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Re: QME Billing Question (California) (California)

PostPosted: Thu Jul 02, 2009 9:18 am
by steve appell
Most do QME's perform the entire formualtion in a word processing software

With all due reapect, most QME's, AME's, & docs I know perform the entire formulation in a tape recorder, dictaphone, or speech recognition software.

Re: QME Billing Question (California) (California)

PostPosted: Thu Jul 02, 2009 9:34 am
by appliedpsych
I agree.

When a QME has finished his QME process of analyzing, synthesizing, thnking critically, making QME decisions and opinions, summarizing succinctly the issues of the case, formulating his opinions is whatever format, answering referal questions in whatever format ...

... and then turns that material over for a secretaty to type up into a smooth format, that final clerical.secretarial work should not be billed at QME rates.

However the complex QME time up to the point of turning it over to a clerical person is billable at QME rates.

Same thing with an attorney. The attorney would not charge at attorney rates for the secretary to type of his dictated or written notes into a smooth format.

However I don't think that any attorney will deny that any portion of an hour that goes into the complex specialty mental work that only an attorney can carry out WILL BE BILLED AT ATTORNEY RATES.

That would include time to think and consider the legal issues and the facts of the case, to consider precedents, to try and perform the critical analysis and synthesis or the case, formulate his opinion, and then turn that either into rough written or dicated notes for the secretary to assemble. Yes, this is mental work, complex work, and work that takes place using both brain, pencil and paper, dictation, or word processing software, depending on the preferences of the attorney.

If an attorney thinks about the issues of a case, how to respond, what laws to cite, what standards to apply, and then spends time writing notes about that or dicating about it, that time is certainly billed at attorney rates.

The same is true for all the mental processes that a QME must go through in formulating the QME report. The formulation of a QME report does not jump from interview and records review to finished product without lot of detailed consideration, analysis, and synthesis that ONLY the QME can do, and that time IS billable, just as attorney time is billable.

Re: QME Billing Question (California) (California) (California)

PostPosted: Thu Jul 02, 2009 9:39 am
by appliedpsych
steve appell wrote:
With all due reapect, most QME's, AME's, & docs I know perform the entire formulation in a tape recorder, dictaphone, or speech recognition software.

OK - and you agree that all the time spent doing that is billable at QME rates, correct?

Re: QME Billing Question (California) (California)

PostPosted: Thu Jul 02, 2009 10:00 am
by steve appell
Yes I do

Re: QME Billing Question (California) (California)

PostPosted: Thu Jul 02, 2009 10:08 am
by rider001
I know of some highly respected AME's who bill $20 for typing and they probably get it paid. Most of the transcription services charge 5 cents a line. Get out of the dark ages and into the 21st centrury.

Re: QME Billing Question (California) (California) (California)

PostPosted: Thu Jul 02, 2009 10:18 am
by appliedpsych
steve appell wrote:Yes I do

We agree then.

Typing is not billable, but legitimate formulation time is. My point exactly.

I was getting the sense that some posters were equating formulation with typing, hence my responses.

Re: QME Billing Question (California) (California)

PostPosted: Thu Jul 02, 2009 11:37 am
by rbaird
Dr. Munday makes some valid points. 8 hours sounds pretty ripe to this retired WCJ. However, the distinction does get a little blurry. Many professionals use word processing and re-draft and edit on the fly; I know I did. This is time effective. In ancient days, a document may have been returned to a secretary more than once for corrections and revisions. Hell, in ancient days the IBM correcting selectric and carbon paper were in wide use.

Re: QME Billing Question (California) (California)

PostPosted: Thu Jul 02, 2009 12:35 pm
by cmunday
Rbaird - as a complete tangent, ask anyone under age 50 or so what "cc" stands for when indicating a copy should go to so and so and I'll bet no more than 10% are aware that cc literally comes from "carbon copy".

Re: QME Billing Question (California) (California)

PostPosted: Sun Jul 05, 2009 3:50 pm
by jonbrissman
Much of the community misunderstands the medical-legal regulations, and a large share of the blame for that rests with poorly written regs. Let's review the basics.

ML102 and ML103 are flat-rate services that include "reimbursement for the history and physical examination, review of records, preparation of a medical-legal report, including typing and transcription services, and overhead expenses." The quote applies to ML102 and ML103 services only, but that fact is not readily apparent when reading regulation 8 CCR 9795. Physicians receive a pre-determined fee for ML102 and ML103 evaluations regardless of the amount of time spent.

ML101, ML104, ML105, and ML106 are time-based services. If the service meets the definitions set forth in Section 9795, then the amount of time the physician spent with the patient, reviewing records, and preparing the report is compensable (when properly documented).

The ML104 section in 9795 is mispunctuated and thus confusing. It sets forth three enumerated circumstances wherein billing as a ML104 is appropriate, and then says "When billing under this code for extraordinary circumstances, the physician shall include in his or her report (i) a clear, concise explanation of the extraordinary circumstances related to the medical condition being evaluated which justifies the use of this procedure code, and (ii) verification under penalty of perjury of the total time spent by the physician in each of these activities: reviewing the records, face-to-face time with the injured worker, preparing the report and, if applicable, any other activities." The problem is that the quoted sentence appears as part of circumstance number 3, which gives the impression that the sentence applies only to circumstance number 3. In fact, the sentence applies to all ML104 billing. Someone at the DWC or the Office of Administrative Law should start a new paragraph after the first sentence in circumstance number three.

Turning to the issue of a physician typing his own report: This seems like a slippery slope to me. I type my own letters because I can do it faster than it would take to dictate, then to proofread and revise a secretary's work. I know a WCJ who was a legal secretary before she went to law school, and she types all of her decisions and correspondence because it's just more efficient than assigning the task to another. I suspect that no one would have an issue with a physician typing his own medical-legal report if he could type at 120 words per minute, and that nearly all of us would see an issue if that physician typed only 5 w.p.m. Between those two extremes, where are you going to draw the line to define what's acceptable and what is not?

My advice remains the same: Pay the physician for the time he billed, and if you think he has abused the system then you should send him no more business.