Cushman, Program Director – Email: [email protected] – Phone: 253-428-8423

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COHE Alliance of Western WashingtonQuestions?

35 Clarity. Communication. Continuity.

For any questions, please call or email COHE Administration.• [email protected]• Toll-free: (855) 594-1351

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Achieving the Zen State: The Art & Mastery of theAchieving the Zen State: The Art & Mastery of the...

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