Question: Which edition of the AMA Guides to the Evaluation of Permanent Impairment should I use?
The Sixth Edition is the most current standard and the standard for the U.S. federal government and many states and countries. Some states use the Fifth Edition and earlier editions. Visit https://www.amaguides.com/usage-state-by-state-charts/ to view the use of editions by state.
Question: Does subscription to the training sites of fifthedition.com or www.6thedition.com include the AMA Guides?
Each subscriber is required to have access to the AMA Guides to the Evaluation of Permanent Impairment. You may purchase this at Amazon, as Hardcover or Kindle, for the Fifth Edition or Sixth Edition. The AMA Guides, Sixth Edition, are now digital. With online access, you can view and search the most current standard.
Question: How do I access the AMA Guides Newsletter?
The AMA Guides® Newsletter, a publication of the American Medical Association, provides you with crucial updates, authoritative guidance, practical information and rationales for proper use of the AMA Guides in assessing impairment, work ability, causation, and other case issues. It is accessible online. With a subscription, you access back issues. This resource is a must to perform quality evaluattions.
Question: What books do you recommend that I read to be most effective at performing independent medical and impairment evaluations?
- AMA Guides to the Evaluation of Permanent Impairment. (You may purchase this at Amazon, as Hardcover or Kindle, for the Fifth Edition or Sixth Edition. The AMA Guides, Sixth Edition, are now digital. With online access, you can view and search the most current standard.)
- AMA Guides Newsletter
- AMA Guides to the Evaluation of Disease and Injury Causation
- AMA Guides to the Evaluation of Work Ability and Return to Work
- AMA Guides to Navigating Disability Benefit Systems: Essentials for the Health Care Professionals
- Physician’s Guide to Medicolegal Practice
Question: What are the prerequisites for taking the Certified Impairment Rater examination?
It would be best if you had a solid understanding of using the AMA Guides, which can be obtained by the online training at fifthedition.com and www.6thedition.com, other courses, or experience. We recommend taking the mini-assessment (no charge, 10 items) to determine if you are ready. You do not have to take specific training.
The examination is open to all, including allopathic, osteopathic, chiropractic physicians, physical and occupational therapists, nurses, attorneys, fact finders, and claims professionals.
Question: How do the learning experiences with fifthedition.com and www.6thedition.com compare to other offerings, e.g., in-person courses?
It is your most cost-effective and efficient solution to learning the AMA With the annual subscription, you have 24/7 access. You can take the training and return as needed. The training is provided by theSenior Editor of the AMA Guides (Sixth Edition) and editor of Guides Newsletter and Guides Casebook.
You have access to resources not provided by others, including video content (physical examination procedures), case exercises, functional inventory calculators, online guidance tools, and access to subscriber-only monthly Question and Answer sessions with Dr. Brigham.
The annual subscription is less than the typical fee for a single-day course. You do not have the added expenses of travel and loss revenue being away from the office (or away from family), saving thousands of dollars.
Question: How do I proceed with training at fifthedition.com?
We encourage you tos tart by viewing the orientation video (click here) and then exploring the site. There are many valuable resources – do not miss the tabs for “calculators” and “forms.” We then encourage you to click here to read what will be required to obtain your Certificate of Training included with your subscription.
Prior to the training, please take the mini-assessment (no charge, 10 items). You should view the syllabus material and view the presentations, starting with those for Chapters 1 and 2, which are the foundations for the AMA Guides. As you view the video content, take notes in your AMA Guides. (You must have the AMA ) View the presentations most appropriate for your specialty, including the videos on physical examination. We continually add content, so revisit the site. Afterward, go through the case exercises.
After completing these learning experiences, take the mini-assessment (no-charge, 10 items) at www.certifiedrater.com. Then, go to the Certificate of Training for the Fifth Edition web page and follow the directions. You will provide information (please make sure this is accurate since this will appear on your certificate), complete another brief quiz (10 items, we want to make sure you have mastered the content), and provide us with feedback. You will then immediately receive your certificate as a .pdf document.
You are welcome to join our webinar Question / Answer discussions on the Fifth Editions. These are held the second Tuesday of every month at 4 pm E.T. – Click here to register for the Fifth Edition monthly sessions. Use the password “amaguides” to enter the meeting. We encourage you to join with video and audio.
Question: How do I proceed with training at 6thedition.com?
We encourage you to start by viewing the orientation video (click here) and then exploring the site. We encourage you to click here to read about the requirements to obtain your Certificate of Training included with your subscription.
You will need, of course, the AMA Guides. You may access the digital version from the AMA site or purchase a hardcover version at Amazon. We encourage you to obtain digital access to the Guides Newsletter archive; the content will benefit you.
To start, take a pre-learning mini-assessment. You should download and read the syllabus material and view the presentations, starting with Chapters 1 and 2 – the foundations for the AMA Guides. As you view the video content, take notes in your AMA Guides. View the presentations most appropriate for your specialty, including the videos on physical examination. We continually add content, so revisit the site. Next, go through the case exercises. As you perform assessments, use the guidance tool. There are many valuable resources – do not miss the tabs for “calculators” and “forms.”
Once you have completed the learning experiences, do a post-learning assessment. Next, go to the Certificate of Training for the Sixth Edition web page and follow the directions. You will provide information (please make sure this is accurate since this will appear on your certificate), complete another brief quiz (10 items, we want to make sure you have mastered the content), and provide us with feedback. You will then immediately receive your certificate as a .pdf document.
You are welcome to join our monthly webinar Question / Answer discussions. These are held on the second Tuesday of every month at 11 am ET. . You must register in advance, and there is no charge as a subscriber. Click here to register for the Sixth Edition monthly sessions. The password for these sessions is “amaguides,” and join with audio and video, if possible.
Question: How do I obtain Certification of Training?
Subscribers to online training on the AMA Guides to the Evaluation of Permanent Impairment will receive Certification of Training at no additional cost. For the Fifth Edition, complete all of the steps at https://www.impairment.com/trainingcertificate5/ For the Sixth Edition, complete all the steps at https://www.impairment.com/trainingcertificate6/ This involves completing the learning experiences at fifthedition.com or www.6thedition.com, as explained at the links above. Complete the mini-assessment and the application form, as explained at the links above. Upon completing all of these steps, you will receive a Certificate of Training as a .pdf.
We highly encourage you to become a Certified Impairment Rater, as explained at www.certifiedrater.com This distinguishes you from others who lack this credential. It is also a great learning experience.
Question: Do subscriptions to fifthedition.com, www.6thedition.com, and www.emedicolegal.com provide Category I AMA credits?
No; however, you can claim Category II credits. There are a myriad of resources to obtain Category I AMA credits; therefore, this is rarely an issue.
Question: How do I bill for an impairment rating, and what should I charge?
If the evaluation is requested by an attorney, insurer, third-party administrator, employer, or governmental entity, you will typically bill that client unless they ask that you bill someone else. If you are billing someone else, it is essential to obtain approval in advance. Workers’ compensation systems or independent medical evaluation companies may have a fee schedule; however, otherwise, your fee may be based on the time involved or other factors, such as the case complexity, number of body parts, issues, and amount of medical records. The value of the examiner’s time varies, depending on the uniqueness of knowledge, skills and experience, specialty and training, and geographical location.
Impairment rating performed by the treating physician usually is considered an extension of the treatment process (office visit, medical records review, diagnostic studies, current physical findings, and a written report). Treating physicians who perform the examination can bill this work using CPT code 9455; CPT code 99456 applies if a non-treating physician performed the work (the code is used for each 30-minute increment). Payment for these codes is dependent on the complexity of the case, the time required in the evaluation and report writing, and the value of the examiner’s time.
Do I need a professional (e.g., medical or chiropractic) license to perform impairment ratings?
The need for licensure depends on jurisdiction and context. It is important to disclose to your examinee the scope of an evaluation and that you are not establishing a physician-patient relationship.
In performing independent medical evaluations (IMEs), it is typically viewed that you do not form a doctor and patient relationship; however, the American Medical Association, in their Code of Medical Ethics Opinion 1.2.6, states there is a limited patient-physician relationship. However, IMEs often involve other issues, such as appropriateness of care and recommendations, that may not be dealt with in performing an impairment rating. Therefore, the need for licensure may be less in this more limited role.
State workers’ compensation systems may require evaluators to be licensed in that state; however, others may state the evaluations are performed by a licensed physician, e.g., you could be licensed in another state. The US Department of Labor requires for their evaluations a valid medical license and board certification in the field of expertise (e.g., toxicology, pulmonary, neurology, occupational medicine, etc.)
Physician opinions are often challenged by opposing counsel; therefore, the lack of a medical license could result in challenges.
Any qualified individual may review an impairment rating and provide an opinion on the correctness. These impairment rating reviewers include non-physicians, e.g., claims professionals, attorneys, and nurses.
It is highly recommended that you have credentials documenting your expertise in using the AMA Guides, e.g., Certified Impairment Rater.
If an overseas medical doctor gets the certificate, will he or she be permitted to work as an impairment rater in the U.S. without a USMLE certificate?
The United States Medical Licensing Examination (USMLE) is a three-step examination program for medical licensure in the United States sponsored by the Federation of State Medical Boards and the National Board of Medical Examiners that physicians with a medical degree and international medical graduates must pass after successful completion of medical training to receive their medical license and begin practicing medicine. Federal and state workers’ compensation jurisdictions typically require physicians to have an active medical license to perform an independent medical or impairment assessment, even though they do not establish a traditional physician-patient relationship. Therefore, without a USMLE certificate and subsequent medical licensure, it is probable that they could not perform a direct examination in most jurisdictions. Physician opinions are often challenged by opposing counsel; the lack of a medical license would raise serious questions about medical qualifications. Any qualified individual may review an impairment rating and provide an opinion on the correctness of the rating. These impairment rating reviewers include non-physicians, e.g., claims professionals, attorneys, and nurses. Therefore, the short answer is no in the traditional role of evaluating a patient; however, yes, if reviewing impairment ratings.