Congratulations on passing the California Qualified Medical Evaluator (QME) exam! Becoming a QME is a significant achievement, but now comes the crucial next step: setting up your practice and ensuring you’re ready to receive QME case assignments. Here’s a step-by-step guide to getting started.
1. Decide How to Handle Your QME Practice Administration
Running your own QME practice has never been easier with the right tools. Advances in QME software solutions, such as Simplexam, allow QMEs to efficiently manage scheduling, report writing, billing, and compliance. You can now run your practice independently without being overwhelmed by administrative burdens.
When setting up your QME practice, you have two main options:
- Use Software to Manage Your Own Practice – Platforms like Simplexam streamline case management, report writing, scheduling, and billing, helping you stay compliant with DWC regulations without the need for extensive administrative staff.
- Join a Management Company – Some QMEs opt to work with a QME management company, which takes care of administrative tasks in exchange for a fee.
2. Complete a 16-Hour Disability Evaluation Report Writing Course
Before you can begin accepting QME cases, you must complete a 16-hour disability evaluation report writing course. This training is essential for understanding how to properly document and evaluate disability claims in compliance with California regulations.
The importance of writing high-quality, well-supported QME reports cannot be overstated—it directly impacts a QME’s credibility, reputation, and long-term success. A strong reputation as a fair, thorough, and well-reasoned evaluator increases the likelihood of being selected for cases and reduces the chances of being struck during the panel selection process.
Because both the injured worker and the claims administrator have the right to strike one QME from a panel (known as the Strike Process), reputation plays a crucial role. If an evaluator is perceived as biased, inconsistent, or prone to poorly reasoned reports, one party is more likely to strike them, reducing their panel assignments over time. On the other hand, QMEs who produce clear, objective, and defensible reports are more likely to remain on panels and gain the trust of both applicants and insurers.
3. Choose Your Office Locations & Register Them with the DWC
QMEs can register for multiple office locations, which can increase the volume of panel assignments. Some locations have a higher demand for QMEs than others, so consider strategically selecting areas where you’ll receive the most cases. Simplexam offers proprietary location consulting services to help QMEs optimize their office placements and will soon be launching a self-serve tool for subscribers, making it even easier to identify high-volume locations.
Once you’ve decided on your office locations, send a written request to the DWC Medical Unit to have them officially registered.
You’ll need a professional office space to conduct your QME evaluations. QME offices must meet specific DWC requirements (listed in detail under Title 8, California Code of Regulations, Section 26(a)). Many QMEs conduct exams out of their own medical office, but if they want to expand their geographic footprint, they can rent office space through platforms like Simplexam, which provides a network of office spaces for rent that meet QME regulatory requirements.
4. Familiarize Yourself with the QME Claim Process
Understanding the end-to-end QME claim process is crucial for efficiency and compliance. The typical workflow includes:
- Intake – Receiving and reviewing panel assignments, scheduling the evaluation, obtaining the claimant’s history.
- Appointment Prep – Gathering medical records, reviewing case history, and preparing for the evaluation.
- Examination – Conducting a thorough and objective medical-legal evaluation.
- Report Writing – Drafting a detailed, compliant QME report that is clear, well-supported, and defensible. Timely submission of these reports is mandated by the California Code of Regulations, Title 8, Section 38, which requires that an initial or follow-up report be prepared and submitted within 30 days after the examination.
- Billing and Collections – Submitting claims, tracking payments, and filing requests for Second Bill Review (SBR) and Independent Bill Review (IBR).
5. Leverage Vendor Services for Efficiency
QMEs often rely on third-party services to keep their practice running smoothly. Some key services include:
- Medical Assistants – Assist with patient intake and documentation.
- Location Consulting – Help identify the best office locations for high panel volume.
- Office Leasing – Find affordable and compliant office spaces.
- Medical History & Record Summarization – Streamline review of case files.
- Transcription Services – Convert spoken notes into written reports.
- Interpreters – Provide language support for non-English-speaking patients.
- Billing and Collections – Ensure timely and accurate payment for QME services, including handling disputes with payers.
6. Stay Informed on Best Practices & Compliance
To maintain a successful QME practice, it’s crucial to stay up to date on regulations and best practices. Some key areas to be familiar with include:
- What to Do If Your Claim Is Denied by an Insurance Company
- Proper Documentation & Report Submission
- Timely Compliance with DWC Regulations
Get Started & Build a Thriving QME Practice
Starting as a new QME can feel overwhelming, but by following these steps, you’ll be well on your way to building a compliant, efficient, and successful practice. Whether you choose to run your own practice with software or work with a management company, the key is to stay organized, leverage available resources, and remain compliant with DWC regulations.
Need help finding office space or managing your QME practice? Check out Simplexam for solutions tailored to new QMEs.