February 7, 2017
DWC Adopts Changes to Physician Fee Schedule, Effective March 1
Late last month, the California Division of Workers’ Compensation (DWC) posted an order announcing their upcoming adjustment to the Physician and Non-Physician section of the Official Medical Fee Schedule (OMFS). The move was widely expected, as it allows the DWC to conform to the Medicare payment system, as required by Section 5307.1 of the California Labor Code.
The new fee schedule is effective March 1, 2017. Until that time, the 2016 Physician and Non-Physician Fee Schedule remains in effect.
February 3, 2017
Missed Connections: Indirect Routing of Workers’ Comp e-Bills
Today, we continue our multi-part examination of compliant e-billing for California workers’ comp bills. We kicked off the series with a primer, before diving into electronic EORs and EDI agent responsibilities. Now we turn to another issue that plagues providers across the state. When we speak to providers about the complexity of the workers’ comp e-billing system, a common error stands out: indirect routing of electronic bills.
January 31, 2017
EDI Agent Responsibilities in California Workers’ Comp
Over the past several weeks, we’ve taken a close look at various aspects of compliant e-billing for California workers’ compensation bills. Today, we turn our focus to the role of EDI agents such as DaisyBill. EDI agents are a crucial cog in workers’ comp billing – providers and claims administrators are not equipped to generate and receive the various electronic files that underpin the e-billing system. Choosing a good EDI agent – and knowing their responsibilities – is crucial to billing success.
January 27, 2017
Electronic EORs for Workers’ Comp: Timing and Compliance
This month, we’ve placed an emphasis on analyzing and explaining the vagaries of electronic billing for California workers’ compensation medical bills. The state’s Division of Workers’ Compensation (DWC) requires that providers who choose to submit electronic bills and all claims administrators follow the electronic billing rules set out in its 65-page Electronic Billing and Payment Companion Guide. To be clear, these rules are not optional. Yet some claims administrators demonstrate habitual non-compliance. Today, we zero in on the failure to return an electronic Explanation of Review (EOR).
January 24, 2017
Confusion and Running in Circles: AIG / MedRisk Incorrect Denials
A new scourge of incorrect denials is terrorizing DaisyBill providers. Over the past few weeks, numerous providers reported receiving incorrect and extremely confusing denials from MedRisk, a managed care provider network, for bills that were actually submitted to AIG. The MedRisk denials state: “Not currently a participating MedRisk provider. Please submit bill directly to insurance carrier.”
But in every reported incident, the providers had submitted the denied bills directly to AIG, the correct carrier for the particular patient and injury.
January 24, 2017
A Timely Reminder: SB 1175 Brings Speed to Workers’ Comp
Early in 2017, a piece of workers’ comp legislative reform is making its presence known to California claims administrators and providers. No, we’re not talking about Senate Bill 1160 again – though that bill is certainly worthy of your attention. We’re talking about Senator Tony Mendoza’s other piece of landmark reform. We’re talking about Senate Bill 1175.
January 19, 2017
The Seven Reasons for Rejected Workers’ Comp e-Bills
Last week in this space, we published an introductory primer on compliant workers’ compensation e-billing. Since its introduction in 2012, electronic billing has consistently offered providers a fast, efficient, and reliable avenue for processing their workers’ comp bills. This week, we examine rejected e-bills – why this happens, what it means, and how rejections actually benefit the workers’ comp system.
January 16, 2017
New Original Bill Requirement Raises Lien Questions
On a typically overcast San Francisco morning earlier this month, the California Workers’ Compensation Appeals Board (WCAB) held a public hearing. The subject? Proposed regulations for the implementation of Senate Bill 1160’s lien reforms. For an issue with such long-reaching implications, the audience was surprisingly sparse – only two speakers rose to present statements. Despite the public hearing, details about the new Division of Workers’ Compensation (DWC) lien forms are still scarce. And one question in particular has us perplexed: When it comes to filing a lien, what, exactly, constitutes an “original bill”?