If you are looking to understand medical legal billing in California, then “Qualified Medical Evaluator” (QME) and “Agreed Medical Evaluator” (AME) are two terms you need to be familiar with.
What Is a QME?
The acronym QME stands for “Qualified Medical Evaluator.”
In California, a QME is a physician who evaluates a worker when there are questions (also known as medical legal disputes) about what benefits the worker should receive.
Physicians have to meet certain educational and licensing requirements in order to become a QME. To get a sense of what the process to become a QME looks like, check out our previous blogs, “How to become a Qualified Medical Evaluator (QME) in California?” and “California’s DWC is accepting applications for QMEs.”
What Is an AME?
If the worker has an attorney, then the worker together with their attorney can agree with the worker’s claim administrator on a physician that will help settle medical legal disputes.
This physician is called an Agreed Medical Evaluator, or AME. There are two things worth noting about AMEs:
- Once the worker sees an AME, they are not entitled to see a QME
- AMEs can be certified as QMEs, although this is not a requirement
What Is the Difference Between a QME and an AME?
As you can see from the definitions offered above, the differences between a QME and an AME are straightforward:
- An AME is chosen by agreement between the worker, their attorney, and the worker’s claim administrator
- A QME, on the other hand, is picked from a list compiled by DWC medical unit
- QMEs may serve all workers, while AMEs are available only to workers who are represented by a lawyer
However, QMEs and AMEs have one basic thing in common. Despite some important differences, the role of a QME and an AME is the same: to resolve medical disputes in a workers’ compensation case.
Practice IQ: Medical Legal Billing in California
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