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Billing for QME Records Review (California) (California)

PostPosted: Tue Jul 07, 2009 11:52 pm
by appliedpsych
There was recently a discussion on this same forum, labeled as Re: QME Billing Question.

This caused me to think more about how various players in the QME system may see a particular situation in different or even opposing ways.

In the spirit of better understanding QME billing issues, I would like to hear view points on the sometimes arduous issue of reviewing records sent to the QME by parties in a panel QME. What follows is an issue a colleague posed to me along these lines, presented here for your comment. Here’s a summary of what I was told.

There are usual cases where there are several hundred pages sent, some nice and clear treatment reports that are typewritten, and others that are handwritten notes that require a lot of time and a magnifying glass to try and fully understand. I think I have a good handle on a set of records such as that, and usually expend 2 to 4 hours in such cases.

Then there are cases like one I had last year as a strike panel QME. I was shocked to get a full 3,000 pages (yes, a 13 inch stack) prior to seeing the applicant for a neuropsychological QME. These were a mixture of psychological treatment records, neurological treatment records, various QME reports, depositions, investigation reports, surveillance records, etc., all by the way very pertinent to the case, and all very detailed and complex.

I spent an average of 30 seconds per page for 3000 pages, for about 25 hours of records review, just for the preliminary read through while marking the most pertinent pages for further more detailed review.

My colleague told me he chose to underbill the time it took to go through these records. He felt that the claims examiner would challenge the billing if he was totally honest in time expended.

At the same time, he was ethically bound to give all the records his full attention, because this was an extremely complicated case that had been tied up for years in WCAB litigation.

Cost containment being a portion of the job of case management personnel, I am interested in how those of you in that phase of this medical-legal business would react to such a situation where a huge amount of records are served on the panel QME.

The QME was between a rock and a hard place.

Be accurate and honest and be branded as a “bill padder” and be challenged on the bill, or short himself on work that was nevertheless performed in an ethical manner.

Comments ? ? ? Tips ? ? ? Suggestions ? ? ?

Re: Billing for QME Records Review (California) (California)

PostPosted: Wed Jul 08, 2009 7:01 am
by jpod
Frankly I would have no issue with him/her billing the amount of time actually spent. We know how many records there are, we sent them to the doctor so that they would be reviewed and commented upon if pertinent.

Maybe this is a SOCal thing but I really do not have an issue with a billing that charges for the time it took to review the records. If one is concerned about being perceived as padding then address it at the beginning of the report so the parties can see the justification for why 25 hours was spent reviewing 3,000 pages of records. Padding a bill is charging 25 hours for records review when there are only 30 pages of medical records.

I have an issue with reports that reflect that virtually no consideration was given to the issues raised in the cover letter so the parties are left with unresolved issues after having gone through the whole tedious, time consuming process required to resolve medical legal disputes.

Re: Billing for QME Records Review (California) (California) (Ca

PostPosted: Wed Jul 08, 2009 9:14 am
by steve appell
There is no reason whatsoever why the QME should not charge for and be timely paid for the actual time spent reviewing the records in addition to the other reasonable charges: IE exam, report prep etc.

Re: Billing for QME Records Review (California) (California)

PostPosted: Wed Jul 08, 2009 10:00 am
by jonbrissman
Jpod and Steve give good advice -- bill for the actual time spent. On what evidence could defendant prevail if the matter proceeded to a lien trial?

I recall a case in which defendant sent 35 hours of video to an A.M.E. that I represent, then complained when he billed them $8.750.00 (using 2002 medical-legal fee schedule rates), plus report-preparation time. I filed a D.O.R. but defendant paid before a hearing date was assigned.


Re: Billing for QME Records Review (California) (California)

PostPosted: Wed Jul 08, 2009 4:45 pm
by appliedpsych
I'm glad to hear what you responders are saying, as I totally agree. Sometimes the reality is different though.

I started a new topic using the below story, to demonstrate the walls that some of us hit.


A self-insured city, San ___, had a psychiatrist QME who referred for neuropsychological testing regarding a head injury case and resultant problems that led to approved pscyhological treatment, and claims of injury to the psyche, as well as cognitive and memory problems. The psychiatrist got involved off a QME panel, and referred to a panel for a neuropsycholgical exam, given the head injury. I was the one picked off the panel.

The psychiatrist only billed one hour for reviewing the 400 pages of documents including neurological and medical reports, treatment notes, general medical records, etc. I guess he was a fast reader, as it took me 6 hours to review the same set of records, which were a mixture of well written typed reports, and hard to read handwritten treatment notes and lots of general medical notes and history. I note that the psychiatrist made no mention of what he saw in the records review.

When I billed appropriately for my time, the City of San ___ balked, saying that since the psychiatrist only took one hour to review the documents, that I could not charge more than one hour either, and that's all they would pay for.

Also, the psychiatrist had administered an MMPI - the old style, outdated version. When I felt it necessary to have the applicant take a different but similar test, the City of San ___ also replied that they did not have to pay for that time either, as since the psychiatrist had used one test to look at psych symptoms, that I should have just used those results as well, even though I explained it was an outdated test.

I went all the way before the WCAB Judge at a settlement conference I was asked to come to by the City of San ___ defense attorney.

The WCAB Judge backed the City of San ___, saying that "this applicant has filed way too many WC claims anyway".

Re: Billing for QME Records Review (California) (California)

PostPosted: Thu Jul 09, 2009 9:18 am
by steve appell
Now I am confused. Was the applicant referred to you only for neuropsychological testing or a full blown QME exam + testing?

Re: Billing for QME Records Review (California) (California)

PostPosted: Thu Jul 09, 2009 12:49 pm
by postscript2
As a C/A, I would read every single word of records sent to me. I know how long this process takes, so if it took me 10 hours, I'd expect a doctor would take equal or a little less time. Not much though. Many C/A's never read the SDT'd records and then complain when they receive a thorough report, not wanting to pay for it. Not very smart!

I once had a C/A spend1-1/2 weeks dedicated to an extremely complex case, just going through about 10 boxes of records, if not more. YES, his bill was about $6k, but the file had remained dormant for 3-4 years by the prior D/A.

If more C/A's would use common sense, cases would move forward and get resolved.

If I were you, I'd bill the full amount of time!!!


Re: Billing for QME Records Review (California) (California)

PostPosted: Thu Jul 09, 2009 1:57 pm
by steve appell

Re: Billing for QME Records Review (California) (California) (Ca

PostPosted: Thu Jul 09, 2009 3:28 pm
by appliedpsych
steve appell wrote:Now I am confused. Was the applicant referred to you only for neuropsychological testing or a full blown QME exam + testing?

Yes, it was a NPsych exam. The psychiatric protocols do allow the use of other tests, since other symptoms can affect. Since the psychiatrist had used an outdated test, I felt justified in using a current edition test of another type to make sure I was getting a good read on general psych symptoms.

Here's what the protocol says:

c.Neuropsychological testing Time: 8 to 15 hours

Purpose and criteria warranting testing: There are instances where the neuropsychological approach to assessment is indicated to help determine the role an organic mental disorder plays in disability. This is not a routine type of evaluation in Workers' Compensation cases and, when used, must be justified by the report. [In this case, it was specifically requested by the psychiatrist QME]

Typically there is a specific head injury, toxic exposure or some other situation that raises the issue of organic brain syndrome. Here the patient often
registers impairment on the mental status examination and there is a history consistent with serious cognitive dysfunction. A condition such as depression, anxiety, and chronic pain may cause a complaint of cognitive difficulties but this type of situation would not necessarily warrant neuropsychological testing. ...

Types of tests used: This category of testing utilizes a number of cognitive tests in the form of an organic testing battery. ... The neuropsychological test battery may include other standard measures such as the MMPI beyond those used exclusively for assessing cognition.

Re: Billing for QME Records Review (California) (California)

PostPosted: Sat Jul 11, 2009 2:03 pm
by jobmdpsych
The lesson is use an MCMI3 or something else if there is a recent MMPI or MMPI2 and you still have issues. Plus it gives you useful information on Axis II disorders.