How to discredit the consultative social security exam before, during and after the exam. Discredit the exam when it is: inaccurate; allows for bias of the examiner; where the claimant has difficulty getting to the exam; it costs the government money; it hurts the claimant; it scares the claimant.
The 2012 Food and Drug Administration Safety and Innovation Act (FDASIA) includes a provision that allows sponsors to request that their drug be designated as a "Breakthrough Therapy". This designation is primarily based on the early clinical finding of substantial efficacy in s serious medical need indication. A Breakthrough Therapy Designation provides fast track program advantages alongside a frequent FDA guidance on an efficient drug development program. The FDA also makes an organizational commitment to involve experienced reviewers and senior management in such guidance. This presentation provides an overview of Breakthrough Therapy Designation and discusses why CMC aspects can lag-behind clinical development and how this may be addressed.
The time has come to seriously work on leveraging End-of-Phase II for setting regulatory specifications.
Creative Strategies in Dealing with FDA for Approval of Drugs and Medical Dev...Michael Swit
Webinar sponsored by PSC Creative Learning, covering key ways that FDA allows drug and device companies to seek alternative ways to secure approval/clearance of drugs and medical devices. Presentation covers:
* accelerated approval
* breakthrough therapies
* fast track drugs
* priority review
Preparing for Increased FDA Enforcement Activities Impacting Clinical StudiesMichael Swit
Presentation covers:
Understanding the Warning Letter in FDA’s Enforcement Arsenal
GCP Warning Letters – Highlights of 2010 and 2011
How to Respond if Targeted
Consequences of Non-Compliance
Lessons Learned
Appendices – Details on Warning Letter observations by type of citation/type of recipient
The 2012 Food and Drug Administration Safety and Innovation Act (FDASIA) includes a provision that allows sponsors to request that their drug be designated as a "Breakthrough Therapy". This designation is primarily based on the early clinical finding of substantial efficacy in s serious medical need indication. A Breakthrough Therapy Designation provides fast track program advantages alongside a frequent FDA guidance on an efficient drug development program. The FDA also makes an organizational commitment to involve experienced reviewers and senior management in such guidance. This presentation provides an overview of Breakthrough Therapy Designation and discusses why CMC aspects can lag-behind clinical development and how this may be addressed.
The time has come to seriously work on leveraging End-of-Phase II for setting regulatory specifications.
Creative Strategies in Dealing with FDA for Approval of Drugs and Medical Dev...Michael Swit
Webinar sponsored by PSC Creative Learning, covering key ways that FDA allows drug and device companies to seek alternative ways to secure approval/clearance of drugs and medical devices. Presentation covers:
* accelerated approval
* breakthrough therapies
* fast track drugs
* priority review
Preparing for Increased FDA Enforcement Activities Impacting Clinical StudiesMichael Swit
Presentation covers:
Understanding the Warning Letter in FDA’s Enforcement Arsenal
GCP Warning Letters – Highlights of 2010 and 2011
How to Respond if Targeted
Consequences of Non-Compliance
Lessons Learned
Appendices – Details on Warning Letter observations by type of citation/type of recipient
Google Panda and Penguine: A quick SummaryRahul Kumar
We have covered complete information about Google Panda & Penguin Algorithm update of Google. How it Works? Which Site it damages? And how to recover? Call at +91-782-774-2414 if you have any query or know more.
Quote burgemeester ''Een gemeentegids is niet volledig zonder advertenties van de handelaars, bedrijven, instellingen, vrije beroepen, en zelfstandige ondernemers in dienst- en/of goederenverlening. Immers ook zij zorgen voor de informatie, waaraan in het bijzonder nieuwe inwoners behoefte hebben.'' Een mooiere omschrijving konden wij niet wensen als onderdeel van onze legitimatie. Dank hiervoor en hopelijk tot een volgende publicatie Moorslede ;-) Jan Duchau - 0498/361 531 - jan@inforegio.be
JMO to dSeries, A 10 Stage Conversion Process - CA Workload Automation Techno...Extra Technology
Please contact us via our contact page - http://www.extratechnology.com/contact - to learn more about CA Technologies' Workload Automation products and to book your place at the next WATS event.
This 'JMO to dSeries, A 10 Stage Conversion Process' presentation by Extra Technology's Bhupinder Janjuha was delivered at 'CA Workload Automation Technology Summit (WATS) 2014' in London, October 2014.
Extra Technology has a proven method to migrate workflows from CA's JMO to dSeries.
Since 2013 the UK User Group meetings for JMO, dSeries, AutoSys and CA7 are incorporated into WATS. Customers agree that WATS is a must-attend event for the CA Workload Automation community, showcasing CA's Workload Automation solutions.
WATS is a free-of-charge event, sponsored and arranged by Workload Automation experts Extra Technology. It features guest speakers from CA Technologies and CA Community Group Members.
#JMO #CAUnicenter #WATS #JobManagementOption #dSeries #WorkloadAutomation @CAinc @CA_Community @extratechnology
The presentation defines the benefits of persuing engineering as a career. It tells the outcomes and benefits of being an engineer. The impact on the life styles of an engineer and the advantages one could have in following this path as a career. Its a way to change ones life and the life of the people around you.so be an engineer and bring the change in this world with new ideas and innovations. for details http://www.chiefpapers.com/do-my-extensive-essay
Met deze editie van de infogids informeert het bestuur zijn bevolking over de stedelijke en OCMW dienstverlening. Een brede waaier aan diensten dewelke de jongste jaren enorm gegroeid zijn. Dit komt omdat Diksmuide bloeit en groeit. Voor realisatie werkte het stadsbestuur samen met uitgeverij Publi-Touch, die voor het drukwerk, de afwerking en de bus-aan-busbedeling zorgde. Dankzij de adverteerders kan Diksmuide deze gids opnieuw gratis verspreiden. Interesse in een volgende uitgave? Jan Duchau - 0498 361 531 - jan@inforegio.be
Is health information always admissible as evidence in court Explai.pdfjeeteshmalani1
Is health information always admissible as evidence in court? Explain your answer and provide
APA references.
Solution
What is one of the most important non-clinical uses of the medical redcord?
It serves as the legal document recording a particular episode of a patient\'s care. (of the facility
and treatment)
When can a patient\'s information be disclosed?
With the written consent or authorization of the patient.
pursuant to statutory requirements or on proper legal process.
Define Evidence
Testimony, writings, material objects, or other things presented to prove or disprove a fact.
Define ADMISSIBLE EVIDENCE
Info. or things that may be admitted as evidence in a trial if the applicable rules establish that the
info. is BOTH PERTINENT and PROPER (timely, accurate, complete records) for the the judge
or jury to consider when deciding issues involved in the lawsuit.
What is HEARSAY?
Out-of-court statements that are offered to prove the truth of the matter asserted. Not signed
under oath.
Why are medical records considered hearsay evidence?
Because the health-care providers making the statements, (entries into the record) do not do so
under oath in a court of law. Therefore under the Hearsay rule they are not admissible as
evidence in court.
So, if Hearsay evidence is not addmisible in court, how can medical records be an exception to
the rule? There ARE exceptions to the rule...
BUSINESS RECORD EXCEPTION to the HEARSAY EXEMPTION RULE specifically allows
medical records to be used as evidence. if the person offering the records can successfully
convince the judge the records are kept in the ordinary course of business and not in preparation
for litigation.
BUSINESS RECORD EXCEPTION to the HEARSAY EXEMPTION RULE
HIM Mgr. / Custodian must establish in court the FOUNDATION and TRUSTWORTHINESS
of their record-keeping.
The three elements of a FOUNDATION REQUIREMENT to the hearsay exemption?
Person submitting the evidence must extablish that the record was;
1. Made and kept in the ordinary course of business
2. recorded at or near the time the event
3. By a person with knowledge of the facts, events, conditions, opinions, or diagnoses appearing
in it.
How is TRUSTWORTHINESS REQUIREMENT to the hearsay exception established?
One of the requirements of the Business Record Exemption to the hearsay rule. HIM/custodian
must testify to:
- Internal policies/procedures governing access to meddical record
- quality control techniques (i.e. corrections & abbreviations of the record)
How does the party wishing to introduce a medical record as evidence establish the accuracy and
trustworthiness of the medical record?
They will bring in the custodian of medical records to testify to the accuracy and trustworthiness
of the records.
How does the Medical Records Custodian testify as to both the foundation and trustworthiness
requirements of the business record exception?
The custodian, the HIM professional, testifies in a trial or deposition:
- To FOUNDATION - testifi.
Regulatory Challenges to Successful Global Clinical StudiesMichael Swit
A review of key issues that can make or break the success of a clinical study conducted outside the United States, with an emphasis on site, GCP issues, challenges that vary nationally, and enforcement concerns.
Federally Qualified Health Centers must provide all required primary, preventive and enabling health services, in addition to additional health services, as appropriate and necessary. This can be managed either directly through health center employees and volunteers, or through formal written contracts and formal written referral arrangements.
It is important for health centers to understand that contracts and formal written referral arrangements are not just a piece of paper and not only come with requirements, but also responsibilities on the part of both the health center and the contracted/referral provider(s).
This webinar will address the following:
• HRSA required clinical language for Column II contracts and Column III formal written referral arrangements
• The responsibilities of the health center and the contracted/referral provider
• A high-level review of the clinical chapters associated with Column II and Column III contracts
• Case studies demonstrating gaps in care creating areas of significant risk
• Best Practices to ensure appropriate continuity and quality of care
Google Panda and Penguine: A quick SummaryRahul Kumar
We have covered complete information about Google Panda & Penguin Algorithm update of Google. How it Works? Which Site it damages? And how to recover? Call at +91-782-774-2414 if you have any query or know more.
Quote burgemeester ''Een gemeentegids is niet volledig zonder advertenties van de handelaars, bedrijven, instellingen, vrije beroepen, en zelfstandige ondernemers in dienst- en/of goederenverlening. Immers ook zij zorgen voor de informatie, waaraan in het bijzonder nieuwe inwoners behoefte hebben.'' Een mooiere omschrijving konden wij niet wensen als onderdeel van onze legitimatie. Dank hiervoor en hopelijk tot een volgende publicatie Moorslede ;-) Jan Duchau - 0498/361 531 - jan@inforegio.be
JMO to dSeries, A 10 Stage Conversion Process - CA Workload Automation Techno...Extra Technology
Please contact us via our contact page - http://www.extratechnology.com/contact - to learn more about CA Technologies' Workload Automation products and to book your place at the next WATS event.
This 'JMO to dSeries, A 10 Stage Conversion Process' presentation by Extra Technology's Bhupinder Janjuha was delivered at 'CA Workload Automation Technology Summit (WATS) 2014' in London, October 2014.
Extra Technology has a proven method to migrate workflows from CA's JMO to dSeries.
Since 2013 the UK User Group meetings for JMO, dSeries, AutoSys and CA7 are incorporated into WATS. Customers agree that WATS is a must-attend event for the CA Workload Automation community, showcasing CA's Workload Automation solutions.
WATS is a free-of-charge event, sponsored and arranged by Workload Automation experts Extra Technology. It features guest speakers from CA Technologies and CA Community Group Members.
#JMO #CAUnicenter #WATS #JobManagementOption #dSeries #WorkloadAutomation @CAinc @CA_Community @extratechnology
The presentation defines the benefits of persuing engineering as a career. It tells the outcomes and benefits of being an engineer. The impact on the life styles of an engineer and the advantages one could have in following this path as a career. Its a way to change ones life and the life of the people around you.so be an engineer and bring the change in this world with new ideas and innovations. for details http://www.chiefpapers.com/do-my-extensive-essay
Met deze editie van de infogids informeert het bestuur zijn bevolking over de stedelijke en OCMW dienstverlening. Een brede waaier aan diensten dewelke de jongste jaren enorm gegroeid zijn. Dit komt omdat Diksmuide bloeit en groeit. Voor realisatie werkte het stadsbestuur samen met uitgeverij Publi-Touch, die voor het drukwerk, de afwerking en de bus-aan-busbedeling zorgde. Dankzij de adverteerders kan Diksmuide deze gids opnieuw gratis verspreiden. Interesse in een volgende uitgave? Jan Duchau - 0498 361 531 - jan@inforegio.be
Is health information always admissible as evidence in court Explai.pdfjeeteshmalani1
Is health information always admissible as evidence in court? Explain your answer and provide
APA references.
Solution
What is one of the most important non-clinical uses of the medical redcord?
It serves as the legal document recording a particular episode of a patient\'s care. (of the facility
and treatment)
When can a patient\'s information be disclosed?
With the written consent or authorization of the patient.
pursuant to statutory requirements or on proper legal process.
Define Evidence
Testimony, writings, material objects, or other things presented to prove or disprove a fact.
Define ADMISSIBLE EVIDENCE
Info. or things that may be admitted as evidence in a trial if the applicable rules establish that the
info. is BOTH PERTINENT and PROPER (timely, accurate, complete records) for the the judge
or jury to consider when deciding issues involved in the lawsuit.
What is HEARSAY?
Out-of-court statements that are offered to prove the truth of the matter asserted. Not signed
under oath.
Why are medical records considered hearsay evidence?
Because the health-care providers making the statements, (entries into the record) do not do so
under oath in a court of law. Therefore under the Hearsay rule they are not admissible as
evidence in court.
So, if Hearsay evidence is not addmisible in court, how can medical records be an exception to
the rule? There ARE exceptions to the rule...
BUSINESS RECORD EXCEPTION to the HEARSAY EXEMPTION RULE specifically allows
medical records to be used as evidence. if the person offering the records can successfully
convince the judge the records are kept in the ordinary course of business and not in preparation
for litigation.
BUSINESS RECORD EXCEPTION to the HEARSAY EXEMPTION RULE
HIM Mgr. / Custodian must establish in court the FOUNDATION and TRUSTWORTHINESS
of their record-keeping.
The three elements of a FOUNDATION REQUIREMENT to the hearsay exemption?
Person submitting the evidence must extablish that the record was;
1. Made and kept in the ordinary course of business
2. recorded at or near the time the event
3. By a person with knowledge of the facts, events, conditions, opinions, or diagnoses appearing
in it.
How is TRUSTWORTHINESS REQUIREMENT to the hearsay exception established?
One of the requirements of the Business Record Exemption to the hearsay rule. HIM/custodian
must testify to:
- Internal policies/procedures governing access to meddical record
- quality control techniques (i.e. corrections & abbreviations of the record)
How does the party wishing to introduce a medical record as evidence establish the accuracy and
trustworthiness of the medical record?
They will bring in the custodian of medical records to testify to the accuracy and trustworthiness
of the records.
How does the Medical Records Custodian testify as to both the foundation and trustworthiness
requirements of the business record exception?
The custodian, the HIM professional, testifies in a trial or deposition:
- To FOUNDATION - testifi.
Regulatory Challenges to Successful Global Clinical StudiesMichael Swit
A review of key issues that can make or break the success of a clinical study conducted outside the United States, with an emphasis on site, GCP issues, challenges that vary nationally, and enforcement concerns.
Federally Qualified Health Centers must provide all required primary, preventive and enabling health services, in addition to additional health services, as appropriate and necessary. This can be managed either directly through health center employees and volunteers, or through formal written contracts and formal written referral arrangements.
It is important for health centers to understand that contracts and formal written referral arrangements are not just a piece of paper and not only come with requirements, but also responsibilities on the part of both the health center and the contracted/referral provider(s).
This webinar will address the following:
• HRSA required clinical language for Column II contracts and Column III formal written referral arrangements
• The responsibilities of the health center and the contracted/referral provider
• A high-level review of the clinical chapters associated with Column II and Column III contracts
• Case studies demonstrating gaps in care creating areas of significant risk
• Best Practices to ensure appropriate continuity and quality of care
Are you a new FQHC? Or new to an FQHC? Wondering what FTCA coverage is all about? How do you prepare to be ready to apply for coverage?
Get answers to these questions and more in this introductory webinar that will benefit everyone
The goal of medical review is to determine whether the services are reasonable and necessary, delivered in the appropriate setting, and coded correctly, based on appropriate documentation. The speaker will begin this seminar by discussing the goals of Medical Review and various Medical Review programs including Recovery Audit Contractor (RAC) and Carrier (Medicare Administrative Contractor or Fiscal Intermediary) Medical Review programs.
The goal of medical review is to determine whether the services are reasonable and necessary, delivered in the appropriate setting, and coded correctly, based on appropriate documentation. The speaker will begin this seminar by discussing the goals of Medical Review and various Medical Review programs including Recovery Audit Contractor (RAC) and Carrier (Medicare Administrative Contractor or Fiscal Intermediary) Medical Review programs.
This presentation reviews the key points of therapy and nursing documentation to support skilled care. Carrie will share tips and strategies for both responding to a medical record request and appealing a denied claim. Recommended for Administrators, Executive Directors, CEOs, CFOs, COOs and Interdisciplinary Staff.
Matt Lewis Law - Indemitty Dispute ResolutionMatt Lewis Law
Practices, Procedures & Problems Update 2009.Form DWC-45 Certify good faith effort has been made to resolve the issues identified.Sometimes requires more than a letter to the opposing party. No consistency with this requirement.
Evidentiary exchange – 14 days prior.Matt Lewis Law, P.C. is a firm serving Dallas in Administrative practice, Division of Workers' Compensation cases and Temporary income benefits cases.
For More Info Visit
https://www.mattlewislaw.com/
https://www.youtube.com/channel/UCTdOLbzX96zv0G-XjTgA61A
https://www.crunchbase.com/person/matt-lewis-law-dallas-texas
https://www.facebook.com/Matt-Lewis-Law-PC-86986124799/
https://vimeo.com/mattlewislaw
https://medium.com/@mattlewislaw
https://www.behance.net/mattlewislaw/
Matt Lewis Law Dallas Texas - Indemnity Dispute Resolution July 2009Matt Lewis Law
INDEMNITY DISPUTE RESOLUTION
Requesting A BRC
Form DWC-45
Certify good faith effort has been made to resolve the issues identified.
Sometimes requires more than a letter to the opposing party. No consistency with this requirement.
Evidentiary exchange – 14 days prior
......
In 2020, the Ministry of Home Affairs established a committee led by Prof. (Dr.) Ranbir Singh, former Vice Chancellor of National Law University (NLU), Delhi. This committee was tasked with reviewing the three codes of criminal law. The primary objective of the committee was to propose comprehensive reforms to the country’s criminal laws in a manner that is both principled and effective.
The committee’s focus was on ensuring the safety and security of individuals, communities, and the nation as a whole. Throughout its deliberations, the committee aimed to uphold constitutional values such as justice, dignity, and the intrinsic value of each individual. Their goal was to recommend amendments to the criminal laws that align with these values and priorities.
Subsequently, in February, the committee successfully submitted its recommendations regarding amendments to the criminal law. These recommendations are intended to serve as a foundation for enhancing the current legal framework, promoting safety and security, and upholding the constitutional principles of justice, dignity, and the inherent worth of every individual.
Car Accident Injury Do I Have a Case....Knowyourright
Every year, thousands of Minnesotans are injured in car accidents. These injuries can be severe – even life-changing. Under Minnesota law, you can pursue compensation through a personal injury lawsuit.
Lifting the Corporate Veil. Power Point Presentationseri bangash
"Lifting the Corporate Veil" is a legal concept that refers to the judicial act of disregarding the separate legal personality of a corporation or limited liability company (LLC). Normally, a corporation is considered a legal entity separate from its shareholders or members, meaning that the personal assets of shareholders or members are protected from the liabilities of the corporation. However, there are certain situations where courts may decide to "pierce" or "lift" the corporate veil, holding shareholders or members personally liable for the debts or actions of the corporation.
Here are some common scenarios in which courts might lift the corporate veil:
Fraud or Illegality: If shareholders or members use the corporate structure to perpetrate fraud, evade legal obligations, or engage in illegal activities, courts may disregard the corporate entity and hold those individuals personally liable.
Undercapitalization: If a corporation is formed with insufficient capital to conduct its intended business and meet its foreseeable liabilities, and this lack of capitalization results in harm to creditors or other parties, courts may lift the corporate veil to hold shareholders or members liable.
Failure to Observe Corporate Formalities: Corporations and LLCs are required to observe certain formalities, such as holding regular meetings, maintaining separate financial records, and avoiding commingling of personal and corporate assets. If these formalities are not observed and the corporate structure is used as a mere façade, courts may disregard the corporate entity.
Alter Ego: If there is such a unity of interest and ownership between the corporation and its shareholders or members that the separate personalities of the corporation and the individuals no longer exist, courts may treat the corporation as the alter ego of its owners and hold them personally liable.
Group Enterprises: In some cases, where multiple corporations are closely related or form part of a single economic unit, courts may pierce the corporate veil to achieve equity, particularly if one corporation's actions harm creditors or other stakeholders and the corporate structure is being used to shield culpable parties from liability.
Matthew Professional CV experienced Government LiaisonMattGardner52
As an experienced Government Liaison, I have demonstrated expertise in Corporate Governance. My skill set includes senior-level management in Contract Management, Legal Support, and Diplomatic Relations. I have also gained proficiency as a Corporate Liaison, utilizing my strong background in accounting, finance, and legal, with a Bachelor's degree (B.A.) from California State University. My Administrative Skills further strengthen my ability to contribute to the growth and success of any organization.
A "File Trademark" is a legal term referring to the registration of a unique symbol, logo, or name used to identify and distinguish products or services. This process provides legal protection, granting exclusive rights to the trademark owner, and helps prevent unauthorized use by competitors.
Visit Now: https://www.tumblr.com/trademark-quick/751620857551634432/ensure-legal-protection-file-your-trademark-with?source=share
Synopsis On Annual General Meeting/Extra Ordinary General Meeting With Ordinary And Special Businesses And Ordinary And Special Resolutions with Companies (Postal Ballot) Regulations, 2018
2. Why Discredit The Exam
They are inaccurate
The allow for the bias of the Examiner
Our clients have difficulty getting there
They cost the government money
They hurt the clients
They scare the clients
Nosscr October 2014
2
3. When Is SSA Supposed To Order
Consultative Evaluation
20 CFR 404.1519a
They will purchase a CE when:
If SSA doesn’t get information from a
Medical Source
To resolve inconsistencies in the medical
evidence
When the evidence is insufficient to decide
Highly technical evidence is not available
Current severity is not established
Nosscr October 2014
3
4. Who Should Perform The CE
20 CFR 404.1519(H)
When in our judgment your treating source is
qualified, equipped, and willing to perform
the additional examination or tests for the fee
schedule payment, and generally furnishes
complete and timely reports, your treating
source will be the preferred source to do the
purchased examination. Even if only a
supplemental test is required, your treating
source is ordinarily the preferred source.
Nosscr October 2014
4
5. Objecting To A CE
§ 404.1519j. Objections to the medical source designated to perform the
consultative examination.
If there is a good reason for the objection, we will schedule the
examination with another medical source.
A good reason may be that the medical source we designated had
previously represented an interest adverse to you
The presence of a language barrier, the medical source's office location
(e.g., 2nd floor, no elevator), travel restrictions,
whether the medical source had examined you in connection with a
previous disability determination or decision that was unfavorable to
you.
If your objection is that a medical source allegedly “lacks objectivity” in
general, but not in relation to you personally, we will review the
allegations.
To avoid a delay in processing your claim, the consultative examination
in your case will be changed to another medical source while a review
is being conducted.
We will handle any objection to use of the substitute medical source in
the same manner.
Nosscr October 2014
5
6. How Do They Read The Report
(a) We will review the report of the consultative examination to determine
whether the specific information requested has been furnished. We will
consider the following factors in reviewing the report:
(1) Whether the report provides evidence which serves as an adequate basis
for decision making in terms of the impairment it assesses;
(2) Whether the report is internally consistent; Whether all the diseases,
impairments and complaints described in the history are adequately assessed
and reported in the clinical findings; Whether the conclusions correlate the
findings from your medical history, clinical examination and laboratory tests
and explain all abnormalities;
(3) Whether the report is consistent with the other information available to us
within the specialty of the examination requested; Whether the report fails to
mention an important or relevant complaint within that specialty that is noted
in other evidence in the file (e.g., your blindness in one eye, amputations,
pain, alcoholism, depression);
(4) Whether this is an adequate report of examination as compared to
standards set out in the course of a medical education; and
(5) Whether the report is properly signed..(20 CRF 404.1519p)
Nosscr October 2014
6
7. What If SSA Can’t Read The
Report
(b) If the report is inadequate or incomplete, we will contact the
medical source who performed the consultative examination, give
an explanation of our evidentiary needs, and ask that the medical
source furnish the missing information or prepare a revised report.
(c)With your permission, or when the examination discloses new
diagnostic information or test results that reveal a potentially life-threatening
situation, we will refer the consultative examination
report to your treating source. When we refer the consultative
examination report to your treating source without your permission,
we will notify you that we have done so.
(d)We will perform ongoing special management studies on the
quality of consultative examinations purchased from major medical
sources and the appropriateness of the examinations authorized.
Nosscr October 2014
7
8. The Studies say 26% of CE’s are
deficient.
An Assessment of Consultative Examination (CE) Processes,
Content, and Quality: Findings from the CE Review Data
Final DATED November 12 2012 Report(http://www.
socialsecurity.gov/ disabilityresearch/document
/CE%20Report%202.pdf)
COMS Medical Consultants’ Assessment of CE Quality and
Completeness
Minority of cases (11 percent) judged deficient for making
disability determination
Minority of cases (16 percent) judged not to include all of
the items expected (expected findings, conclusions, and
responses to specific questions); more frequent
occurrences of not including
Nosscr October 2014
8
9. What Is The CE Report
Required To Include
The Green Book explains : Consultative Exams: A
Guide for Health Professionals
List A-K at a minimum
Then Specific types of exams-Musculoskeletal,
Special Senses and Speech, Visual Impairments,
Hearing Impairments, Respiratory System,
Cardiovascular System, Digestive System,
Genitourinary Impairments, Hematological
Disorders, Skin Disorders,
Endocrine Disorders, Neurological Disorders,
Mental Disorders, Malignant Neoplastic Diseases,
Immune System Disorders
Nosscr October 2014
9
10. Minimum Requirements
A. Identity of Claimant with longitudinal
Medical History
B. Current Medical History, onset date,
current symptoms, treatment and results,
typical daily activities, dates
C Past medical History
D. Current medications
E. Review systems-other symptoms and
pertinent negatives
Nosscr October 2014
10
11. Minimum Requirements
F. Social History – tobacco and DA&A
G. Family History
H. Physical Exam
I. Interpretation of Lab tests
Imagining tests
Medical Source Statement- opinion
Nosscr October 2014
11
12. Minimum Requirements
Lifting/carrying/pushing/pulling
Sitting/standing/walking
Posture (for example,
climbing/stooping/bending/balancing/cra
wling/ kneeling/crouching)
Fine motor skills (that is,
handling/fingering/gripping/feeling)
Overhead and forward reaching
Vision/hearing/speech
Environmental exposures (for example,
heat/cold/humidity/noise/vibration)
Nosscr October 2014
12
13. How Long Should The Exam
Last
20 CFR § 404.1519n
(1) Comprehensive general medical
examination—at least 30 minutes;
(2) Comprehensive musculoskeletal or
neurological examination—at least 20 minutes; (3)
Comprehensive psychiatric examination—at least
40 minutes;
(4) Psychological examination—at least 60 minutes
(Additional time may be required depending on
types of psychological tests administered); and
(5) All others—at least 30 minutes, or in
accordance with accepted medical practices.
Nosscr October 2014
13
14. What Is The Effect Of Not
Going To The CE
HALLEX I-2-5-24 Claimant Fails or Refuses to
Submit Evidence or Undergo a Consultative
Examination or Test
It is never proper to dismiss a claimant's RH for
failure to provide requested evidence or to
undergo a requested CE. The ALJ should
schedule the case for hearing and if after
notice of hearing, the claimant fails to appear
for the hearing, then dismissal may be proper
under I-2-4-25. (20 CFR §§ 404.957
and416.1457.)
Nosscr October 2014
14
15. Scheduling The Appointment
POMS DI 23007.010
Failure to attend a CE appointment means
the claimant did not state orally or in writing
that he or she would not attend the CE
appointment, but the claimant fails to attend
the CE appointment.
However, a claimant cannot fail to attend a
CE appointment if: the claimant did not
confirm the appointment, see DI 22510.019D;
Nosscr October 2014
15
16. What Is Good Cause Not to
Attend The CE
1. The claimant was seriously ill and unable to comply with the
request.
2. There was a death or serious illness in the claimant's immediate
family which prevented him or her from complying with the request.
3. The claimant did not receive the request to submit evidence or
appear for a CE or test, or the claimant received the request
untimely.
4. The request to submit evidence or appear for a CE or test
contained incorrect or incomplete information about when and
where to submit the evidence or appear for the CE or test.
5. The evidence requested is not available due to destruction or
damage.
6. The claimant did not understand the requirement to provide the
requested information.
7. The claimant lacked the financial ability/means to obtain the
evidence requested. (20 CFR §§ 404.911)
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17. What Can Be Done Before The
Consultative Exam
Send a letter asking why they need the
CE
Object to the CE
Have a doctor write a letter explaining
why the claimant cannot have the exam.
(depression example)
Offer to pay for the difference between
what SSA is willing pay and what the Dr. is
going to charge
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18. What Can Be Done During
The Consultative Exam
Advise the client to bring the records with
Advise the client to have somebody go
with them(a nurse)
Have them ask if they can record the
session blame it on the lawyer
Advise the client to explain if it is a bad
day
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19. What Can Be Done After The
Exam.
Have the client fill out the questionnaire
Submit the Questionnaire
Have the client’s doctor fill out the range
of motion questionnaire
Submit the Range of Motion for to DDS
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20. What do you do at the
hearing
In court Compare the ROM Form to that
of the Treating physician or PT
Have the client testify about what he
disagrees in the CE
Have the witness come to court to testify
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Editor's Notes
I want point out ways to discredit the CE before during and after the exam
Clients come to us at all phases of the there case that is why we need to be able to discredit the exam before during and after it has occurred
Today we are going to Review the law the studies they have done
because the statute says they have to do studies
Review the studies and then make suggestions about how you can deal with the problems that arise
The ALJ’s heavily rely on them
If you want to know why the DDS is doing the CE send a letter and ask.
See the letter I send before hand
I offer to pay for the CE’s save the government money and point out they are he preferred source
It doesn’t say object because the treating doctor could do the CE
This is done before the hearing
B would mean they would contact the original provided if he did the CE
Coms –Comprehensive occupational medical Service 2012
IOM-Institute of medicine -2005 interem report 2007 final report