Below are some best practices to ensure you have the right supporting documentation to get your med-legal bills paid.
To schedule an evaluation through Simplexam:
- Identify if the patient needs an interpreter. If so, tick the box “Needs Interpreter” and select relevant language in the dropdown menu
- Create and submit the QME110 form using “Mail On Demand”
- Include any custom documents you need (e.g. parking information)
Scenarios to charge for a Missed Appointment (ML200):
- Injured worker does not show for the evaluation
- Interpreter does not show for the evaluation, which makes it impossible to proceed with the evaluation
- Injured worker leaves before completion of the evaluation
- Injured worker is more than 30 minutes late
- The appointment has been canceled within six business days of the scheduled evaluation (here’s a link to a free online working days calculator)
Supporting Documentation needed for a Missed Appointment:
- Request for the QME appointment (with panel strike letter if available)
- E-mail request for appointment
- Fax request for appointment
- Letter of request for appointment
- Advocacy letter
- Dated request to cancel or reschedule the appointment (you must get it in writing, via fax or email)
In the scenarios where a patient does not show, is late, leaves early, or the interpreter no-shows, you need to generate a “Missed Appointment” letter under “Transcription and Compilation” since you will not have a written request.
If medical records are provided prior to the appointment, the examiner has 30 days to produce a record review report, in addition to the missed appointment fee. They will be reimbursed for the review of records in excess of 200 pages. It is required that the examiner include in the report a verification under penalty of perjury of the total number of pages of records s/he reviewed as part of the medical-legal evaluation and preparation of the report.
As a reminder, any pages reviewed for this record review report will be excluded from the page count for reimbursement when the face-to-face or supplemental evaluation takes place in the future.
Checklist of Supporting Documentation
- Request for QME
- Served 110 form
- Request to cancel/reschedule (that supports within six business days) or missed appointment letter for no show
- Record review report if appropriate
IBR examples of what NOT to do:
These IBR examples fail to adequately support that the appointment was canceled within 6 business days.
If you’ve got questions or concerns regarding the ML200 or any other forms, don’t hesitate to reach out to the Simplexam Team!