Blog: Daisy News

News, data, & insights about workers' comp billing

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  • May 3, 2018

    OMFS Update: DWC Orders Changes to Pathology/Clinical Lab Fee Schedule

    The DWC posted an update order bringing the Pathology and Clinical Laboratory section of the Official Medical Fee Schedule (OMFS) into line with Medicare.

    The order removes three Current Procedural Terminology (CPT) codes from the schedule, adds one new CPT code, and significantly increases reimbursement for one CPT code. Importantly, this update is RETROACTIVE to dates of service April 1, 2018.

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  • May 2, 2018

    DME: Invoice Not Required for (Most) Durable Medical Equipment

    Too often, we see claims administrators demand extraneous paperwork from providers, adding unnecessary friction to the workers’ comp billing and payment process. One example is requests for invoices for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).

    Some claims administrators insist that an invoice accompany the bill to substantiate charges for DMEPOS. With a single exception, this is an incorrect demand.  

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  • April 27, 2018

    CA Workers' Comp Alert: MTUS Drug Formulary Update

    California’s Division of Workers’ Compensation (DWC) ordered an update to the state’s drug formulary, effective May 15.

    The update adds 20 drugs to the formulary and removes 12, bringing the total listed drugs from 275 to 283. The update also includes one change in exemption status, changes to “special fill” rules, and changes to application recommendations for several drugs.

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  • April 25, 2018

    3 Facts About Automatic Authorization for Workers’ Compensation

     

    Recently, a DaisyBill client reached out with questions regarding automatic authorization. The source of the confusion was a slideshow presentation from the California Coalition on Workers’ Compensation (CCWC)’s 15th annual conference, held last July. The presentation contained no outright falsehoods, but used puzzling language and left out a key point regarding billing deadlines.

    Tellingly, the conference was sponsored by Sedgwick, the third-party claims administrator. Given claims administrators’ interest in keeping providers in the dark regarding the new rules, we thought we’d clear up some confusion.

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  • April 23, 2018

    Filter and Search CA MTUS Drug Formulary With New Tool

     

    California’s new drug formulary isn’t exactly user-friendly. For that reason, we developed a new tool to make authorization for pharmaceuticals much, much easier.

    The drug formulary, included in the Medical Treatment Utilization Schedule (MTUS) since January 1 of this year, is simply a massive list of available drugs, each designated either “exempt” from utilization review or “non-exempt.” The list, as provided by the DWC, cannot be filtered or searched in any way.

    So we fixed it.

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  • April 20, 2018

    York Risk Services Must Treat CA Providers Better

    DaisyBill strives to make workers’ comp billing and payment smoother for both providers and payors.

    We work with thousands of payors, including employers, insurers, and third-party administrators across California to electronically submit over 1.25 million compliant bills annually. We’ve seen good behavior and bad from payors. But we’ve never heard of a more frustrating experience than the one providers endure with York Risk Services — an experience we’ve endured ourselves.

    When York fails to respond to bills for treating injured employees, providers report facing an infuriating uphill battle to track those bills. We strongly encourage medical billers to alert their providers about York’s unnecessary payment friction.

    York can (and should) do better to help providers.

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  • April 19, 2018

    Audit Complaints Show Workers’ Comp Providers Face Uphill Battle

    In California, workers’ compensation providers face a labyrinth of billing and payment rules, and struggle with an enforcement structure that favors employers and insurers. As our clients’ experiences demonstrate, provider compliance does not guarantee proper reimbursement.

    Each year DaisyBill clients submit thousands of audit complaints to the DWC regarding  employers’ and insurers’ non-compliant payment behaviors. Subsequent action from the DWC can be inconsistent, however, demonstrating the disadvantage providers face.

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  • April 13, 2018

    “By Report” Billing Codes: Best Practices for Proper Reimbursement

    When the Official Medical Fee Schedule (OMFS) assigns the reimbursement for a procedure code as “By Report” (BR), establishing the correct payment amount is one of the trickier aspects of California workers’ compensation billing.

    For codes designated a BR reimbursement, the Division of Workers’ Compensation (DWC) does not assign a specific reimbursement amount. Instead, the provider must determine and request a reasonable amount for these procedures from the employer or insurer’s claims administrator.

    To help providers determine and obtain the correct reimbursement for these codes, we’ve put together this “By Report” reimbursement guideline.

    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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