With attorneys dumping tens of millions of pages of medical records on California Medical-Legal evaluators annually, daisyBill physicians conducted over $93 million worth of record review in 2023.

The Medical-Legal Fee Schedule (MLFS) instructs evaluators to report code MLPRR when the number of pages of records they review exceeds the page limit allowed for the Medical-Legal evaluation. For each page reviewed over the limit, MLPRR pays $3.

We remind readers that physician evaluators are legally bound to review every page of records attested to and sent by attorneys on either side of a Medical-Legal dispute.

In other words, no legislator, regulator, or payer can blame physician evaluators for the record review costs outlined below. These physicians are simply doing their assigned job and should be compensated accordingly.

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MLPRR for Medical-Legal Record Review

daisyBill evaluators reviewed over 50 million pages of medical records in 2023, roughly 31 million of which were billable with MLPRR.

As a reminder, the Medical-Legal Fee Schedule instructs evaluators to bill MLPRR for each page of records that exceeds the page count included in the primary evaluation ML Code.

For example, if an attorney sends a QME 300 pages of medical records for a Comprehensive Medical-Legal Evaluation, reimbursement for reviewing 200 pages is included in the payment for ML201. For the remaining 100 pages, the MLFS instructs the evaluator to report MLPRR at a reimbursement rate of $3 per unit.

When the Division of Workers’ Compensation (DWC) updated the MLFS in April 2021, the new payment amounts assigned to each primary Medical-Legal Code incorporated the time required for the physician evaluator to:

• Perform the evaluation
• Prepare the Medical-Legal report
• Review the MLFS-assigned page counts of medical records

The DWC agreed that if the parties sent additional medical records beyond the MLFS page limits, the evaluator should be reimbursed for the additional time required for review — hence MLPRR.

2023 MLPRR Data

In 2023, daisyBill Qualified Medical Evaluators (QMEs) and Agreed Medical Evaluators (AMEs) were sent over 50 million medical record pages for almost 131,000 bills.

In 2023, evaluators billed MLPRR for 31,068,314 pages of record review over the page limits incorporated into the primary evaluation ML Code, with a total amount due for MLPRR of $93,204,942.  

As Medical-Legal expenses climb, payers and their representatives have suggested that evaluators are being paid too much. At a recent DWC Conference in Los Angeles, daisyBill representatives witnessed several references to potential “adjustments” to the MLFS to reduce costs.

It would be a serious injustice to physician evaluators for the DWC to acknowledge (and put a monetary value on) the time and effort required to review medical records only to “adjust” the MLFS after realizing the enormous volume of records the parties send to evaluators to review.

MLPRR Explained

To learn (much) more about MLFS reimbursements and pose your Medical-Legal billing questions to our experts, join us for a free live MLFS webinar on April 9. We’ll cover reimbursements for all the codes and modifiers below, including MLPRR.

Get a handle on reimbursement for all Medical-Legal services in California. Join us live — and don’t forget to submit your questions at registration!

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