The History of the New Medical Legal Fee Schedule - PART 1
The Qualified Medical Evaluator program is undergoing a massive change in the hope of upgrading the content and quality of QME Reports. The first step in the direction toward the improvement of the program involves a new system for reimbursing Qualified Medical Evaluators for the work that they do.
THE HISTORY OF THE NEW MEDICAL LEGAL FEE SCHEDULE - PART 2
The New Medical Legal Fee Schedule has as its driving purpose to eliminate "gaming" by the players and stakeholders. However, I cannot eliminate all gaming because of the built in incentives that both the QMEs and the Claims Payers have under each of the new ML billing codes. Here, we dissect the billing codes under the microscope to uncover and discover the hidden and unspoken incentives that will drive the behavior of the QMEs, and the Claims Payers - for years to come.
THE HISTORY OF THE NEW MEDICAL LEGAL FEE SCHEDULE - PART 3
Within each of the new ML billing codes (ML200, ML201, ML202, ML203, ML204, and ML205) resides the incentives of both the QMEs, and the Claims Payers. By knowing what each party hopes to gain from the evaluation, you as a QME can win by first satisfying the need of the other party, and by maximizing your hourly rate in the process. Here we dissect the built in incentives hidden deep within the ML billing codes.
THE HISTORY OF THE NEW MEDICAL LEGAL FEE SCHEDULE - PART 4
The most common evaluations assigned to Qualified Medical Evaluators are 1) the Initial Comprehensive Evaluation, 2) the Follow Up Reevaluation, and 3) the Supplemental Report. The new MLFS disincentivizes #2 and #3 with tight time constraints and fixed reimbursement rates. Here, were take a look at actual examples of each of these levels of service to see how the QME's procedures are modified based on the built in incentive of each of the billing codes ML201, ML202, and ML203.
THE HISTORY OF THE NEW MEDICAL LEGAL FEE SCHEDULE - PART 5
With the elimination of the time based billing codes under the "old" medical legal fee schedule, Qualified Medical Evaluators no longer have the luxury of TIME in the completion of 1) the face to face evaluation, or 2) the production of their final Reports.
THE HISTORY OF THE NEW MEDICAL LEGAL FEE SCHEDULE - PART 6
Most of the evaluations under the new medical legal fee schedule (MLFS) will involve fewer than 200 pages of medical records. Those are the small cases (the minnows) for which the QME's profit margins are very very slim. Every once in a while, a case comes along that involves a huge stack of medical records (the whales) where the QME can win with a large profit.
BONUS VIDEOS
PART 7
The New Medical Legal Fee Schedule (MLFS) has been in effect now for 60 days. In that time period, the entire procedure of evaluating injured workers in the State of California has changed. And this changes is not just on the part of the QMEs. All the parties - including the Claims Administrators, the Applicant Attorneys, and the Defense Attorneys have strategically changed their procedures in an effort to comply with, and benefit by the new MLFS. Each party has an incentive and an angle to attempt to WIN under the new MLFS.
PART 8
The new medical legal fee schedule is a fascinating study of the operation of incentives on the parts of both the QMEs, and the Claims Payers. Like any game, the parties seeks to use the rules to gain an advantage and to realize some benefit. Unfortunately, in some instances, the parties' interpretation of the use of the new medical legal fee schedule can erode the QME's profitability. Here is how to NOT let that happen to you!
PART 9
Time is of the essence for the Qualified Medical Evaluator under the New Medical Legal Fee Schedule. There are many factors not under the control of the QME that conspire to erode the profitability of the evaluation. Therefore, for the factors that ARE under the control of the QME, the QME needs to focus on the relevant issues, and bring the evaluation to an accurate resolution - quick quick quick!
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