CA Med-Legal Reports: REQUIRED Physician Verification

CA Med-Legal Reports: REQUIRED Physician Verification

Last spring, California introduced a new Medical-Legal Fee Schedule (MLFS). Since April 2021, daisyBill clients have submitted over 80,000 medical-legal bills where the new MLFS is applicable. In the interest of keeping physician evaluators paid for their medical-Legal reports, this article outlines the guidelines that evaluators must carefully follow for record review verification.

When submitting a medical-legal report, the new MLFS mandates that physician evaluators must ALWAYS verify, under penalty of perjury, the exact count of pages of records the evaluator reviewed. This physician verification is required even if zero records were received or reviewed.

Failing to properly verify the page count allows claims administrators to deny reimbursement for the medical-legal report, even if zero pages were reviewed.

Always Required: Physician Record Review Verification

California Code of Regulations (CCR) Section §9795 dictates that physician evaluators must always include “a verification under penalty of perjury of the total number of pages” reviewed during a medical-legal evaluation. CCR §9795 specifies neither the language nor the location of this physician verification.

Some claims administrators deny medical-legal bills by falsely asserting that the report fails to include this physician verification. Accordingly, daisyBill recommends that our med-legal doctors document the required physician verification in a separate section of the evaluation report entitled “Physician Record Review Verification.”

By documenting the verification in a dedicated section of the report, a doctor’s billing team can more easily submit a Second Review appeal to dispute these false bill review ‘errors.’ Below is an example of the Physician Record Review Verification, which your office can modify as needed.

Physician Record Review Verification

Under penalty of perjury, I, [physician name], verify the total number of pages of records reviewed as part of the preparation of this Medical-Legal evaluation report: XX pages.

Remember: The Physician Record Review Verification is required even if the physician evaluator reviewed ZERO records.

MLPRR: Record Review Hygiene

A physician evaluator may also consider including a table in the medical-legal report to reflect the records received and reviewed. A table makes it easier for all parties to precisely track the records relevant to the medical-legal evaluation that the parties sent to the physician.

The example table below lists details regarding both the records sent to the physician evaluator and the records the physician evaluator reviewed in preparation of the report. When completing this table, physicians should remember the table is not the page count verification. Instead, this table alerts all parties to the details of the records sent by parties.

ML[200,201,202, or 203] report dated XX/XX/20XX: The table below indicates the pages of records the physician received and reviewed as part of this Medical-Legal evaluation and preparation of the report.

Record Sender Name

Record Sender Company

Declaration Page Count Attestation

Physician Record Receipt Date

Number of pages of records reviewed by the physician as part of the Medical-Legal evaluation and preparation of the report

Larry M.

ABC Insurance

200

9/1/2021

200

Sally Smith

Beta Law Firm

800

9/5/2021

800

Adhere to the laws regarding verification of records, and to good record review hygiene; it’s the best way to protect your practice and its revenue under the new MLFS.

Disclaimer: the information in this post is strictly for informational purposes. It is not legal advice; use at your own risk and discretion.


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