California Medical-Legal record review expenses soared into the wide blue yonder after the Division of Workers’ Compensation (DWC) updated the Medical Legal Fee Schedule (MLFS) effective April 1, 2021.
In November, daisyBill published a post on the apparent correlation between climbing MLFS costs and the introduction of MLPRR which reimburses California evaluators $3 per page of record review.
Surprisingly, as a percentage of the total medical-legal expenses owed to daisyBill clients, MLPRR expenses remain the same as reported in November 2021, even though the number of medical-legal bills doubled.
The official purpose of the MLPRR billing code is to provide physicians a way to receive reimbursement for review of records beyond the number of pages included in “base” Medical-Legal numerical billing codes ML200, ML201, ML202, and ML203.
As we noted in our prior post, the reimbursement for each of these numerical billing codes includes payment for record review up to the following page limits:
MLFS Evaluation Code |
Record Review Reimbursement Included in MLFS Evaluation Code |
ML200 - Missed Appointment |
200 Pages |
ML201 - Comprehensive Medical-Legal Evaluation |
200 Pages |
ML202 - Follow-up Medical-Legal Evaluation |
200 Pages |
ML203 - Supplemental Medical-Legal Evaluation |
50 Pages |
However, attorneys regularly dump documents far in excess of 200 pages on physician evaluators for review. MLPRR ensures Medical-Legal physicians are compensated for the extra time required to sift through the additional pages of records.
Moreover, MLPRR offers a tangible way to track precisely the count of pages lawyers are shipping to doctors’ doorsteps for review. (Hint: It’s way more than the DWC originally expected.)
In the nine plus months since the new MLFS became effective, daisyBill data for medical-legal bills submitted by our clients demonstrate the following:
Remember, as noted above, the reimbursement for each of these numerical billing codes includes payment for record review up to an established page limit. The $54.7 million in MLPRR expenses demonstrates the following:
Surprisingly, a comparison of the MLPRR data published by daisyBill in November to the current data displayed above demonstrates that MLPRR’s outsized impact on total Medical-Legal expenses remains precisely the same.
As shown below, this trend has continued unchecked since MLPRR was first implemented.
Date of Service (new MLFS, only) |
April 1, 2021 - Oct. 12, 2021 |
April 1, 2021 - Jan. 13, 2022 |
Total MLFS Expenses |
$110,481,117 |
$187,626,725 |
MLPRR: Total Record Review Expense |
$31,958,841 |
$54,719,749 |
Percent of MLPRR Expense to Total MLFS Expense |
29% |
29% |
For years, our Medical-Legal physician clients have expressed frustration over being inundated by all parties’ attorneys with piles of irrelevant, disorganized, and duplicated medical records. Now, the cost of this obnoxious practice can be easily tracked in terms of page numbers and cold hard cash.
With the numbers laid out plainly, the question remains: Who’s going to do something about it (other than blame physician evaluators for the high cost of medical-legal evaluations)?
DaisyBill provides content as an insightful service to its readers and clients. It does not offer legal advice and cannot guarantee the accuracy or suitability of its content for a particular purpose.