Northern California Engineering Contractors Association

Verify Medico Legal

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A medical examiner may also consider including a chart in the medico-legal report to reflect the records received and reviewed. A table makes it easier for all parties involved to track documents relevant to the forensic assessment that the parties have provided to the physician. If the page number is not properly verified, claims administrators may refuse reimbursement of the forensic report, even if no pages have been reviewed. Disclaimer: The information in this article is provided for informational purposes only. This is not legal advice; Use is at your own risk and discretion. Some claims administrators reject medical bills by falsely claiming that the report does not include this medical examination. Therefore, daisyBill recommends that our medical officers document the required medical audit in a separate section of the assessment report entitled “Medical Record Review Audit”. Last spring, California introduced a new medical-legal fee schedule (MLFS). Since April 2021, daisyBill customers have submitted more than 80,000 medico-legal invoices to which the new MFFS is applicable. In the interest of compensating medical evaluators for their medico-legal reports, this article describes guidelines that evaluators should follow carefully when reviewing files. Section 9795 of the California Code of Regulations (CCR) requires medical examiners to always include “an examination under penalty of perjury of the total number of pages” examined during a forensic evaluation. CCR ยง9795 does not specify the language or location of this medical examination. When submitting a medico-legal report, the new MFCS states that medical adjudicators must ALWAYS verify the exact number of pages of file reviewed by the assessor or face perjury.

This medical examination is required even if no records have been received or verified. Documenting the exam in a dedicated section of the report makes it easier for a physician`s billing team to file an appeal against the second exam to challenge these false “errors” in the audit. Below is an example of a review of medical records that your office can modify as needed. Observe the laws on file review and good hygiene when reviewing records. This is the best way to protect your practice and its revenues under the new MFCS. The following sample table provides details about the records that were sent to the medical evaluator and the records that the physician`s assessor reviewed when the report was generated. When completing this chart, physicians should remember that the chart is not page number verification. Instead, this table notifies all parties of the details of documents sent by the parties. Remember: it is necessary to review the physician`s record even if the assessor has reviewed the NULL records. Number of pages of records reviewed by physician as part of the forensic assessment and report preparation.