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CWCI: Payments for Med-Legal Services Exceeded Anticipated Increase Under New Fee Schedule

  • State: California
  • Topic: Top
  • - Popular with: Legal
Payments for medical-legal services increased more than the 25% anticipated by the Division of Worke…

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Scott Thompson Jul 1, 2024 a 2:45 pm PDT

Interesting study performed by CWCI, whose primary interests include employers and payers. Californias Med/Legal Fee Schedule was negotiated by employers, payers, physicians, and other stakeholders during the course of several meetings at the DWC headquarters in 2020. The fee schedule is loosely based on Nevadas fee schedule, which actually pays more even though the cost of living in Las Vegas is 40% lower compared to Los Angeles according to Its also worth noting that theres no income tax in NV, compared to over 13% for the maximum in CA. Another important detail lost on CWCI is that theres no built-in cost of living adjustment for CAs medical legal fee schedule, unlike the other medical-based fee schedules that apply to workers compensation reimbursements. In light of the past three years of high inflation, this can be perceived as a 20% discount compared to a fee schedule with a COLA. Finally, it cannot be overstated that the new CA MLFS removed the expensive friction and gamesmanship by both payers and providers by creating a more simple fee schedule that reduced costs to the system associated with lien hearings, and years long payment delays and litigation. Its no wonder physicians were fleeing the system prior to 2021. Another benefit to the system has been an influx of Qualified Medical Evaluators, which filled a gap in what was a QME shortage before the fee schedule update. Thank you for the research CWCI, but its important to tell the whole story.

Kurt Hoffman Jul 1, 2024 a 3:59 pm PDT

Absolutely ! Now when do the Doctor's finally get an increase to the regular fee schedule as the issues are the same there too?

Dr. Steven Feinberg Jul 1, 2024 a 4:46 pm PDT

The $3/page has led to some very large bills from QMEs/AMEs and occasionally unusually high charges for supplemental reports (over 5000 pages would be about $15,000). Despite 2 times the base rate, many mental health providers spent considerable time on these reports, and if they are not sent more than 200 pages of records, the time spent may not be adequately compensated. Others of my colleagues feel they are doing okay with the new system. Now that we have had some time to work with the new MLFS, it is time to go back and look again at it and this effort is underway to my understanding. The elephant in the room that is widely acknowledged has to do with quality (or the lack of it). Providers of medical legal reports need feedback which they do not get. Steven Feinberg, MD


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