Enormous Victory for the Qualified Medical Examiners (QMEs) of California

California Division of Workers’ Compensation

California Division of Workers’ Compensation

The Division of Workers’ Compensation will now allow the Qualified Medical Evaluators QMEs to cite medical causation as a complexity factor on accepted claims; allow them to bill for medical research that is within their scope of practice and it will allow them to charge for time spent preparing reports when using the ML 104 billing code. QMEs, a few examples of these complexity factors are:

  • Spending two hours or more of face-to-face time with the injured worker
  • Two or more hours of record review by the physician
  • Two or more hours of medical research by the physician

However, the issue was citing medical causation on uncontested cases which is a requirement; this is NOT included in the language of the fee schedule.

Suzanne Honor-Vangerov, President of Honor System Consulting, said she is in support of the QMEs, that an error was added to the med-legal billing rules in 2008 that eliminated a line break and created confusion as to whether doctors are allowed to bill for writing reports when they meet the criteria of using the ML104. She also said she pointed out this error but it was never corrected and should be considered as another underground rule.

If you encounter questions about complexity factors, Qualified Medical Evaluators or any other topics around Workers Comp billing feel free to give us a call at (949) 863-0022 or use our handy contact form.