The Division of Workers’ Compensation (DWC) has posted proposed amendments to the Medical-Legal Fee Schedule to its online forum where members of the public may review and comment on the proposals. The draft regulations show additions to the regulatory language in red type, and include:
– Objective standards for the application of complexity factors in the fee schedule;
– Provisions that align the Medical-Legal Fee Schedule with the statutory scheme for reimbursement of medical-legal expenses;
– Elimination of provisions that refer to medical-legal evaluations no longer being performed; and
– Clarification of when billing under the Official Medical Fee Schedule can be accomplished in conjunction with billing under the Medical-Legal Fee Schedule.
There are no changes to the amount of fee schedule payments.
The proposals clarify the use of the complexity factors relating to causation, medical research, record review and apportionment. The factors that indicate the presence of extraordinary circumstances in a medical-legal evaluation are more clearly defined. The language required in a report to define extraordinary circumstances is explained.
For example, medical legal physicians often quote, and bill for “medical research” they claim to have performed as part of the evaluation. They charge by the hour. But, sometimes they bill for boilerplate “research” and language used over and over in subsequent reports.
This will be limited in the new regulations should they be adopted. The proposed language does not allow for billing for medical research, “using sources that have not been cited in any prior medical report authored by the physician in the preceding 12 months in support of a claim citing or relying upon this complexity factor.”
Realistic limits on certain areas of billing are implemented.
The forum can be found on the DWC forums webpage under “current forums.” Comments will be accepted on the forum until 5 p.m. on Friday, May 18, 2018.