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Med-Legal Costs Soar Following Changes to the Fee Schedule in 2021

The old fee schedule consisted of a flat fee for basic and complex evaluations, with time-based payments for evaluations that involved extraordinary circumstances. The new fee schedule combined those three levels of service into a single billing code paying a flat fee of $2,025, including the review of up to 200 pages of records. The reimbursement rate for additional records is $3 per page. The new schedule also continued to allow additional fees for evaluations by those involving an interpreter, and expanded fee multipliers to certain medical specialists.

Cost Increases

The new flat fee increased the payments for Each Evaluation Tier as follows:

  • Basic Evaluations increased by 222%.
  • More complex evaluations increased by 115%.
  • Supplemental follow-up reports increased from 34.2% of med-legal services in 2019 to 37.8% under the new schedule.
  • The average payment for a comprehensive evaluation that includes a face-to-face exam of the injured worker increased 52.9%.
  • The average payment for a supplemental evaluation increased 39.1%.
  • The per-page record review fee added an average of:
    • $1,917 to the base fee for comprehensive evaluations
    • $1,410 to the base fee for follow-up evaluations and
    • $1,437 to the base fee for supplemental evaluations.

The WCIRB initially projected the new fee schedule would increase med-legal costs by about 22%, but the actual increase was about 39%.

Source: WorkCompCentral Inc.: www.workcompcentral.com

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