SRTK Shareholder Aaron Hemmings was recently quoted in Andrea Childers’ Business Insurance article “Fee schedule changes could cost Calif. comp system $270M.” In the article, Angela discusses the potential impact of the new medical-legal fee schedule and regulations, which took effect on April 1, 2021. As noted in SRTK’s previous summary, the regulations apply to all evaluations taking place on or after April 1st, 2021, and include new multipliers that can further increase the cost of exams and evaluations.
While the E&M system increases stem mainly from changes in procedure codes, about 11% of the potential price increase in medical-legal reviews comes from a record review reimbursement overhaul that has many defense attorneys concerned. The prior schedule, which had been in place since 2006, had paid QMEs an hourly fee. The new schedule, introduced by the California Division of Workers Compensation in February, will pay QMEs a flat fee of $2,015 for a comprehensive case review plus an additional $3 per page for any records in excess of 200 pages.
“I see a lot of potential frictional costs in terms of how the fee schedule and the new procedures are going to be implemented,” said Aaron Hemmings, shareholder in the Woodland Hills and Thousand Oaks, California, offices of Stander Reubens Thomas Kinsey APC, which represents employers.
In the medical-legal review process, plaintiff and defense attorneys are meant to agree, in theory, on the medical records sent to the QME, Mr. Hemmings said. However, these files tend to be extensive and contain duplicates and irrelevant records, he said.
“I think that most people are overestimating the level of cooperation between the parties,” Mr. Hemmings said. “I hope I’m proven wrong.”
Plaintiffs attorneys may use the per-page fees as a “sword to try to threaten the employers into higher settlement amounts — or face multiple (medical-legal) evaluations at this increased cost,” Mr. Hemmings said. “I just see a lot of the burden falling on the employers and the defendants … and the potential for abuse. We’ll see how it all unfolds. I think it’s going to be a big change in how we do business.”
Read the full article.