California’s Office of Administrative Law (OAL) issued final approval of the revamped Medical-Legal Fee Schedule (MLFS) for workers’ compensation, effective for dates of service on or after April 1, 2021. The state’s Division of Workers’ Compensation (DWC) announced OAL’s approval of the changes in a recent Newsline.

DaisyBill will host a webinar detailing the ways in which this rethinking of the MLFS will alter Medical-Legal billing.

A Simpler Medical-Legal Fee Schedule

The new Medical-Legal Fee Schedule is encoded in California Code of Regulations (CCR) Sections 9793 through 9795. It streamlines various aspects of Medical-Legal billing, most significantly by replacing time-based billing for codes ML101, ML104, and ML106 with a flat fee structure.

Other notable changes include:

• Increases in reimbursement for evaluations
• A standard missed appointment fee of $503.75
• Standard $3.00 per page reimbursement for medical record review
• Elimination of complexity factors
• Increases in reimbursement for medical-legal testimony and review of sub rosa recordings
• Increases in reimbursement for evaluations in which psychiatric, psychological, toxicological, or oncological issues are the primary focus.

The new MLFS also requires medical records to include a declaration asserting that the records comply with California Labor Code. Otherwise, the records in question will not be considered legally available to the physician for review. The relevant language states:

“Any documents sent to the physician for record review must be accompanied by a declaration under penalty of perjury that the provider of the documents has complied with the provisions of Labor Code section 4062.3 before providing the documents to the physician. The declaration must also contain an attestation as to the total page count of the documents provided. A physician may not bill for review of documents that are not provided with this accompanying required declaration from the document provider. Any documents or records that are sent to the physician without the required declaration and attestation shall not be considered available to the physician or received by the physician for purposes of any regulatory or statutory duty of the physician regarding records and report writing.”

The DWC noted that some pending Medical-Legal evaluations already scheduled for on or after April 1 may not comply with the above declaration requirement. In such cases, the DWC suggests that the parties to the evaluations “communicate with each other to reach agreement on the handling” of the requirement.

DaisyBill will host a comprehensive webinar on Medical-Legal billing, including a thorough explanation of the new MLFS. We will announce the webinar date and open registration in this space — subscribe at the bottom of this page to secure your seat.

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