New Va Rule: Physicians No Longer Need To Co-Sign C&p Exams

[pacmanx1]

NEW VA RULE: PHYSICIANS NO LONGER NEED TO CO-SIGN C&P EXAMS

NEW VA RULE: PHYSICIANS NO LONGER NEED TO CO-SIGN C&P EXAMS A physician's co-signature is no longer required for a C&P examination performed by a mid-level practitioner. This should expedite the claims process.

by Larry Scott, VA Watchdog dot Org

I am not sure if this is good or bad.

It certainly could speed up the claims process.

However, I already hear complaints from many veterans that they don't want mid-level practitioners, such as a NP or PA, doing their C&P exam ... they want a doctor.

Now, in many cases, doctors are being taken completely out of the loop.

VBA's Fast Letter 10-32 is posted below.

-------------------------

DEPARTMENT OF VETERANS AFFAIRS

Veterans Benefits Administration

Washington, D.C. 20420

September 1, 2010

Director (00/21)

All VA Regional Offices and Centers

In Reply Refer to: 211

Fast Letter 10-32

SUBJ: Removal of Certain Co-Signature Requirements and Ordering Specialist Examinations

Purpose

A joint workgroup of the Veterans Benefits Administration (VBA) and the Veterans Health Administration (VHA) identified several initiatives to expedite compensation and pension (C&P) examinations. This fast letter implements one of these initiatives by liberalizing signature requirements for VHA clinicians performing C&P examinations.

Examination Report Signature Requirements

Effective immediately, regional office and center staff may accept examination reports signed by a nurse practitioner or physician's assistant that are not co-signed by a physician. This change in signature requirements does not apply to examinations conducted by specialists, such as mental health, dental, audiology and optometry.

The M21-1 Manual Rewrite (MR) requires that a physician signs all original examination reports (see M21-1MR Part III, Subpart iv, Chapter 3, Section D, Topic 18, Block a, or

M21-1MR III.iv.3.D.18.a). Law does not mandate this policy, and it can unduly delay processing C&P examinations. In VHA, an individual physician accepts legal responsibility for the unsigned work of a mid-level practitioner, such as a nurse practitioner or physician's assistant. As a result, a physician's co-signature is no longer required for a C&P examination performed by a mid-level practitioner.

We will update the MR to reflect this change.

Specialist Versus Specialty Examinations

Please note that a specialist is only required in limited situations such as dental, vision, hearing, and psychiatric examinations, as indicated by

M21-1MR III.iv.3.A.8. For all other types of examinations, a generalist clinician may perform the examination. For example, an office may order a cardiac examination, but it should not generally request that a cardiologist (a specialist) conduct it.

Questions

E-mail questions concerning this letter to VAVBAWAS/CO/21Q&A.

/S/

Thomas J. Murphy

Director

Compensation and Pension Service

[Rockhound]

If this is the case, then it should be ok for our PC Dr's to do these same examinations also, since most C&P examines are done from a list of things to cover, that the exaiminer follows. My logic behind this that every C&P examines I have had, even I could havve cunducted, having only the training and experiance I had accrewed as a Hospital Corpsman in the Navy. If I had any question about my opinion,I could haved looked it up from any number or resources on the particular subject.

Another question that I wonder about, is whether or not the Dr. gets paid for his part in the C&P eamine and opinion. If this is the case, then I would say that their saying it is to cut down the time of the claim is just a cover sceem for the VA to cut their cost down so they would have more to pay themselves by way of boneneces, and such.

I believe I shot mysefl in the foot on my present claim when I told the examiner when shae asked me did I have any questions, was when I tld her I was disappointed in that I was being given an exam and opinion from a NP instead of a ENT Dr. Who I felt would have a better understanding of my claim and the several factors involved.

After being denied, it became clear to me that I was correct, in fact, the NP did not have a grasp on the foundation of my claim.

Is their a way to protest this rule and or get someone in authority to. I for one would care less if it took a week or two for a DR. to sign off on the exame, as long as they actually checked out the cliam and what the NP or PA are correct in their findings and opinions. Otherwise, if the Dr. are only ruberstamping everything, then saving time is fine with me, that is, so long as my PCP can make their opinion just as valid.

Rockhound Rider

[Philip Rogers]

They can speed up the claims process just by eliminating smoke breaks. jmo

pr

[pacmanx1]

I posted this to another thread but the bottom line is this; Get a medical specialist opinion (IMO) prior to filing a claim or at least prior to your C & P exam and get it in your records. DO NOT let the C & P examiner's medical opinion be the only medical opinion in your file. Get treated and get the evidence that you need to win your claim, try to get enough evidence in your file to support your claim that VA has to grant it the first time.

Credible evidence, we can always use VA regulations against VA rating decisions to help our claims. In most cases, C & P exams are not done by specialist, they are completed by PA's and NP's. If a veteran is treated by a specialist (VA or Non-VA) and have the evidence in his or her file prior to his or her C & P exam, the C & P examiner will most likely follow the opinion of the specialist. Even if the C & P examiner disagrees with the specialist, the C & P examiner must give a rationale that would be more plausible than the specialist and I do not think that is possible. The key here is the veteran would have been or is being treated by a specialist working in his or her field to give a diagnosis of the condition claimed as a disability. The condition could be for service connection or for an increase and VA "should" award the claim based on all the evidence.

I still do not think this new rule will speed up the process, just the number of appeals being filed.

Hope this makes sense

Edited September 19, 2010 by pacmanx1

[Wings]

I posted this to another thread but the bottom line it this; Get a medical specialist opinion (IMO) prior to filing a claim or at least prior to your C & P exam and get it in your records. DO NOT let the C & P examiner's medical opinion be the only medical opinion in your file. Get treated and get the evidence that you need to win your claim, try to get enough evidence in your file to support your claim that VA has to grant it the first time.

Agree !!!

[john999]

When I had my cardiac C&P the NP was using my exam to train another NP. The NP did a hell of a job. She just guessed at things that required tests. I read the rating schedule exam. A doctor signed off on that joke of an exam. Without more evidence I would have been sunk. The IMO is the major tool of vets. Where the VA has tried to get around the IMO like with PTSD it is a real crime. All based entirely on cost. Save a buck and screw a vet. "To care for those who have borne the battle" is a joke at the VA water cooler.

[caubulldog]

Believe it or not but when I went to my exam with my small forest of documents and imaging.She took the time to do a proper exam,reviewed my papers I brought,did the occupational questions,and the full blown exam. She basically was amazed they had sent me to her when 3 Va doctors had already agreed my knees are getting worse. I got the results and there is very little wiggle room in that document which the American Legion Rep,Bva,& Amc now has in their hands. Just waiting on what they will rate it at since she said I was misrated (wrong code) back in 1993 and she was gonna document that be fixed.