Blog: Daisy News

News, data, & insights about workers' comp billing

Header illustration blog
  • June 21, 2018

    Modifier 26 for Workers’ Comp Professional Services

    Modifiers play a vital role in California workers’ compensation billing. But for all the value they add in allowing providers to more precisely specify the services rendered, modifiers also add something else: another layer of complication.

    As any workers’ comp professional can tell you, complication equals potential friction. That’s why it’s so important to know when to apply (and when not to apply) modifiers. One modifier on which providers often stumble is Modifier 26 for the professional component of a medical service. 

    Read more →

  • June 20, 2018

    Data Show MPNs Do Not Benefit Employers

     

    Medical Provider Networks (MPNs) allow employers to limit where employees may seek treatment for work-related injuries. Theoretically, the purpose of MPNs is to direct care with the goal of containing employer costs for treatment.

    But preliminary findings from the California Workers’ Compensation Institute (CWCI) show that when employers use MPNs to direct care, the average savings per claim is next to nothing. Meanwhile, a study from the Journal of Occupational and Environmental Medicine (JOEM) concluded that directing employee care actually costs employers more than it saves, since more frequent attorney involvement raises the cost per claim for directed care.

    Frankly, we’re not surprised. Given existing authorization and billing rules, MPNs are a perfect example of how the opacity of workers’ comp leaves unknowing employers susceptible to redundant, pointless expenses.

     

    Read more →

  • June 15, 2018

    Clearinghouses Under the Microscope: CorVel Corporation

    Most claims administrators lack the technology to process electronic bills from providers. Instead, these claims administrators rely on clearinghouses. Since DaisyBill has direct access to all 5 California clearinghouses, we’re uniquely qualified to evaluate and compare the performances of each. With this series, we take a look at the value each clearinghouse adds to (or subtracts from) workers’ comp.

    To kick this clearinghouse series off, we’ll start with the most efficient kind of clearinghouse: no clearinghouse at all.

    Corvel Corporation is not a clearinghouse, per se. But CorVel is something even more important: a claims administrator that essentially functions as its own clearinghouse, directly accepting and processing providers’ e-bills. This vastly reduces complications and potential friction for providers and employers, both of whom benefit from CorVel’s integrated approach.

    We applaud any time a claims administrator’s practices make things simpler for all concerned. By taking on the duties of a clearinghouse, CorVel sets a new standard of efficiency.

     

    Read more →

  • June 14, 2018

    Discount Dangers: Providers Cheated for PR-2 Reports

    Discount Dangers is a DaisyBill series on the ways some discount contracts unscrupulously reduce providers’ reimbursements. With this series we shine a light on the worst practices, to help providers fight back.

    It seems like claims administrators really, really want to cheat California workers’ comp providers by reducing payment for the Treating Physician’s Progress Report, or PR-2.

    First, we noticed an unsettling pattern in which claims administrators purposely underpay providers for PR-2 reports by using outdated reimbursement rates for WC002, the workers’ comp procedure code California providers use to bill for PR-2 reports.

    Now, claims administrator practices compel us to point out another frequent source of WC002 underpayment: network discount contracts.

    Read more →

  • June 13, 2018

    Liable by Default: Failure to Deny A Claim Means the Claim is Accepted

    In California, when it comes to accepting or rejecting an injured employee’s claim, the claims administrator that neglects to issue a decision is still effectively making a decision.

    A recent Workers’ Compensation Appeals Board (WCAB) trial serves as a reminder that legally, claims administrators must timely either accept or reject liability. When the claims administrator fails to issue a timely decision, the claim is presumed accepted— even when the claim is deniable on its merits.

     

    Read more →

  • June 8, 2018

    CorVel Error: Incorrectly Reimbursed ASC Services

    CorVel Corporation, a national third-party administrator, incorrectly reimbursed multiple California workers’ comp providers for Ambulatory Surgical Center (ASC) services, at rates established by Medicare’s ASC fee schedule.

    Medicare ASC reimbursement rates are not applicable to California workers’ comp. Fortunately, DaisyBill clients alerted us to the problem.

    We reached out to CorVel, whose representatives acknowledged the error. Working proactively with DaisyBill, CorVel updated their payment practices and agreed to reprocess all bills with dates of service 3/15/2018 through 5/22/2018.

    Where applicable, CorVel will send providers additional payment for incorrectly processed bills.

    Read more →

  • June 7, 2018

    Workers’ Comp Billing Error: Resubmit or Request Second Review Appeal?

    Mistakes happen.

    When a provider accidentally submits an original bill that contains an error, taking the appropriate action is key to avoiding further delay in reimbursement. Often, providers attempt to submit revised or corrected bills, rather than waiting to submit a second review appeal.

    Theoretically, submitting a corrected bill can seem like the appropriate option in some situations. In reality, the process of resubmitting a corrected bill is undermined by poorly constructed regulations, and is completely unreliable — even pointless.

    Read more →

  • June 6, 2018

    Do Not Send RFAs With Bills

    When treating an injured worker, a provider must fax the Request for Authorization (RFA) to the fax number designated by the claims administrator. RFAs should almost never be sent with a bill.

    Often claims administrators delegate bill review and utilization review (UR) to different entities. A provider who fails to fax RFAs to the correct destination is out of compliance with RFA regulations which require providers to fax these requests using the fax number issued by the claims administrator.

    Read more →

  • ← PREVIOUS NEXT →

Search results for:

About Us Logo small inverted

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.