FROM: Barbara Hannah, Chief Counsel
SUBJECT: Approve proposed changes to the Independent Medical Examiners' Fee Schedule.
RECOMMENDATION:
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Approve the new fee schedule for the Independent Medical Examiners through First Medical Experts and authorize the Chief Executive Officer to execute an amended Agreement with First Medical Experts including the newly adopted fee schedule.
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BACKGROUND:
On April 1, 2021, the Division of Workers' Compensation adopted new rules governing payment for Agreed Medical Evaluations. The new rules raised the flat fee for most medical-legal reports from $1,200.00 to $2,015.00. The flat fee includes 200 pages of record review, thereafter, the doctor is paid $3.00 per page reviewed. Most, if not all, SBCERA's independent medical examiners (IME) provide medical-legal evaluations in the workers' compensation system, and are requesting to be paid under the newly adopted fee schedule for IME evaluations. The request is industry wide among all examiners performing either Workers' Compensation or independent medical evaluations.
SBCERA's current IME fee schedule with First Medical Expert has been in place since 2009. (See Exhibit C) To maintain the quality of SBCERA's evaluations and reports for SBCERA members while keeping these costs under control to remain competitive, staff is recommending the Board adopt a fee schedule for its IME panel that closely matches the workers' compensation fee schedule by adopting the flat fee provided in the workers' compensation systems, but not the $3.00 per page cost for record review, and instead adopted an hourly fee for record review.
If adopted, the proposed schedule (Exhibit B) would result in an approximate 58% increase in fees. SBCERA currently budgets $600,000 for medical consultant fees for fiscal year 2021/2022. As of September 30, 2021 SBCERA has expended $41,716 on medical consultant fees; thus, even with an estimate of about 50% increase, SBCERA will remain ...
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