Joined: Dec 2005
Thursday February 12, 2009 7:17 PM
Since you are new, are you sure you are providing all required entries, swearings under penalty of perjury, etc? They can hold you up if not. For example I learned quickly on my first QME report, which I was partially stiffed on, was that I did not put in the required billing reasoning on the first page of the eval. This is especially true if you are doing an ML104 level. I later found out that the reason I got stiffed and only partially paid was that I did not put the following up front, as required on the Regs.
THIS IS A PANEL Q.M.E MEDICAL-LEGAL EVALUATION. THIS REPORT IS BEING BILLED UNDER ML104 OF REGULATION 9795. THIS IS DUE TO THE FOLLOWING QUALIFYING FACTORS: 1) Two or more hours of face-to-face time were spent with the patient. 2) Two or more hours of record review were required. 3) Two or more hours of medical research were required, to examine issues related to the clinical and medical-legal issues pertinent to the case. 4) Complex issues of permanent and stationary status, temporary disability, permanent disability, and related issues were addressed, upon request of the Insurance Carrier and case related Attorneys who agreed to the referral question. 5) Detailed analysis in relationship to the issue of good faith personnel action versus bad faith, temporary disability, and temporary versus permanent disability was carried out, including research into recent WCAB cases, and analyzing this case in light of recent changes in the WC system. (6) A complex and comprehensive psychological evaluation which was the primary focus of this medical-legal evaluation.
I don't know what you specialty is, or if your QME's were ML 104 level, but if they were, this could be part of your problem. Also if you do not list all required sworn statements correctly at the end, in the Physician Affadavit, the adjustor or payment reviewer can feel justified in withholding payment. Here's an example.
I declare under penalty of perjury that the information contained in this report and its attachments, if any, is true and correct to the best of my knowledge and belief, except as the information I indicated I have received from others. As to that information, I declare under penalty of perjury that the information accurately describes the information provided to me, and, except as noted herein, I believe it to be true. I further declare under penalty of perjury that I personally performed the evaluation of the patient on **/**/**** at_________, and that except as otherwise stated herein, the evaluation was performed and the time spent performing the evaluation was in compliance with the guidelines, if any, established by the Industrial Medical Council or the administrative director pursuant to paragraph (5) of subdivision (j) of Section 139.2 or Section 5307.6 of the California Labor Code. I further declare under penalty of perjury that I have not violated the provisions of California Labor Code Section 139.3 with regard to the evaluation of this patient or the preparation of this report. I further declare under penalty of perjury that the name and qualifications of each person who performed any services in connection with the report, including diagnostic studies, other than clerical preparation, are as follows: No other persons were involved in this evaluation.
I herby declare under penalty of perjury that I have not violated Labor Code Section 139.3 in that I have not offered, delivered, received or accepted any rebate, refunds, commission, preference, patronage dividend, discount or other consideration whether in the form of money, or otherwise as compensation or inducement for any referred examination or evaluation.
** day of ****** at ____________ County, California
Making sure that you follow all these steps should help you get paid.
I have never NOT been paid after that first screw up on my part in 1996.