February 24, 2017
Claim to Fame: 2016's Elite California Claims Administrators
Every quarter, we analyze and publish data on California claims administrators and time to payment for electronic workers’ comp bills. These reports provide a valuable snapshot of compliance – and non-compliance – throughout the industry. In recent days, we’ve examined time to payment for original electronic medical treatment and medical-legal bills. Today, we combine the two bill types to uncover the cream of the crop. Four claims administrators outshine all others in terms of speed.
February 23, 2017
2017 California-Specific Code Reimbursements Updated
Earlier this month, we reported on the upcoming changes to the Physician and Non-Physician Services section of the Official Medical Fee Schedule (OMFS). The California Division of Workers’ Compensation adopted these changes to conform to the Medicare payment system, and the changes roll into effect on March 1, 2017. New conversion factors and an updated RVU file combine to change the reimbursement amounts for all procedure codes – we covered the changes to the twenty most commonly-used Physician and Non-Physician HCPCS in our analysis. Lost in the shuffle of these changes are another critical shift: Changes to the California-specific codes laid out in CCR § 9789.12.14.
February 22, 2017
Claims Administrator Days to Payment for 2016 Med-Legal Bills
Last week on the blog, we published data on the top 20 California claims administrators who processed original electronic medical treatment bills on behalf of our clients in 2016. The takeaway? Electronic billing for California workers’ comp is really, really fast. Today, we turn our eye on a different type of workers’ comp bill – one for medical-legal services. Unlike medical treatment bills, no California regulations exist to govern – or even condone – electronic billing for medical-legal evaluation. Yet electronic billing still yields astonishingly fast payment for medical-legal bills – to say nothing of its environmental impact.
February 17, 2017
2016 Claims Administrator Days to Payment: Liberty Mutual to AmTrust
If you’re a regular visitor to our blog, you’ll recognize a common refrain: Electronic billing for California workers’ comp is fast, efficient, and easy. How fast, exactly? California Labor Code § 4603.4 makes it pretty clear: “Payment for medical treatment provided or prescribed by the treating physician… shall be made with an explanation of review by the employer within 15 working days after electronic receipt” of an electronic bill.¹
Now that all of our data from 2016 is officially in the books, let’s take a closer look at which claims administrators beat this fifteen-day requirement for original medical treatment bills – and which ones left something to be desired.
February 16, 2017
Place of Service and Work Comp Bills: Oh, the Places You'll Code
The early weeks of 2017 saw a torrent of significant changes to the California workers’ comp system. Last week on the blog, we singled out the addition of a new Place of Service Type and Code for telehealth as an intriguing component of the forthcoming Physician and Non-Physician section of the Official Medical Fee Schedule (OMFS). Today, we take a closer look at what a Place of Service is and what it means for providers.
February 14, 2017
Late Bill Payment? Collect Penalty and Interest.
The passage of Senate Bill 1175 last autumn placed a lot of emphasis on the timely filing of California workers’ comp bills. But what about timely payment? Claims administrators must also meet billing deadlines. And if they miss those deadlines, they owe providers self-executing penalty and interest.¹ Claims administrators often ignore this requirement altogether, but providers do have a recourse.
February 9, 2017
New Fee Schedule Adds Place of Service Code for Telemedicine
This week, we provided an overview of the upcoming changes to the Physician and Non-Physician section of the Official Medical Fee Schedule (OMFS). Today, we turn our attention to another intriguing update included in the forthcoming Physician and Non-Physician Fee Schedule: The new Place of Service Code for telehealth.
February 8, 2017
Non-Face-To-Face Service Reimbursable in 2017 (CPT Codes 99358, 99359)
Yesterday in this space, we examined the new order from the California Division of Workers’ Compensation (DWC) announcing the upcoming adjustment to the Physician and Non-Physician section of the Official Medical Fee Schedule (OMFS). The adjustment goes into effect on March 1, 2017, and with it come a variety of new CPT codes. Today, we’re focusing on two of these codes in particular: 99358 and 99359. Each allow physicians or nonphysician practitioners to bill for prolonged services that are not face-to-face.