Another Odd QME Report Payment Question (California) (Califo

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Re: Another Odd QME Report Payment Question (California) (Califo

Postby LienExaminer on Wed Dec 02, 2009 9:03 am

I believe the question is in regard to the psych testing and how this is to be billed with ML codes.
I am attaching (and I hope I did it correctly as I have never attached a docuemnt here) the Medical-Legal Fee Schedule Tutorial developed by Suzanne Honor-Vangerov of the Medical Unit of the DWC.

Please see Slide #16

The following services are paid according to the Official Medical Fee Schedule (OMFS).
Diagnostic tests including X-rays and Laboratory services.
These services are not payable unless the subjective complaints and physical findings warranting the test are included in the medical-legal evaluation report.
Absent prior authorization, they are not payable if adequate medical information is already in the medical record provided to the physician.
Consultations by other physicians, including the PTP.

Then refer to OMFS Code 96100 -- Psychological testing including psycho-diagnostic assessments and INCLUDES interpretation

The proper way to bill for a QME/AME psych evalution is to bill the number of units of 96100 based upon the time spent doing the psych testing with interpretation and then bill the appropriate ML code based upon the complexity factors -- the tutorial also details how to dteermine which level of ML to bill based upon these complexity factors. Therefore, the face to face time spent to determine the level of ML does not include the time spent doing the testing billed under code 96100.
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Re: Another Odd QME Report Payment Question (California) (Califo

Postby appliedpsych on Wed Dec 02, 2009 10:47 am

LienExaminer wrote:Please see Slide #16

The following services are paid according to the Official Medical Fee Schedule (OMFS). (Referring to Page 16 of your attachment)



Please see the NEXT page of your slides, page 17.

Medical-Legal Fee Schedule
• The following services are paid under the Medical-Legal (MLFS)
– Comprehensive medical-legal evaluations
– Follow-up medical-legal evaluations
– Supplemental medical-legal evaluations
– Medical-Legal testimony

This seems to me to conform to the earlier analysis that I posted.

Reports by treating or consulting physicians --- OTHER THAN --- comprehensive, follow-up or supplemental medical-legal evaluations, ... shall be subject to the Official Medical Fee Schedule adopted pursuant to Labor Code Section 5307.1 ---- rather than to the fee schedule set forth in this section.

In other words, --- comprehensive, follow-up or supplemental medical-legal evaluations ---- ARE subject to the SPECIAL RULES OF 9795 ---- AND THUS ARE NOT subject to the OMFS.
Last edited by appliedpsych on Wed Dec 02, 2009 10:51 am, edited 1 time in total.
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Re: Another Odd QME Report Payment Question (California) (Califo

Postby appliedpsych on Wed Dec 02, 2009 10:48 am

LienExaminer wrote:Please see Slide #16

The following services are paid according to the Official Medical Fee Schedule (OMFS). (Referring to Page 16 of your attachment)



Please see the NEXT page of your slides, page 17.

Medical-Legal Fee Schedule
• The following services are paid under the Medical-Legal (MLFS)
– Comprehensive medical-legal evaluations
– Follow-up medical-legal evaluations
– Supplemental medical-legal evaluations
– Medical-Legal testimony

This seems to me to conform to the earlier analysis that I posted.

Reports by treating or consulting physicians --- OTHER THAN --- comprehensive, follow-up or supplemental medical-legal evaluations, ... shall be subject to the Official Medical Fee Schedule adopted pursuant to Labor Code Section 5307.1 ---- rather than to the fee schedule set forth in this section.

In other words, --- comprehensive, follow-up or supplemental medical-legal evaluations ---- ARE subject to the SPECIAL RULES OF 9795 ---- AND THUS ARE NOT subject to the OMFS.
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Re: Another Odd QME Report Payment Question (California) (Califo

Postby LienExaminer on Wed Dec 02, 2009 10:53 am

your psych testing is billed under code 96100 under OMFS
your ML evaluation is billed under the MLFS
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Re: Another Odd QME Report Payment Question (California) (Califo

Postby appliedpsych on Wed Dec 02, 2009 11:34 am

LienExaminer wrote:your psych testing is billed under code 96100 under OMFS
your ML evaluation is billed under the MLFS


I believe you are incorrectly trying to mix apples and oranges. Medical-Legal under the ML Codes of 9795 are just that, and are not parsed out into OMFS.

I do not believe that an orthopedic Panel QME parses his QME billings into part OMFS and part MLFS. If he is a Treating or Consulting Physician, yes, but as a Panel QME or AME, NO.

Read 9795 closely. It delineates that treating or consulting physician charges are billed per OMFS, but it also in its muddled way specifies that the OMFS schedules to not apply when billing under 9795 - ONLY the MLFS applies for all services.
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Re: Another Odd QME Report Payment Question (California) (Califo

Postby cmunday on Wed Dec 02, 2009 6:12 pm

Perhaps a call to Suzanne Honor-Vangerov would be in order. I have heard her in lecture say very specifically that psych testing and similar procedures are not billed at QME/AME med-legal rates but via the OMFS. We could parse the meaning of the statutes but if that's the position of the DWC Medical Unit then I think that's what I would follow. I spoke with another attorney with some experience representing QMEs who told me rather forcefully that he/she would advise against the practice of billing psych testing or similar procedures at med-legal rates. Anyway, the ultimate answer would be per a call to the DWC medical unit.

Now I do agree and believe it is quite clear that the time spent integrating the test findings to formulate medical-legal conclusions is properly billed as report writing time at med-legal rates.

Claude
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Re: Another Odd QME Report Payment Question (California) (Califo

Postby appliedpsych on Wed Dec 02, 2009 8:13 pm

If you happen to take action on that call, please share the results.

The last time I tried to get an answer out of the medical unit, it took about 45 days.

My question was simple. "When will you be publishing a new QME manual for all us QME's out in the field, to update us with all the changes".

The answer I got ? ? ? A voice mail that said the answer to my question was "probably not anytime soon".

If they ever do get around to publishing one, hopefully they can include some answers to questions such as these.

cmunday wrote:Now I do agree and believe it is quite clear that the time spent integrating the test findings to formulate medical-legal conclusions is properly billed as report writing time at med-legal rates. Claude


Since you bill direct psych testing time as 96100, how do you describe the billing line item when you bill these services above? Do you just lump it in with general report writing formulation time, or list such services separately?
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Re: Another Odd QME Report Payment Question (California) (Califo

Postby cmunday on Thu Dec 03, 2009 12:50 pm

Dear Applied

I do things a little different than some of my colleagues. First, I pretty much limit myself to Neuropsych except for an occassional Panel QME or once in awhile when both sides impose on me to see a straight psych case as an AME. So, I discuss each test and the results separately. That I consider psych testing. But, once I'm conceptualizing med-legal opinions then that is report writing and I just list the time for report writing whether it's considering what weight I give to an MRI scan or what weight I give to a poor memory score. I will see if I can get an answer from the medical unit and If I do I'll post it here.

Claude
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Re: Another Odd QME Report Payment Question (California) (Califo

Postby appliedpsych on Thu Dec 03, 2009 1:08 pm

cmunday wrote:I do things a little different than some of my colleagues. First, I pretty much limit myself to Neuropsych ...


I hope you don't mind another question Doctor M, I am just trying to learn from your experience.

On your neuropsych testing, both as a treating or consulting doctor, do you bill that testing per hour with the 96100 code from the OMFS ?

Do you do the same when you take on a Panel QME in neuropsych, bill with 96100 for all that neuropsych testing time ?

Thanks for your time.
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Re: Another Odd QME Report Payment Question (California) (Califo

Postby cmunday on Fri Dec 04, 2009 9:42 am

Applied

Yes to both. We bill the testing under 96100 per the OMFS for any Workers' Comp evaluation whether consult, AME, or Panel QME. When doing a civil litigation case I also bill the psych testing at my regular non-comp rate and then bill the rest of my time (record review, interview, discussion with attorney) at medical-legal rates and I have chosen to have only one medical legal rate that applies to everything. That is, record review in a civil case is billed at same rate as deposition - this seems cleaner to me. Many Drs. charge more for deposition arguing that the stress of the process so warrants. I am sympathetic to that but I not only believe charging both sides equally for my time is "fair" but I also think it speaks to credibility.

claude
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