In May of this year, California’s Division of Workers’ Compensation (DWC) announced proposed changes to the state Medical-Legal Fee Schedule (MLFS), and welcomed public comment via the division website’s online forum. The response to these proposals was impassioned, to say the least, as medical-legal professionals reckoned with the potential impact.

Now, the DWC will hold a public meeting to further discuss these significant changes. The meeting is scheduled for Wednesday, October 17 at 10:00 am in Oakland.

Controversial Rule Changes

The DWC’s proposals would not alter reimbursement rates for medical-legal services. Rather, the changes would alter the way medical-legal doctors may apply certain medical-legal billing codes, as well as limit the application of Official Medical Fee Schedule (OMFS) rates. The proposals’ highlights include:

• Limiting medical-legal doctors to 3 hours of billable time for report preparation.

• More stringent rules on permissible combinations of complexity factors to bill with code ML103

• Official recognition of the fact that providers may always bill for report preparation under code ML104, despite previous misinterpretations.

• Allowing medical-legal doctors to apply OMFS rates to diagnostic tests only.

• A rule banning prior agreement of the parties that certain factors are present (eg “extraordinary circumstances”) as a condition of conducting a medical-legal evaluation.

• New restrictions on applying codes ML103, ML104, and ML106 to medical research.

Written comments physicians and others submitted to the DWC online forum were swift, strong, and overwhelmingly critical. Many decried the potential impact on Qualified Medical Evaluators (QME), Agreed Medical Evaluators (AME), and injured workers, predicting that the new rules would discourage doctors from taking on complex cases — and leave patients with nowhere to turn.

October Meeting

In a September 19 Newsline, the DWC described the planned October 17 meeting as “intended to respond to [public forum] input and develop next steps for revising the fee schedule,” also noting that most of the public forum comments called for “an overhaul of the entire medical-legal fee schedule.”

In addition to discussing “the best format for the new fee schedule” that would benefit all stakeholders, the DWC will also use the meeting to begin the process of selecting representatives for future “small pre-rulemaking meetings” to further develop ideas.

The meeting will take place at 10:00 am at the Elihu Harris Building at 1515 Clay Street, Oakland. The DWC will allow those who attend the meeting to speak for up to three minutes regarding the new proposals. The division also encourages stakeholders to submit further written comments, either at the meeting, via email to DWCRules@dir.ca.gov, or via mail to:

Division of Workers’ Compensation

P.O. Box 420603

San Francisco, CA 94142

Attn: Medical-Legal Schedule Forum

As always, we’ll keep readers updated on any further developments.

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