If you are treating workers compensation patients and performing Functional Capacity Evaluations, offering impairment ratings is a relatively easy way to expand your clinical services and increase your value to referral sources.
What is an impairment rating? In a nutshell, it is an evaluation performed on a patient to assign a percent of impairment. These impairment percentages are used in settling workers’ compensation cases. The American Medical Association (AMA) has developed a very prescribed methodology for performing impairment ratings. This methodology is published in The AMA’s Guides to the Evaluation of Permanent Impairment . The “AMA Guide” covers the process of determining impairment in all the systems of the body. However, the sections on musculoskeletal and neurological impairments are the sections most relevant to physical and occupational therapists. The typical extremity musculoskeletal impairment involves taking goniometric range of motion measures and then using tables and graphs in the “AMA Guide” to determine the percent impairment.
In some states, only physicians are allowed to perform impairment ratings. However, many physicians are reluctant to perform them as they can be time-consuming from the physician perspective. Therefore, you may want to partner with some orthopedic or neurosurgeons to perform this service. In these cases, therapists make the measurements and assign the percentages and the physician reviews and signs off on the report. When therapists and physicians collaborate to provide this service, they may engage in some revenue sharing.
How does offering impairment ratings help you expand your practice? Most physicians don’t have time in their busy schedules to make precise range of motion measures and calculate the percent. So many of them are happy to pass this on to a therapist. Also, impairment ratings are often needed and requested in conjunction with an FCE. Therefore, performing impairment ratings allows you to meet all the needs of physician given workers’ compensation case.
How much are impairment ratings reimbursed?? Reimbursement will vary by state. However, typically impairment ratings are billed by using the same CPT code as you would for an FCE (97750 in most states). For an average evaluation, clinicians are allowed to bill 4-6 units depending on how complicated the patient’s disability may be.
Will you need training? It is certainly possible to open up the “AMA Guide” and teach yourself how to do AMA Impairment Ratings. However, the time and energy you expend and the confusion that results may not be worth the money you would spend by going to a course. The procedures are not rocket science but they can be somewhat confusing based on reading the text alone. ErgoScience offers affordable training courses, lasting about 1 ½ days. Impairment ratings also do not require expensive equipment or software. So the entrance into this subspecialty is relatively painless.
Where do you begin with marketing? You may want to start by speaking with orthopedic and neurosurgeons in your area that are already sending you referrals. Another avenue is to let workers’ compensation case managers and insurance adjustors know that you offer this service. Providing a seminar on impairment ratings will help establish your credibility as a provider in this specialty area of practice. By investing a minimal amount of money and time, you can add a service that will be valuable to your referral sources and that could have a significant impact on your practice and the perception of your expertise among your peers. Case managers, physicians and attorneys will know that they can have all of their assessment needs met with your clinic(s) thereby easing some of their burden and building a stronger relationship.