Medical-Legal Fee Schedule - Curiouser and Curiouser

Yesterday's public hearing (zooming) yielded few surprises including the quality of testimony from the physician community itself which was extremely well done – thoughtful and insightful.

Our written input is attached in two parts.  The first, authored before the hearing, concentrated on one somewhat overlooked topic and one not raised until yesterday:

1. A COLA and the Division's position it does not have the authority to place one into the fee schedule, and
2. Training/educating Maximus how to resolve IMR issues under a new (or any) fee schedule.  This critical issue must be part of the Division’s focus going forward regardless of the final language of a revised MLFS.

It was heartening to hear so many propose rather than installing a completely, new, untried, and potentially friction-filled fee schedule, that the current MLFS could be clarified, and a raise given so reports would continue to be reimbursed based on complexity rather than how many pages of records are delivered – a variable the brunt of which under the proposal would fall squarely on the shoulders of the evaluator. 
 
The immense friction anticipated from the page count “innovation” has both providers and payors on edge – and rightfully so.  Plus, copy services do not seem very eager to take on any additional responsibility.
 
The second point must be thrust to the forefront regardless of how the MLFS is updated.  I urge readers to peruse the testimony dated December 9, 2020 for background on this issue which arose during the QME Inquisition that wreaked havoc and did much damage among the Corps of QMEs a few years ago.  The main point is the Division's Medical Unit trains (educates?) Maximus staff how to review IBR requests.  If the Division does this by itself, Maximus knows only one viewpoint.  By definition, a medical-legal IBR has at least two such viewpoints.  Since Maximus staff otherwise has only the Division’s viewpoint to draw from and given the inherently vague and ambiguous language of both the current and proposed fee schedules, from now on the Division must utilize a team approach to properly and completely train/educate the Maximus reviewers.

Back to the point made by many regarding improving the current fee schedule, readers will find also attached the CSIMS 2015 MLFS white paper entitled, “Physician Reporting in the California Workers’ Compensation System” wherein Dr. Rick Newton and his team of CSIMS members came to the same conclusion as many of yesterday’s witnesses, a position little heeded…perhaps until now.
 
Has the fun just begun (over again)?

CWCSA MLFS Comments
CWCSA MLFS Additional Comments
CSIMS Position Paper - Physician Reporting in the CA Workers' Compensation System