Grinberg: The New Med-Authorized Price Schedule, Half III| Employees Compensation Information

By Gregory Grinberg

Monday, April 12, 2021 | 0 | 0

And now the end of a review of the new California medical fee schedule.

Gregory Grinberg

Last time we covered the different billing codes and their corresponding base price fees. But nothing in employee compensation is immune to circumstance-related changes, least of all the doctor’s bill.

These previously discussed fees were just the basic fees. The new regulations also include several modifiers and special fees. Agreed medical assessors are now multiplying the base by 35% from 25% before April 1st. Using an interpreter on an exam increases the base by 10%, while an AME who needs an interpreter gets a 45% bump.

Physicians certified in toxicology or internal medicine (or certified as qualified medical reviewers in internal medicine) will receive a 50% increase in base for toxicology-oriented assessments with similar modifiers for interpreters (60%), AMEs (85%), and AMEs with interpreters (95%). The same applies to oncological examinations.

Psychologists and psychiatrists calculate double the basis, 210% for an interpreter, 235% for an AME without an interpreter and 245% for an AME with an interpreter.

However, do not think that the psyche QMEs and AMEs will retire any earlier than they did before. Imagine an orthopedic AME with an interpreter doing an initial orthopedic exam: that’s a base of $ 2,015 below ML201, up 45% to $ 2,921.75. However, a Psyche AME with an interpreter would get 245% of the base, or $ 4,936.75.

Now look at the time and test difference required for an orthopedic exam versus a psyche exam.

If the Orthopedic QME spends three hours face-to-face and another three hours creating a report and a few hours reviewing 400 pages, and charging $ 600 for the additional 200 pages, that’s nearly $ 500 an hour .

Conversely, if a psyche AME spends four hours in a face-to-face interview on the exam, five hours on psychological tests, another six hours on a report and reviewing the same 400 pages, it will earn about $ 330 an hour.

In other words, the new fee schedule may not attract as many psychology and psychiatry medical and legal reviewers into the pool as other specialties.

There are many changes here, and ultimately the goal is the same as in any situation where more money is put on the table: increasing the availability and quality of a particular service.

Will the increased fees for medical assessors attract more doctors to the QME and AME pools? We will see.

Perhaps this will just result in the same product quality at a higher price, or maybe the defense community will ultimately save money by getting a higher rate of high quality, substantive, and party-responsive reports that will help actually address the disputes that cause cases to litigation.

Gregory Grinberg is the managing partner of Gale, Sutow & Associates’ SF Bay South office and a certified employee compensation law specialist. This post was reprinted with permission from Grinberg’s WCDefenseCA blog.