Ca Med Legal Fee Schedule

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On Thursday, April 1, 2021, the Office of Administrative Law approved the new medico-legal fee schedule proposed by the California Division of Workers` Compensation (DWC). The new fee schedule was created to reduce billing disputes, reduce friction costs, increase the quality of medico-legal reports and attract more doctors to the QME panel system. We anticipate that these changes may increase litigation costs and result in significant medical and attorney costs if security measures are not taken. The increased cost of file review will have a significant impact on settlement strategies, litigation fees and debt reserves. Since claim files often contain thousands of pages of medical records, it is essential that examiners and defense counsel review the records that need to be sent to the physician in order to minimize the cost of the review. In some cases, considering resolving the case without a forensic assessment may be the best strategy. In April 2021, the DWC introduced a new fee schedule that changed the payment formulas for medical law assessments and reports for the first time since 2006. The former MLFS had provided for various lump sum payments for full «basic» and «complex» assessments (ML102 and ML103) and time-based payments for assessments with «exceptional circumstances» (ML104). The new schedule replaced these three levels of service with a single code (ML201) for which medical examiners receive a single, fixed fee plus $3 per page for more than 200 page file reviews (MLPRR) and time-based payments for sub-pink video exams (ML205).

The new MLFS also continued to allow additional fees for assessments performed by a Chartered Medical Appraiser (MFA) or those involving an interpreter, and to extend fee multipliers to specific medical specialists. The DWC noted that some pending forensic assessments already scheduled for April 1 or later may not comply with the above reporting requirement. In such cases, the DWC suggests that the parties to the assessments «communicate with each other to reach agreement on the treatment» of the requirement. Another potential logistical problem is when records are duplicated because they are generated from an electronic medical record (EMR) source. Many medical institutions send EMRs for a patient from one specialist to another within the same medical group or outside a medical group. As a result, each specialist has the common MRE datasets in their own specialized files. Thus, an orthopedic surgeon would have the same EMR records of a patient as an internist, the records double by default. There is no way to modify these repetitive records for review by an external QME or AME. So who checks these records before contacting a forensic expert? Athens will continue to assess the impact of the new medico-legal fee schedule and ensure that we take the necessary steps to control the costs associated with the forensic process. Remember that Article 4062.3 and Rule 35 of the Labor Code stipulate that each party must submit the information it intends to send to a forensic expert 20 days before providing the information to the assessor to an opposing party.

The other party then has 10 days to appeal non-medical records such as a claims administrator`s notice of rejection, a party`s advocacy letter, witness testimony, investigator`s reports, etc. If there is a bona fide objection, the information will not be provided to the assessor and the parties may seek the assistance of a workers` compensation judge. A judge may need to determine the accuracy or authenticity of the disputed documents and order that they be sent to the examiner or excluded from the files sent. Finally, we are pleased to inform you that medical expenses have not had as negative an impact as many thought when the law was passed. There is an increase in payment rates for forensic testimonies and reports from psychiatrists, psychologists and internal medicine physicians reviewing cases where the claim relates primarily to toxicology or oncology. There is a new affidavit that the parties must sign to confirm the number of pages to be checked by the physician. Physicians must, under penalty of perjury, indicate the number of pages of documents they have reviewed. There is also a flat fee for missed appointments. The California Office of Administrative Law approved the new medico-legal fee schedule for workers` compensation cases on March 30, 2021. This article summarizes the new fee schedule with some comments on the possible consequences of the new rules and how they may affect the practice of workers` compensation law and medico-legal assessments.

The new rules are set out in Title 8 of the Code of Regulations, sections 9793 to 9795. Section 9793 contains definitions. Section 9794 is mandated to reimburse forensic examinations and reports, including payment and collection procedures and IBR requirements, and Section 9795 is the actual fee schedule. Problems can occur when opposing sites send duplicate records to the evaluator. Can the assessor charge for a duplicate file review per page? What happens if the plaintiff`s lawyer sends 1,000 pages of Kaiser Permanente files to a QME and the defense lawyer also sends the same files? This could result in unnecessary double costs for a claims manager. Can the assessor charge for the duplicate document review? Maybe. Section 9795 does not even deal with the billing of duplicate file checks. Title 8 is also not Cal. Section 9794 of the Code of Regulations, which refers to billing for forensic services, including annexes, the basis for objections to billing, explanation of benefits, requests for review of the second invoice, and IBR and non-IBR procedures. The lawyer is strongly advised to meet and advise in accordance with article 4062.3 of the Labour Code and to comply with Title 8 of the Code of Regulations of Article 35. In fact, paragraph 35(c) states: «At least twenty (20) days before the information is made available to the assessor, the party providing such medical and non-medical reports and information shall provide it to the other party.» The best practice is for the lawyer to meet, advise and agree on what will be sent to a forensic assessor for review.

The fee schedule has been established in consideration of the cooperating parties and agrees before a medico-legal examination which documents will be sent for review by a QME or MEA and who will send them. Without best practices, parties could incur unnecessary and additional litigation costs to appear before a WCAB district office and plead, which will be sent to a forensic expert. Part of the best practice in this regard is to prevent a judge from intervening in these discovery disputes, which result in unnecessary delays and additional costs. Here are more specific aspects of the new billing schedule for forensic reports: Under Title 8 of California Code of Regulations Section 9795(f), the fee schedule for a physical examination or forensic testimony issued on or after 1. April 2021. Note that the effective date of the fee schedule is not the date on which a report is issued by a medical examiner. For supplementary reports, the Schedule of Fees shall apply if the request for additional notification is made on or after 1 April 2021. Additional reports do not require a physical examination and usually include a request from a party asking the medical examiner to clarify his or her findings in a previous report or to answer questions that were originally asked but not addressed in the previous report. Eight months have passed since California`s new medical calendar went into effect — the one from which doctors, mostly PQMEs, receive a $3 per page exam after the first 200 pages.

Well, where are we now? OAKLAND, Calif.–(BUSINESS WIRE)–Payments for forensic services used to resolve medical disputes over compensation issues in Workers` Compensation Claims in California have risen sharply under the new Medico-Legal Fee Schedule (MLFS) that went into effect last year, according to a new CWCI study, with total medical attorneys` fees increasing in the first seven months after the date. The timetable far exceeded the 25% increase provided for by the Workers` Compensation Division (DWC). In workers` compensation cases where there is disagreement on the general practitioner`s opinion on work-related matters, a medical expert is invited to carry out an independent assessment of the injured worker`s condition in order to determine entitlement to workers` compensation (WC) benefits. The Workers` Compensation Division (DWC) of the California Department of Industrial Relations (DIR) has asked RAND to review the California Workers` Compensation ML (ML) fee schedule, which has not been revised since 2007.