What are the documentation requirements for billing?

What Documentation Is Required When Billing for QME Services?

Submitting an invoice without the proper backup is the fastest way to delay—or forfeit—payment for your Qualified Medical Evaluator work. California’s Medical-Legal Fee Schedule (MLFS) spells out exact documentation requirements for each billed code. Meeting these standards protects your revenue, withstands audit, and speeds collections.

Core Billing Packet Components

1. Medical-Legal Report or Proof of Non-Attendance
   • ML200 / ML201 / ML202: Attach the comprehensive, follow-up, or supplemental narrative.
   • ML203: Provide a signed “Proof of Non-Attendance” statement noting the appointment time and no-show or late-cancellation details.
2. Itemized Invoice
   • List the base code (e.g., ML200) and each modifier on separate lines.
   • State the flat fee and add record-review hours in 15-minute increments (modifier –B).
   • Include your QME number, tax ID, and pay-to address.
3. Record-Review Log (if claiming –B modifier)
   • Chronological index with Bates-page ranges and minutes spent.
   • Example: “02:15 hrs – Bates 001–432 (Ortho notes, imaging).”
4. Proof of Service
   • A certificate listing all parties served, signed and dated the same day you transmit the report and invoice.
   • Acceptable service: first-class mail or secure e-service under CCR §10628.
5. Deposition Time Sheet (ML400)
   • Start/stop times, breaks, and portal-to-portal travel noted in quarter-hour blocks.

Electronic vs. Paper Submission

The regulations permit either method, but electronic service (secure PDF, encrypted e-mail) accelerates timestamp verification and reduces “lost in mail” disputes. Retain electronic read receipts for your records.

Common Documentation Errors—and Fixes

• Missing Bates ranges: Add a one-page log to justify record-review hours.
• No proof of service: Re-serve the packet with a signed certificate; the 60-day payment clock restarts on the new service date.
• Incorrect code usage: If you mistakenly billed ML200 for a supplemental review, submit a corrected invoice (CCI) referencing the original.

Retention Requirements

Under CCR §9795(f), keep all billing records, reports, and proof-of-service documents for five years. Auditors may request them at any time.

For the full documentation language, see the Medical-Legal Fee Schedule (CCR §9795(c)) and related billing regulations.