Blog: Daisy News

News, data, & insights about workers' comp billing

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  • February 16, 2018

    Authorization/Utilization Review: Why Peer-to-Peer Calls Are a Bad Idea

    There’s been lots to say about authorization and utilization review (UR) this year, especially given the major changes to the process. However, one UR rule that remains the same in 2018 also remains sadly overlooked: those conducting UR on behalf of employers or insurers should not telephone providers for further information needed to make a UR decision.

    This practice is non-compliant, wasteful, and has the potential to compromise the integrity of a decision to approve, modify, or deny the requested treatment.

    Read more →

  • February 15, 2018

    How to Bill for Physician-Dispensed Pharmaceuticals

    Payments for physician-dispensed drugs are some of the most misunderstood — and incorrectly denied — in workers’ compensation billing. Too often, the employer or insurer’s claims administrator denies payment based on inapplicable Physician Fee Schedule status code rules. Beyond that, the Division of Workers’ Compensation (DWC) and state legislature seem keen to discourage physician dispensing.

    Regardless, physicians have permission to dispense pharmaceuticals, and to bill according to the Pharmacy Fee Schedule.

    Read more →

  • February 13, 2018

    Providers: Don’t Accept 2017 OMFS Reimbursement Rates for 2018 Dates of Service

    Lately, we’ve noticed a problem. Some claims administrators are reimbursing providers incorrectly. Instead of paying the higher 2018 Official Medical Fee Schedule (OMFS), claims administrators are paying last year’s lower 2017 reimbursement rates for services rendered this year. This is not acceptable. In these cases, it’s up to the provider to protect their revenue.

    Fortunately, there are tools for providers to calculate — and obtain — proper reimbursement.

    Read more →

  • February 9, 2018

    What’s New for Workers’ Comp in 2018: CA Senate Bill 1160

    In 2016 California passed Senate Bill 1160, which heralded significant workers’ compensation reform. SB 1160 outlined major changes to authorization, utilization review, lien filing, billing deadlines, and more. Some changes took effect in 2017, while others are newly effective, as of January 1 this year.

    Let’s take a look at the major changes SB 1160 brings to workers’ comp in 2018.

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  • February 8, 2018

    Treatments That Do NOT Qualify for Automatic Authorization in Workers’ Comp

    Automatic authorization for California workers’ comp is in effect, but not all treatments qualify.

    In fact, the Division of Workers’ Compensation (DWC) has specifically barred certain treatments from automatic authorization. In these cases, the usual Request for Authorization (RFA) and prospective utilization review (UR) remains required — with some exceptions. Since many of our recent webinar attendees asked about specific services, we thought a review of ineligible treatments was in order.

    Read more →

  • February 7, 2018

    “Automatic” Authorization, but Denied Bill? How to Appeal the Denial

    The new “automatic” authorization process for workers’ comp is in effect, as of January 1. We’ve discussed this new system extensively on our blog and in our recent webinar, covering everything from eligibility to timeliness to new utilization review requirements. But what happens if the employer or insurer’s claims administrator denies payment for automatically authorized services rendered? Does the usual second review appeal process apply?

    In short, authorized is authorized, automatically or otherwise — but in this case, there is a twist.

    Read more →

  • February 2, 2018

    Ultimate 2018 Workers’ Compensation Reimbursement Cheat Sheet

    Here it is: your complete, downloadable go-to resource for California workers’ comp reimbursement rates in 2018. This guide features the Official Medical Fee Schedule (OMFS) reimbursements for the procedure codes providers use most, including:

    • Evaluation & Management (E/M)
    • Surgery
    • Radiology (Professional Services)

    ...and more, plus reimbursements for medical-legal services! All OMFS reimbursements are effective for dates of service on or after January 1, 2018. 

    Read more →

  • February 1, 2018

    Fast-Track UR for Workers’ Comp: New Rules for Entities Conducting UR

    We spent the last few weeks bringing readers up to speed on the new “automatic” authorization and “fast-track” utilization review (UR) process for workers’ comp. While we’ve explored in detail the new requirements for providers, there are also newly mandated standards for the entities that conduct UR. These entities ultimately determine whether the employer or insurer’s claims administrator authorizes a given treatment.

    This year’s authorization overhaul includes new rules both to encourage consistency in UR decisions and to discourage financially incentivized bias. Today, we explore those rules and their potential impact on the treatment of injured workers.

    The new authorization rules became effective January 1, 2018. DaisyBill hosted a free, comprehensive webinar on automatic authorization and fast-track UR on February 6.

    Read more →

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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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