On a typically overcast San Francisco morning earlier this month, the California Workers’ Compensation Appeals Board (WCAB) held a public hearing. The subject? Proposed regulations for the implementation of Senate Bill 1160’s lien reforms. For an issue with such long-reaching implications, the audience was surprisingly sparse – only two speakers rose to present statements. Despite the public hearing, details about the new Division of Workers’ Compensation (DWC) lien forms are still scarce. And one question in particular has us perplexed: When it comes to filing a lien, what, exactly, constitutes an “original bill”?
Since October 2012, California claims administrators are legally obligated to compliantly accept and process workers’ compensation e-bills. In that time, electronic billing has consistently offered providers a much faster and more efficient avenue for processing their workers’ comp bills, and DaisyBill has answered thousands of questions about e-billing rules and compliance.
Emerging from millions of data points – we’ve successfully processed and tracked over 1.5 million electronic bills – is a rock-solid understanding of compliant e-billing and its substantial differences from traditional paper billing. Can’t tell your 837s from your 275s? Not sure why your electronic bills are rejected? We compiled this primer to help you through the alphanumeric soup.
At the start of the year, the California Division of Workers’ Compensation (DWC) made good on the lien reforms promised by Senate Bill 1160. Along with the Workers’ Compensation Appeals Board (WCAB), the DWC released an amended lien form, including the new declaration requirements set forth by Labor Code Section 4903.05(c). A second form – for liens filed prior to January 1, 2017 – was also released.¹
It’s the most wonderful time of the year to be a California workers’ compensation blogger – the changes just keep coming. In today’s update, we take a look at the new adjustment to reimbursements for the Pathology and Clinical Laboratory section of the Official Medical Fee Schedule (OMFS). These reimbursement changes apply to all dates of service on or after January 1, 2017, and were announced by the Division of Workers’ Compensation (DWC) on December 29th. Shockingly, 95% of reimbursements changed, with most of the adjustments clocking in at a little under one percent.
The start of the new year is always a hectic time in the world of California workers’ compensation. California’s Division of Workers’ Compensation (DWC) often posts an order adjusting the Physician and Non-Physician Fee Schedule to conform to the Medicare payment system prior to January 1. Not so in 2017. As of January 4, the DWC has not yet made such an adjustment.
Without an order from the DWC, the 2016 Physician and Non-Physician Fee Schedule remains in effect for all 2017 dates of service.
2017 is almost upon us, and the Division of Workers’ Compensation (DWC) is ringing in the new year with an adjustment to the Official Medical Fee Schedule (OMFS). The new order adjusts the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) section of the OMFS for dates of service on or after January 1st, 2017, to conform to Medicare’s first quarter changes. A staggering 92% of DMEs are affected by this order – buckle up and join us as we take a closer look.
Last week, we examined claims administrator compliance and electronic billing for original submissions of medical treatment bills. Even though four years have passed since the Division of Workers’ Comp mandated that claims administrators must accept electronic workers’ comp bills, some still underperform. This week, we turn our focus to the claims administrators who demonstrate a regular failure to accept electronic Second Reviews (SBRs), even though regulations require a provider to submit Second Reviews electronically when the Original Bill was transmitted electronically.¹
Let’s start with some old news: Since October 2012, California claims administrators must accept electronic billing for workers’ compensation bills. Fast-forward four years, and most claims administrators complied. Some even thrived. Others, however, still struggle with habitual non-compliance.