In today’s post, we discuss medical legal expenses, from a basic definition to how the fees for medical legal expenses are billed in California. Keep reading to learn more!
What Is a Medical Legal Expense?
According to California law, the term “medical legal expense” refers to any expense made to prove or disprove a workers’ compensation claim.
Some common examples of medical legal expenses include;
- Medical testimony
- X-rays
- Laboratory services
- Interpreter’s fees
- Medical records
It’s important to note that all the expenses listed above are considered medical legal expenses ONLY if they are used for the production of a comprehensive medical-legal evaluation report, follow-up medical-legal evaluation report, or a supplemental medical-legal evaluation report.
Also, all the following conditions must be met:
- The report is prepared by a qualified physician.
- The report is obtained at the request of a party or parties, the administrative director of the California Division of Workers’ Compensation, or the appeals board for the purpose of proving or disproving a contested claim.
- The report is capable of proving or disproving a disputed medical fact essential to the resolution of a contested claim
- The medical-legal examination is performed prior to receipt of notice by the physician, the employee, or the employee’s attorney, that the disputed medical fact or facts for which the report was requested have been resolved.
How Are Medical Legal Expenses Billed?
In California, medical legal expenses are determined in accordance with two documents: the Official Medical Fee Schedule and the Medical Legal fee schedule.
X-rays, laboratory services and other diagnostic tests are billed according to the Official Medical Fee Schedule.
On the other hand, medical legal evaluations, follow-up medical legal evaluations, supplemental legal medical evaluations, medical legal testimony, record reviews, and reviews of sub rosa recordings, are billed according to the Medical Legal Fee Schedule.
To learn more about medical legal billing, be sure to check out our previous posts, “What Is the Medical Legal Fee Schedule,” “Med-Legal Billing Codes in California: a Quick Guide,” and “California Adopts Rule Allowing Electronic Service of Med-Legal Reports.”
Practice IQ: Medical Legal Billing in California
Looking for efficient medical billing services? We are located in Pomona, California, and serve clients all over the Golden State.
Start improving the efficiency of your practice today. Contact us today by telephone (424-433-5704) or email (piqusinfo@practiceiqusa.com), or fill out the contact form to learn more about our services.
