California approves changes to medical-legal fee schedule

The California Office of Administrative Law on Tuesday approved proposed changes to the state Division of Workers Compensation’s medical-legal fee schedule, which substantially overhauled the current reimbursement system for workers comp evaluations. All medical-legal valuations occurring on or after April 1 will be subject to the new fee schedule.

The medical-legal fee schedule, which has not been updated since 2006, outlines required reimbursement to qualified medical evaluators tasked with evaluating workers’ continuing eligibility for workers compensation benefits. For the past 15 years, QMEs have been paid an hourly fee — generally starting at about $250 an hour — to review medical records, write medical-legal reports and testify in trials.

Under the approved changes, QMEs will receive flat fees and an additional $3 per page for reviewing records in excess of 200 pages. Under the proposal, a QME hired to conduct a comprehensive medical-legal evaluation will be paid $2,015, plus the per-page fee if applicable.

Although the proposed changes received hundreds of comments expressing concerns — including fears that payers would be paying thousands to physicians for reviewing potentially redundant or inapplicable medical records — the OAL approved the changes as written and released in late February.

While the change officially takes effect tomorrow, the Division of Workers Compensation noted that QMEs currently scheduled for April may not comply with the new attestation requirements under the fee schedule and that parties need to reach an agreement on the handling of those evaluations.

This article was first published on Business Insurance.

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