DRAMATIC NEW MEDICAL-LEGAL FEE SCHEDULE
The DWC has proposed a new flat-rate medical-legal fee schedule which is expected to be adopted for all services as of April 1, 2021. The 17-pages of regulations are highlighted as follows:
RECORDS/Reg 9793(n): Party sending documents must provide a declaration confirming per L.C. 4062.3 that the documents were provided to the opposing party at least 20 days beforehand, and attest to the total page count; otherwise the physician "may not" bill for review of the records from the document provider.
(Technically under LC 4062.3(b) and Reg 35, the physician should not be considering the improperly provided documents, whether billable or not.)
REPORT FEES/Reg 9795:
a) Missed Appointments: $503.75
b) Comp. Med-Legal Exam: $2,015; including review up to 200 pages of records, with $3 charged per page thereafter.
c) Follow-Up Med-Legal Eval: $1,316.25 if within 18 months of prior exam; and includes up to 200 new records to review (then $3 per page thereafter).
d) Supplemental Med-Legal: $650 provided the report request pertains to reviewing previously unavailable records or addressing a new issue, includes up to 50 pages of records for review ($3 per page thereafter).
e) Testimony: $455/hr with 2 hour minimum; if cancelled within 8 days of deposition, physician is entitled to a one hour minimum.
f) Sub Rosa Recordings: $325 per hour for video review.
g) Increase Modifiers: 10% for interpreter; 35% for AME; psych 100%/135% if AME; toxicology 50%/85% if AME; oncologist 50%/85% if AME.
Example: AME psych w/ interpreter is 135+10=145% of $2,015 for initial exam, plus $3 per page over the 200 page initial allowance.
[COMMENT: Flat rate will help avoid billing abuses and bring some billing certainty. The defense needs to be pro-active in paring down the records, coordinating record delivery to avoid duplication of records, and timely serve the records beforehand. Finally, parties need to develop their declaration and attestation forms, and train the staff to address the new requirements which are mandatory in only a few weeks]