Blog: Daisy News

News, data, & insights about workers' comp billing

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  • July 17, 2018

    Acupuncture Remains Payable for CA Work Comp, Despite MUE

    The Centers for Medicare and Medicaid Services (CMS) recently released a Medically Unlikely Edit (MUE) designating acupuncture billing codes 97810 through 97814 non-payable, effective July 1, 2018. However, these codes remain reimbursable under California’s Official Medical Fee Schedule (OMFS) for workers’ comp services.

    While National Correct Coding Initiative (NCCI) edits, including MUEs, are incorporated into the OMFS automatically “by reference,” specific OMFS rules designating 97810-97814 reimbursable take precedence.

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  • July 16, 2018

    CA DWC Seeks Public Comment on MTUS Updates

    California’s Division of Workers’ Compensation seeks to update the state’s Medical Treatment Utilization Schedule (MTUS). The DWC wants to align the MTUS with recent and not-so-recent guidelines from the American College of Occupational and Environmental Medicine (ACOEM).

    The Division will hold a public hearing regarding the proposed updates on Wednesday, July 18 at 10 am.

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  • July 13, 2018

    Qualifications, Schmualifications: CA Gov Appoints High School Classmate to WCAB

    California Governor Jerry Brown recently appointed former chorus director Juan Pedro Gaffney to the Workers’ Compensation Appeals Board (WCAB).

    Gaffney was a classmate of Governor Brown’s at St. Ignatius College Prep in San Francisco.

    A veteran of the San Francisco choir scene, 80-year-old Gaffney brings to the WCAB a lifetime of experience in music education. However, Gaffney is not without regulatory credentials; he served a yearlong stint with the state’s Alcoholic Beverage Control (ABC) department.

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  • July 12, 2018

    RFA for Emergency Treatment in California Workers’ Comp

    First, let’s be clear that providers never have to wait for authorization before providing emergency treatment for an acute medical condition.

    Never.

    However, the provider must ultimately obtain authorization for all services, even when the injury is time-sensitive or a medical emergency. While the authorization and utilization review (UR) process should never be an obstacle to such treatment, there are mandated procedures and timelines for submitting the official Request for Authorization (RFA).  

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  • July 11, 2018

    Workers’ Comp Billing Tip: Use a Detailed Cover Sheet

    California’s Division of Workers’ Compensation (DWC) has many strict requirements as to what constitutes a “complete” bill for the treatment of injured workers. But given the complexity of workers’ comp billing and payment rules, even a bill that’s complete by DWC standards could use a little extra clarification.

    That’s why DaisyBill recommends providers include a cover sheet —  like the ones we provide for our billing clients — with all bills.

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  • June 29, 2018

    CA OMFS Update: Physician Services and DMEPOS

    California’s Division of Workers’ Compensation (DWC) posted update orders to two sections of the Official Medical Fee Schedule (OMFS), both effective July 1, 2018.*

    The DWC ordered changes to the Physician and Non-physician Practitioner fee schedule, as well as the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule.

    The orders affect reimbursement for 5 codes in total, 4 for Physician Services and one for DMEPOS.

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  • June 27, 2018

    CA Providers: Appeal Denials for Treatment Preceding Liability Decision

    Recently, we pointed out that California employers are liable for treatment that precedes the claims administrator’s decision to accept or deny a workers’ comp claim. Before making this liability decision, the employer is always responsible for medically appropriate treatment up to $10,000.

    If the employer’s claims administrator denies a bill for treatment when the treatment was provided before the liability decision, the provider should appeal for full payment — even if liability is subsequently denied.

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  • June 22, 2018

    Conditional Authorization: How MPNs Cheat Workers’ Comp Providers

    Medical Provider Networks (MPNs) are a drag on California workers’ compensation. Nominally designed to help employers control costs, MPNs rarely achieve more than throwing up obstacles to the treatment of injured workers, and cheating providers out of reimbursement — even for authorized services.

    Authorization, of course, is supposed to be final. But when claims administrators grant authorization on the condition that the treating physician be included in the employer’s MPN, they create opportunities to deny payment.

     

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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.