Blog: Daisy News

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.

In California, physicians use code ML106 to bill for supplemental medical-legal examinations. However, what constitutes a supplemental medical-legal exam for billing purposes can be hard to pin down. Physicians and their billing staff, understandably confused by the regulations, can sometimes mistakenly use ML106 to bill for services that do not qualify.

In particular, there are four scenarios in which physicians regularly, but mistakenly, apply ML106 — which leads to time-consuming bill denials.

It happens far too often: providers treat an injured worker for a California employer, send the bill to the claims administrator, and then...nothing.

Workers’ comp is frustrating enough, but few things are more irritating than hearing crickets in response to a compliant original bill. Fortunately, California law offers remedies. Here’s how to obtain reimbursement (and address blatant non-compliance) when the claims administrator fails to respond to your bill.

Recently, a DaisyBill client faced unreasonable demands from a bill review regarding complexity factors for medical-legal billing code ML104. Fortunately, our client’s refusal to accept arbitrary requirements ultimately won out — proof that providers can succeed when empowered with knowledge of the rules.

Medical-legal billing is a special kind of tricky.

This unique subset of California workers’ comp has its own rules, its own fee schedule, and its own unique complications. Among those complications is how and when to bill for time spent preparing medical-legal evaluation reports.

The California Division of Workers’ Compensation (DWC) announced proposed amendments to the Medical-Legal Fee Schedule yesterday, May 3.

The amendments would make significant changes to medical-legal billing practices. These changes include new limits on billing under the Official Medical Fee Schedule (OMFS), and new rules for the application of the ever-troublesome complexity factors for codes ML103 and ML104.

Here it is: your complete, downloadable go-to resource for California workers’ comp reimbursement rates in 2018. This guide features the Official Medical Fee Schedule (OMFS) reimbursements for the procedure codes providers use most, including:

Evaluation & Management (E/M)

Surgery

Radiology (Professional Services)

...and more, plus reimbursements for medical-legal services! All OMFS reimbursements are effective for dates of service on or after January 1, 2018.

Billing for medical-legal services is one of the trickiest aspects of workers’ comp revenue management. Further complicating the process is the time-based nature of many medical-legal billing codes, with providers and insurance claims administrators disputing which codes are billable by time, and what constitutes a single unit of time.

Here, we offer a guide on compliant medical-legal billing, for your easy reference.