6 Billing (1 hr.) Flashcards
Pay me in accordance to the law
List the 3 fee schedules
QME/AME-Medical Legal Fee Schedule (MLFS)
Treatment - Official Medical Fee Schedule
If an AME or an agreed panel QME is used to evaluate a case, which of the following applies to the amount that can be charged for their medical-legal services?
25% more than the regular ML charge (for example ML 102-94)
A medical legal expense under LC4662 must be paid within how many days?
60
Medical-legal expense means any costs or expenses incurred to:
Prove or disprove a contested claim
Comprehensive Medical-Legal Evaluation ML-201
Includes an initial evaluation
Includes a follow-up evaluation that is 18 months and one day later than the last evaluation. $2,015.00 plus $3.00 per page of review in excess of 200 pages
A Follow Up Medical-Legal Report (ML 202) involves the following:
An evaluation that occurs within 18 months of a prior comprehensive evaluation.
Records previously reviewed are excluded from payment.
$1,316.25 plus $3.00 per page in excess of 200 pages not previously reviewed
Served within 30 days
A Supplemental Medical-legal Report (ML 203) involves the following:
Does not involve examination of the injured worker
Only refers to a request for a supplemental report if the physician failed to address an issue previously requested or a new development occurs
$650.00 plus $3.00 per page after 50 pages
The 50 pages and any additional pages were not previously reviewed
Preparing a narrative report.
Must be served within 60 days
Medical-Legal testimony ML-204
$455.00 per hour with a minimum of 2 hours ($910.00)
Missed appointment ML-200
$503.75
The physician can bill for a record review report if the records were received and reviewed in connection with a missed appointment
Sub rosa review ML-205
$325.00 per hour plus report associated with writing the review
Modifiers – Applies only to Comprehensive Medical-Legal Report, Follow-up Medical-Legal Report, and Supplemental Medical-Legal report
Multiple Bill x Modifier
Modifier 93 Interpreter = 1.1
Modifier 94 AME Modifier = 1.35
Modifier 96 is for psychiatrist or psychologist = 2.10
Modifier 97 Toxicology = 1.5
Modifier 98 Oncology = 1.5
example AME and Interpreter Modifiers combined = 1.45
A physician can bill for time spent reviewing their own records in preparation for the deposition (True/False)
TRUE
If a worker suffers an injury and the employer is uninsured, the employer is responsible for all bills related to the injury or illness. (True/False)
TRUE
The Uninsured Employers’ Benefit Trust Fund (UEBTF), a special unit within the DWC may pay benefits to injured workers who get injured or ill while working for an illegally uninsured employer. The UEBTF pursues reimbursement of their expenditures from the responsible employer through all available avenues, such as filing a lien against their property. (True/False)
TRUE
