How Are QME's Handling ML-104 Issues (California)

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How Are QME's Handling ML-104 Issues (California)

Postby appliedpsych on Wed Dec 13, 2017 3:06 pm

I am just wondering how QME's, especially psychology and psychiatry QME's, are handling recent and sudden changes in the ability to bill for report preparation under ML-104. I know that some of this is under litigation, but what to do in the meantime?
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Re: How Are QME's Handling ML-104 Issues (California)

Postby DrDoc on Thu Dec 14, 2017 8:01 pm

Panic. Dread. Things of that nature.
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Re: How Are QME's Handling ML-104 Issues (California)

Postby DrDoc on Thu Jan 04, 2018 1:49 pm

It’s a good question. Surprised there haven’t been more comments. I haven’t made any real changes. We had been very careful about following the instructions with regard to billing from the beginning. I won’t have to go through the recertification process for about a year. So, maybe there is less a sense of urgency for the moment. I’m hopeful that issues are resolved one way or the other within the next couple of few months. We all need, and deserve, simple and fair means of billing. But then again, participating in this system in any manner has always been associated with a fair amount of irrationality, opaque rules, and craziness.
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Re: How Are QME's Handling ML-104 Issues (California)

Postby jobmdpsych on Thu Jan 04, 2018 7:00 pm

Much of the issue for me is coping with records in PDF form rather than paper.

Initially, it was a very welcome development because electronic records are much easier to deal with. Easier to manage, carry, transport, edit, etc.

However, the ease of emailing 5000 pages of records as opposed to mailing them created an unintended consequence.

That is, when the law office had to mail them it was enough of a burden to filter them down to what was really needed. So they were winnowed down to a manageable level.

When it comes down to a click, we end up receiving a lot of unnecessary and duplicate records, because, hey, copy, paste and forward.

A King James Bible is 1200 pages. It is not unusual to get 3000-7000 pages on an old case. And we are expected to read and comprehend them. I realize a lot s filler but still...one unfamiliar with Christianity cannot read the Bible in three days and understand it with any degree of certitude. And Exodus is a bit more riveting than Kaiser family practice records from 1995.

But we're expected to, and to be challenged on billing for the requisite hours if we do, and nailed in a deposition if we short cut it.

I don't know of any rational solutions when we are getting tag teamed like that.
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Re: How Are QME's Handling ML-104 Issues (California)

Postby appliedpsych on Fri Jan 05, 2018 8:55 am

I recently had a request for a QME re-eval from a few years ago QME before the reported reinterpretation of ML 104 by DWC, along with a thousand pages of new records.

I sent a letter to the parties, explaining the alleged new requirements for an ML104 level of service, language needed, and asked them to verify in writing that they affirmed that the re-eval met the requirements for the new requirements for ML 104 per DWC.

Never heard a word back from them!

The applicant no-showed, so at present I am in a holding pattern.

If it is rescheduled, and they give me no ML104 clearance in writing, am I stuck with billing it as an ML103?
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Re: How Are QME's Handling ML-104 Issues (California)

Postby psych74 on Mon Jan 08, 2018 10:29 am

To appliedpsych: IMHO billing for a ML103 is not an appropriate option. I would have my staff contact the adjustor; they are usually available by email. If there are a 1000 pages of new records
I would spend some of the clinical interview time asking the applicant about them. In my experience there is usually something in the records that needs to be clarified. Therefore, you have:
1) a psych eval; 2) 2 or more hours of record review; 3) 2 or more hours of clinical interview; and 4) apportionment (preliminary or final is virtually always appropriate to address and ther are almost always other body systems to mention). There may be other factors to list. Just my opinion. Take care.
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Re: How Are QME's Handling ML-104 Issues (California)

Postby appliedpsych on Mon Jan 08, 2018 1:32 pm

Hi psych74, thanks for input, but are you aware of the NEW DWC interpretations that say that ML-104's cannot be billed without IN-WRITING OK from the parties, and some other specific language in the letter from the parties....??

And I thought that ML103 was a purely flat rate billing code, something like nine hundred dollars ...

Never billed that code, so not really sure.

Any other input really appreciated.
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Re: How Are QME's Handling ML-104 Issues (California)

Postby Manila on Tue Jan 09, 2018 8:37 am

The requirement to obtain in writing from the parties that the evaluation involves "extraordinary complexity" is onerous. In our experience we are lucky to have one party sign a written statement we mail to them with an explanation. AA's are more likely than the DA to sign such a document if they arrange the med-legal eval. Many times we do not even get a reply from the CA or DA. In the case of an AME so far there is greater luck having each party sign the document. Concur with others, the rate of pay for a ML-103 versus a ML-104 considering the amount of work to do and records to review, makes it not worth it and is driving more good doctors out the comp system
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Re: How Are QME's Handling ML-104 Issues (California)

Postby cmunday on Tue Jan 09, 2018 9:13 pm

Just FYI, the current "interpretation" is not that pre-agreement is needed for a 104. There are three types of 104, the third being per written agreement of the referring parties. Per the current interpretation it is only that third type that allows for billing for report preparation time. One can still justify a 104 with four complexity factors but without pre-agreement only face to face time and record review time are billable.

We are getting pre-agreement on a high percentage of cases.
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Re: How Are QME's Handling ML-104 Issues (California)

Postby mk61347 on Wed Jan 10, 2018 7:11 am

A pre evaluation agreement,places me potentially in conflict and may compromise my neutrality.
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