DWC Proposed Amendments to Medical-Legal Fee Schedule (QME)

The Division of Workers’ Compensation (DWC) has posted proposed amendments to the Medical-Legal Fee Schedule to its online forum where members of the public may review and comment on the proposals. The draft regulations include:

  • A 25% increase in the multiplier for setting fees for evaluations.
  • Standardization of the fee that can be charged for a missed appointment.
  • Flat fees for comprehensive, follow-up, and supplemental medical-legal evaluations.
  • Rates for review of medical records based upon the amount of pages reviewed.
  • Elimination of complexity factors from the Medical-Legal Fee Schedule.
  • An increase in the hourly fee for medical-legal testimony.

The implementation of a predominantly fixed fee for all procedure billing codes is anticipated to reduce frictional costs. Moving to a flat-fee-based schedule and removing complexity factors is contemplated to reduce the incidence of disputes over billing.

The fee schedule was formulated after numerous stakeholder meetings where carriers, employers, physicians, and medical management companies were amply represented. The meetings took place over the course of approximately three months.

The forum can be found on the DWC forums web page under “current forums.” Comments will be accepted on the forum until 5 p.m. on Friday, July 10, 2020.