Most Recent Articles
Apr 1, 2021
ML200 - Next Level Administrators: Grade A
Claims administrator properly processed reimbursement for ML200. Date of Service: 04/24/2021
Apr 1, 2021
ML200 - County of Riverside (CA): Grade F
Claims administrator failed to properly reimburse ML200. County of Riverside (CA) incorrectly reduced reimbursement by taking a noncompliant PPO reduction. Date of Ser...
Sep 16, 2021
Med-Legal Reports: Always Include Page Count Verification!
California’s new Medical-Legal Fee Schedule (MLFS), effective from April 2021, brought with it new rules for reporting, billing, and payment. Among those rules: when submitti...
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Sep 23, 2021
MLFS Billing Tip: CA Med-Legal Deadlines Extended
As providers continue to grapple with COVID-19’s impact on healthcare systems, California Medical-Legal examiners (and workers’ comp claims administrators) are reminded: the ...
Sep 30, 2021
Coming Soon: CA Med-Legal Billing Data
There’s only one way to understand, navigate, and improve workers’ compensation: by the numbers.Since the introduction of the new Medical-Legal Fee Schedule (MLFS) in ...
Oct 6, 2021
CA Med-Legal Reporting Deadline Extension Official
California’s Division of Workers’ Compensation (DWC) has officially extended emergency regulations which add 15 days to the usual time frame for Medical-Legal reporting.<...
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Apr 1, 2021
96136 / 96137 - Sedgwick Claims Management Services: Grade F
Claims administrator failed to properly reimburse 96136 and 96137 as part of a Medical-Legal evaluation. Sedgwick incorrectly denied reimbursement citing prior authorization ...
Nov 3, 2021
Record Review Sends Med-Legal Costs Soaring
Like a bored multi-billionaire, Medical-Legal expenses for California workers’ comp are needlessly approaching the stratosphere.Our data point to the pri...
Nov 4, 2021
AIG & Coventry (and California) Squeeze QME
California Medical-Legal physician evaluators, be advised: some payers still attempt to improperly apply Preferred Provider Organization (PPO) discounts to Medical-Legal bill...
Dec 8, 2021
Download: Med-Legal "Superbill"
Medical-Legal billing for California workers’ comp is like…well, anything in California workers’ comp: a big mess.It’s convoluted, and physicians get nearly zero help ...
Jan 21, 2022
Med-Legal Data: MLPRR Charges Continue to Climb
California Medical-Legal record review expenses soared into the wide blue yonder after the Division of Workers’ Compensation (DWC) updated the Medical Legal Fee...
Jan 20, 2022
MLPRR: Record Review Guide for CA Med-Legal MDs
Millions of pages. Millions of dollars. Potentially serious consequences for non-compliance.Medical-Legal record review can be a big challenge for physician evaluators...