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Blog: Daisy News

News, data, & insights about workers' comp billing

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  • April 20, 2017

    Align Networks: The Charges, The Lawsuit, and The Taunting Rap Videos

    Align Networks is having a very bad 2017. First, there was the eyebrow-raising decision to instruct its California providers to prematurely bill using new Medicare physical therapy codes – never mind that these codes had not yet been adopted by the DWC and were therefore without an official reimbursement. Then came the lawsuit. Last month, the Independent Physical Therapists of California (iPTCA) sued Align Networks, along with its parent company One Call Medical, alleging fraudulent, misleading, and illegal behavior. We won’t mince words: We’re not surprised. Over the past few years, we’ve become used to complaints about Align Networks from providers across the state and requests for our help with payment problems.

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  • April 19, 2017

    Understanding the Difference Between 99080 and WC007

    Everything changed when the Division of Workers’ Compensation adopted the RBRVS-based Physician Fee schedule on January 1, 2014. We don’t say that to be dramatic – everything did change, and medical providers across the state are still learning to adapt three years later. Today, we’re focusing on a specific consequence of the shift to RBRVS: The elimination of CPT 99080 as a reimbursable code for consultation reports, and the erroneous use of California-specific code WC007 in its place.

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  • April 18, 2017

    Taking it to Eleven: How to Convert 10-Digit NDC Numbers

    A common billing predicament facing workers’ comp billers involves the reporting of prescription and nonprescription medications and inserts using an identifying National Drug Code, or NDC. Many NDC codes contain 10 digits. But when entering an NDC code on a bill, 11 digits are needed – and that’s just the start of the problem.

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  • April 13, 2017

    Reform the Reforms: SB 489 Aims to Clean Up SB 1160

    Let’s start with some simple facts. Each two-year session of the California legislature can see as many as 5,000 bills introduced. Of those 5,000, Governor Brown will probably sign 800 to 1,000 into law. That’s a lot of bills, even for the state with the longest-running legislative session in the country. It stands to reason, then, that some of the passed bills need a little cleaning up after the fact. Last year’s Senate Bill 1160 is one of those bills. And Senate Bill 489, introduced by Democratic senator Steven Bradford, is acting as its janitor.

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  • April 12, 2017

    The Power of Data

    Speaking to a panel of industry leaders at the California Workers’ Compensation Institute’s annual meeting last month, Department of Industrial Relations (DIR) director Christine Baker painted a rosy picture of regulation and reform. California’s workers’ comp system needs to be fixed – Baker acknowledged this. And she’s optimistic about making that happen. Her secret sauce? Data, data, data.

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  • April 11, 2017

    Major NCCI Changes to CPT Code 99359

    Among the most important adjustments to the 2017 physician fee schedule was the introduction of CPT Codes 99358 and 99359 as reimbursable codes. For all dates of service on or after March 1, 2017, workers’ comp providers across the state can bill for prolonged non-face-to-face services using the following CPT codes and guidelines:

    • 99358 – Prolonged evaluation and management service before and/or after direct patient care; first hour
    • 99359 (add-on code; list separately) – Each additional 30 minutes

    A new adjustment to the physician fee schedule restricts the amount of time for which these codes may be reported. Effective for all dates of service on or after April 1st, providers will be reimbursed for a maximum of one unit of 99358 and two units of 99359 of non-face-to-face time per patient on any given day. Previously, no limit existed for the amount of non-face-to-face time – and therefore the number of units of 99359 – that could be reimbursed per day.

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  • April 7, 2017

    Procedure Code 0232T and Independent Bill Review

    Late last month, we examined a particularly intriguing Procedure Code – 0232T – as part of our ongoing investigation into when reimbursements are established by report. For certain codes, including 0232T, the Physician Fee Schedule provides no established reimbursement amount, essentially allowing providers to set their own price – as long as they can back it up with proper supporting documentation.

    On top of that, 0232T is a Level III code, per the Current Procedural Terminology (CPT). This denotes a temporary code – its usage is being closely monitored by the CMS, and it will likely shed its temporary status at some point and become a Level I code with a set reimbursement amount. Until then, its “by report” reimbursements are frequently mishandled by claims administrators. The provider’s best recourse for this all-too-common scenario is submitting the bill for Second Review and attaching an Independent Bill Review (IBR) case as support.

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  • April 6, 2017

    Incident To Billing for CA Workers’ Comp

    The DaisyBill support team fields dozens of questions every day from workers’ comp providers across California. In recent weeks, we’ve taken to answering some of those questions here on our blog.

    Today’s topic? Billing for “incident to” services rendered by non-physician practitioners (NPPs). Contrary to popular belief, bills for services rendered by Physician Assistants or other NPPs may be reimbursed at 100% of the Official Medical Fee Schedule (OMFS). “Incident to” billing allows NPPs to bill with a physician’s National Provider Identifier (NPI) number – provided strict criteria concerning that physician’s supervision and availability are met.

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DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.

Drop us a line with any news you would like us to share or any issue that concerns you.

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