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Blog: Daisy News

News, data, & insights about workers' comp billing

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  • August 2, 2017

    Hospital Outpatient Prospective Payment System: C-APC Explained

    Yesterday on the blog, we described how Medicare’s adoption of Addendum B for the Hospital Outpatient Departments and Ambulatory Surgical Centers (ASCs) fee schedule moves the workers’ comp system toward bundled payments via the use of the status indicator J1. Today, we’ll examine instances when a complex procedure warrants additional reimbursement above the amount allowed by the single reimbursement of a primary service (J1). To accommodate these complex procedures, Medicare developed the Comprehensive APC (C-APC) payment methodology.

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  • August 1, 2017

    Hospital Outpatient Prospective Payment System: J1 Status Indicator Explained

    Late last year, the Division of Workers Comp (DWC) drastically changed the reimbursement calculations used for Hospital Outpatient Departments and Ambulatory Surgical Centers (ASCs). Effective for dates of service on or after 12/15/2016, the DWC amended the Official Medical Fee Schedule for outpatient and ASCs to conform to Medicare’s reimbursement methodology.

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  • July 28, 2017

    Kickbacks, Align, And The Burden Of Workers’ Comp Fraud

    Another week, another round of headlines about California workers’ comp fraud. The latest news? A massive U.S. Department of Justice bust of 412 people accused of defrauding state and federal programs. A handful of California defendants were singled out for their participation in pocket-lining referral or kickback schemes. It’s another sad story, and here’s the worst part: We’re used to seeing news like this now. Desensitized. Fraud is a shameful part of the system. But that doesn’t mean we shouldn’t fight it.

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  • July 27, 2017

    Schedule Released For DaisyBillaroo

    We’re just two months away from hosting our first workers’ comp billing conference, and we’re buzzing with excitement. We can’t wait to spend an entire day with leaders across the industry, learning how to create a world where workers’ comp bills speed through claims administration, payments are consistent and timely, and medical providers are no longer reluctant or unwilling to treat injured workers. We’ve just finalized our official conference schedule, and are delighted to share it with you now.

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  • July 25, 2017

    Comments Open For Revised Workers’ Comp Drug Formulary

    When state legislators proposed a workers’ comp drug formulary back in 2015, they knew it would take some time to work out all the kinks. But legislators may not have foreseen this much time. The implementation of the formulary has already been delayed, from July 1, 2017 to January 1, 2018. Now, the latest draft of the formulary rules are available for public comment – and voices across the workers’ comp system are chiming in with feedback.

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  • July 21, 2017

    Data! CPT 99358 Reimbursement

    The 2017 Physician Fee Schedule, officially adopted by the California Division of Workers’ Compensation (DWC) for dates of service on or after March 1, included the introduction of CPT codes 99358 and 99359 as reimbursable codes for non-face-to-face prolonged services such as record review. At the time, we warned that it was “likely that we will see a spike in denials of reimbursement for codes 99358 and 99359 in the coming months.” With over four months of data in the books, we decided to follow up on our prediction. (Spoiler: We were right.)

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  • July 20, 2017

    Reminder: Consultation Codes Not Payable Without Authorization

    Here’s an uncontroversial statement: Workers’ comp billing is constantly changing. In fact, rules and regulations change so quickly that many medical billers and providers struggle to keep up. Case in point? A recent support case our team received about billing using defunct consultation codes.

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  • July 18, 2017

    WC002 And You: PR-2 Reports and Reimbursement

    Every California workers’ comp provider that acts as a primary treating physician (PTP) for injured workers is familiar with the Treating Physician's Progress Report, also known as the Form PR-2. This required report is an integral part of every PTP’s job – primary treating physicians assigned to an injured worker must periodically file a PR-2 to report on their patient’s condition. These PR-2 reports are reimbursable at a rate of $12.29 using the California-specific procedure code WC002.  But reimbursement for the PR-2 is limited to once every 45 days – unless certain conditions in the California Code of Regulations apply.

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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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