Medical Unit's New Interpretation of ML-104 (California) (Ca

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Re: Medical Unit's New Interpretation of ML-104 (California) (Ca

Postby mytwocents on Sun Sep 10, 2017 10:51 am

Right. They're not supposed to double dip. In general, the law never allows anyone to double dip, not limited to medical-legal doctors. The most they can get from face-to-face, record review and research is 3 complexity factors. Then, unless it's a psych eval, they'll need causation or apportionment to get to ML-104. However, they can't get causation unless they're specifically asked to address it, in writing. As you note, apportionment is either applicable or it's not.
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Re: Medical Unit's New Interpretation of ML-104 (California) (Ca

Postby appliedpsych on Mon Sep 11, 2017 2:29 pm

1) Two or more hours of face-to-face time were spent with the patient.
2) Two or more hours of record review were required.
3) Two or more hours of medical research were required, to examine issues related to the clinical and medical-legal issues pertinent to the case.
4) Six or more hours spent on any combination of three complexity factors (1)-(3), which shall count as three complexity factors

Number 4 is not double dipping,it is simply reaffirming to bill review that three complexity factors were meet by the previous 3 items, any combination of which adding up to 6 hours....

Never had a complaint from any bill review, insurance company, or defense attorney about putting that in the ML-104 reasons section.

Know who has trouble getting paid??? QME's who do not put statements like this on page one of the QME report.

On the other factors, I've have never had a QME request that did not ask for issues of causation and apportionment.
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Re: Medical Unit's New Interpretation of ML-104 (California) (Ca

Postby spreare on Mon Sep 11, 2017 5:10 pm

Exactly.. What I am not clear on is the wording "any combination of ..... for a total of 6 hours is 3 complexity factors." Does this "any combination" mean that all three must be used for a minimum of two hours? If you had 4 hours of medical records review, and two hours face to face, is two hours of research required. I asked Winslow and he seemed to imply that we do not need two hours in each cat, but that totaled they must all add up to 6 hours. so then will 15 minutes of research be enough if we have enough time in the other cats? You know where there is a real problem and where they need to fix this: A doc gets a UPS truck load of medical records and apportionment doesn't apply --- the doc will end up working for $15/hour or doing research just to do research..... it shouldn't be like that.
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Re: Medical Unit's New Interpretation of ML-104 (California) (Ca

Postby mk61347 on Thu Sep 14, 2017 2:08 am

If I spend 4 hours on record review and two hours face to face time I have met the criteria of 6 or more hours on factors 1-3 .
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Re: Medical Unit's New Interpretation of ML-104 (California) (Ca

Postby spreare on Thu Sep 14, 2017 12:45 pm

I m not sure this is the case, that you can do two complexity factors and bill for three levels. We may think we can, but I am not sure that is true according to the DWC medical unit, etc.
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Re: Medical Unit's New Interpretation of ML-104 (California) (Ca

Postby mytwocents on Sat Sep 16, 2017 10:50 pm

Just read the plain words of the fee schedule regulation. It says: (5) Six or more hours spent on any combination of three complexity factors (1)-(3), which shall count as three complexity factors. There's no way you can get a combination of three complexity factors if you only have two complexity factors factors to combine.
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Re: Medical Unit's New Interpretation of ML-104 (California) (Ca

Postby spreare on Mon Sep 18, 2017 1:24 pm

Right but it is a little ambiguous, "any combination of the three" Does that mean 15 minutes of research will qualify if the 6 hours is met? I presume "any combination of the three" means three, but i can see where someone would argue "we had two for 6 hours, and that is a combination of the three since it was pulled from the three available complexity factors. I think they should be more clear.
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Re: Medical Unit's New Interpretation of ML-104 (California) (Ca

Postby spreare on Mon Sep 18, 2017 7:54 pm

Lets say you went to get Poki, and "Poki Bowl A" was 6 ounces of any combination of three fish: Tuna, Scallop, or Crab, would that mean that the combination requires some part of all three, or could you get 6 ounces of Tuna, only, or some other combination? This is where I am stuck with the wording. Just to be safe I advise making sure all three components are included when getting 6 hours total for three complexity levels. Although I am not sure, when pushed to the ultimate analyses, that it would pan out like that.
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Re: Medical Unit's New Interpretation of ML-104 (California) (Ca

Postby cmunday on Wed Sep 27, 2017 8:57 pm

http://www.wcexec.com/flash-report/dir- ... -hearings/

Above is the result of all the fuss. More than 13% of all QMEs penalized.
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Re: Medical Unit's New Interpretation of ML-104 (California) (Ca

Postby Manila on Thu Sep 28, 2017 7:05 am

Yet another instance where bureaucrats or bureaucratic organizations, i.e., Mr. West, the DWC, Insurers, IMR and UR act with impunity to the detriment of others.
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