Blog: Daisy News

News, data, & insights about workers' comp billing

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  • October 12, 2017

    Just in Time: RFA and Utilization Review Timeframe Requirements

    In California, proper authorization is one of the most important factors for compliance in workers’ comp billing and payment. Legally, “authorization” is the insurer’s acceptance of liability to pay for treatment. The request for authorization (RFA) and utilization review (UR) process informs everything that comes later in the billing and payment cycle.

    Everyone involved needs to get it right.

    The RFA and UR process is the means by which the insurer and the treating physician agree on the medical necessity of treatment. It is how injured employees get treated and back to work, and how providers obtain proper reimbursement. The rules and regulations regarding this process are vast and complex. That’s why we’ve created this handy guide, including our table of RFA and UR Timeframe Requirements mandated by California law.

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  • October 11, 2017

    Stay Compliant: An Update on Modifier 93 for Exams Requiring Interpreter Services

    Some insurers are making unreasonable demands regarding the application of modifier 93. Medical-legal providers use modifier 93 to bill for the extra time required to conduct an examination with a language interpreter. An important and necessary step, interpretation services ensure accurate communication between patient and doctor —  but at the cost of valuable, reimbursable time.

    According to provider advocates, certain insurers are wasting doctors' time by requiring redundant and unnecessary justifications for using this modifier.

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  • October 6, 2017

    The Provider’s Burden: Appealing Improper Reimbursements

    Worker’s comp billing is hard enough.

    Four years ago, California passed strict requirements that providers must follow to appeal incorrect reimbursements from insurers. These requirements are burdensome to the point of being prohibitive — and insurers know it. Since most providers lack the resources to appeal incorrect payments, insurers and their claims administrators can underpay without fear of consequence.

    With the burden of proof on their shoulders, providers remain vulnerable to the systemic abuse enabled by the Second Review process.

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  • October 5, 2017

    In Case You Missed It: United Airlines Changes TPA

    Self-insured employer United Airlines recently transferred workers’ compensation claims from Gallagher Bassett to a new third-party administrator. Sedgwick Claims Management, Inc. now handles claims for the airline. The switch became effective October 1.

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  • October 4, 2017

    DWC Reconsiders Lien Declarations Filed July 2-3

    When the California Division of Workers’ Compensation (DWC) mandated that lien claimants must file declarations asserting the validity of their liens, they weren’t kidding around. In August, the DWC dismissed over 292,000 previously filed liens for failure to file retroactive Supplemental Lien Declarations by the established deadline of July 1, 2017.

    Now, it appears the DWC may change its mind regarding some of those dismissals. This week, the DWC announced that it will lift the dismissal notice on liens for which claimants filed the Supplemental Lien Declaration on July 2 or 3.

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  • October 3, 2017

    DaisyBillaroo Conference on Workers’ Comp Billing and Payment a Smash!

    We had a fantastic time hosting our very first DaisyBillaroo Conference, the only conference devoted exclusively to California workers’ comp billing and payment. What a blast! With work comp professionals from every area of the field in attendance, we made work comp a little less intimidating for everyone.

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  • September 22, 2017

    Modifier 93 for Examinations Requiring Interpreter Services: A DaisyBill Guide

    Interpreters play a crucial role in workers’ comp treatment. By negating language barriers, interpreters remove a massive source of friction from an already friction-burdened field. When it comes to billing and payment, it’s important for providers to know how to obtain proper reimbursement when a visit requires an interpreter’s services.

    Here’s what providers need to know in order to properly apply modifier 93.

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  • September 20, 2017

    OMFS Update Alert

    The California Division of Workers’ Compensation (DWC) ordered new adjustments to the Official Medical Fee Schedule (OMFS), effective for services rendered on or after October 1, 2017. The order updates fees for Physician and Non-Physician Practitioner services— including a status code change that, in effect, eliminates reimbursement for CPT 93668.

    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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