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News, data, & insights about workers' comp billing

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  • March 22, 2017

    2017 Fee Schedule Changes Again – Learn How to Keep Up

    Well, that didn’t take long. Earlier this month – only eight days after officially adopting the Quarter 1 Physician Fee Schedule – the California Division of Workers’ Compensation (DWC) issued a Newsline announcing the next wave of changes to the Official Medical Fee Schedule (OMFS).¹ Somewhat surprisingly, there are several major reimbursement changes facing California workers’ comp providers for dates of service on or after April 1, 2017. But there’s good news, too – our development team unleashed a brand new tool designed to ensure that you never miss a work comp reimbursement change again.

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  • March 21, 2017

    The 5 Point Checklist for CPT Codes 99358 and 99359

    The 2017 Physician Fee Schedule, officially adopted by the California Division of Workers’ Compensation (DWC) for dates of service on or after March 1, included a number of changes that differentiate it from its 2016 counterpart. Perhaps the most intriguing of these changes was the introduction of CPT codes 99358 and 99359 as reimbursable codes for non-face-to-face prolonged services such as record review. Not coincidentally, these codes are also the subject of our upcoming March webinar.

    Over the past three years, these non-face-to-face services were often difficult for claims administrators and providers to negotiate on a case-by-case basis. The built-in CPT guidelines and reimbursements that come with the new payable status are good for the entire workers’ comp community.

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  • March 16, 2017

    Required Supporting Documentation for California Workers’ Comp Bills

    Yesterday on the blog, we broke down the differences between the California Division of Workers’ Compensation (DWC) forms PR-3 and PR-4 for Primary Treating Physicians. Today, we broaden our focus to include other required supporting documents for workers’ comp bills, along with the circumstances under which each should be used.

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  • March 15, 2017

    Understanding DWC Forms PR-3 and PR-4

    The California Division of Workers’ Compensation (DWC) produces a full slate of standardized forms to cover all aspects of the workers’ compensation system – everything from medical treatment to audit complaints. Today, we’re honing in on the Primary Treating Physician (PTP) Reports PR-3 and PR-4. When the PTP determines that the injured employee's condition is both permanent and stationary, the PTP must issue either a PR-3 or PR-4 report to the claims administrator within 20 days from the date of examination of the injured employee.

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  • March 14, 2017

    “By Report” Reimbursements Explained: Part 1

    One of DaisyBill’s biggest goals is to help medical professionals across California manage the nuances of the Official Medical Fee Schedule (OMFS). To that end, we spill a lot of ink covering changing workers’ comp reimbursements here on our blog. Beyond that, our Work Comp Wizard, around which every other DaisyBill product is built, features an always-accurate OMFS Calculator at its core. But sometimes that isn’t even enough.

    In rare instances, the Physician Fee Schedule fails to provide a reimbursement amount for valid procedure code with directions that the reimbursement is established By Report, also known as a “BR” reimbursement. For these By Report procedure codes, providers may bill – and expect to be reimbursed – at any amount that they establish. But there’s a catch: The billed value must be deemed “reasonable” for the code in question.

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  • March 9, 2017

    QME Report Filing Deadlines Under DWC Scrutiny

    Per a recent report on the California Society of Industrial Medicine and Surgery (CSIMS) website, the Division of Workers’ Compensation (DWC) is taking new measures to enforce timely filing deadlines for medical-legal reports. Though the extent of any potential penalties remains ambiguous, CSIMS writes that the DWC Medical Unit has issued warnings to qualified and agreed medical evaluators (QMEs and AMEs) of “possible enforcement actions” should they fail to “serve medical-legal reports in a timely manner.”¹

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  • March 8, 2017

    SCIF Denying Evaluation and Management Codes

    State Compensation Insurance Fund (SCIF) recently unveiled a “new program” with regard to reimbursement for billed Evaluation and Management (E/M) Codes. Per a conversation with a SCIF representative, if bill review determines that the level of billed E/M service is not justified by the supporting documentation, SCIF will now deny the E/M code and remit $0 in payment.

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  • March 7, 2017

    Telehealth Medicare Restrictions Not Adopted by DWC

    Several weeks ago, we covered the emerging field of telehealth and its powerful ability to alter the California workers’ comp landscape. Reimbursement for these telehealth services was clarified by the recent adjustment to the Physician and Non-Physician Fee Schedule, effective for 2017 dates of service on or after March 1. Telehealth services are now assigned a dedicated place of service code, along with a new array of reimbursable CPT codes. Furthermore, the DWC has not adopted Medicare’s restrictions to telehealth, meaning that any capable California provider is now able to render these services to any injured worker.

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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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