California released an updated Medical-Legal Fee Schedule (MLFS) for workers’ compensation, effective April 1, 2021. Physicians had high hopes that the update, which introduced record review billing code MLPRR, would guarantee fair compensation for Medical-Legal evaluators who cumulatively review literally millions upon millions of pages of records.

Since physician evaluators are routinely sent well over a thousand pages of medical records per Medical-Legal evaluation, MLPRR seemed like a straightforward billing solution to compensate physicians for their time.

Unfortunately, CorVel is struggling to issue an Explanation of Review (EOR) that reflects the large quantities of records being sent to Medical-Legal evaluators for review. Accordingly, providers need to carefully review EORs from CorVel for MLPRR payment accuracy.

CorVel Fails To Update EOR Technology

We wish this was a joke, but CorVel’s bill processing software appears to cap out at 999 units of MLPRR.

In its EORs, CorVel reflects large quantities of pages reviewed by the physician during one comprehensive Medical-Legal evaluation, by listing the record review billing code MLPRR twice.

For the EOR CorVel sent to the evaluator (below), the physician reviewed 1,399 pages of medical records — not an unusual page count for a Medical-Legal evaluation. The EOR clearly shows that CorVel lists MLPRR twice to reflect a quantity of pages greater than 999.

Prior to the introduction of MLPRR, physicians could not charge for record review by the page. As a result, there was no need for providers to review record review reimbursements for accuracy.

The new MLFS, and the addition of MLPRR, created a literal paper trail that’s much easier to follow due to the mandated sender declarations and attestations, and the physician verification requirements.

Although CorVel’s 999-unit MLPRR cap may be comical, it is important for physicians to carefully review these CorVel EORs for payment accuracy. Don’t let your practice pay the price for CorVel’s technological lapse.

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