Blog: Daisy News

News, data, & insights about workers' comp billing

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  • February 15, 2018

    How to Bill for Physician-Dispensed Pharmaceuticals

    Payments for physician-dispensed drugs are some of the most misunderstood — and incorrectly denied — in workers’ compensation billing. Too often, the employer or insurer’s claims administrator denies payment based on inapplicable Physician Fee Schedule status code rules. Beyond that, the Division of Workers’ Compensation (DWC) and state legislature seem keen to discourage physician dispensing.

    Regardless, physicians have permission to dispense pharmaceuticals, and to bill according to the Pharmacy Fee Schedule.

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  • February 13, 2018

    Providers: Don’t Accept 2017 OMFS Reimbursement Rates for 2018 Dates of Service

    Lately, we’ve noticed a problem. Some claims administrators are reimbursing providers incorrectly. Instead of paying the higher 2018 Official Medical Fee Schedule (OMFS), claims administrators are paying last year’s lower 2017 reimbursement rates for services rendered this year. This is not acceptable. In these cases, it’s up to the provider to protect their revenue.

    Fortunately, there are tools for providers to calculate — and obtain — proper reimbursement.

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  • January 30, 2018

    Work Comp Billing: How to Bill for P&S Reports (Do Not Use ML102!)

    Some providers mistakenly believe that Permanent and Stationary (P&S) reports are billable with medical-legal billing code ML102 for Basic Comprehensive Medical-Legal Evaluations. This is incorrect and noncompliant. Worse, the Division of Workers’ Compensation (DWC) can deem billing P&S reports with ML102 an act of fraud, with potentially serious legal consequences.

    Providers, be sure to stay compliant. Here’s how to bill properly for P&S Reports.

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  • January 3, 2018

    Med-Legal Billing: How to Obtain Reimbursement for Diagnostic Tests

    The conditions under which claims administrators must pay medical-legal doctors for diagnostic tests are specific and narrow. To ensure reimbursement, it’s important to know the rules.

    Medical-legal billing has unique regulatory snags that only the intersection of medicine and law could produce. Among those complications is reimbursement for diagnostic services like x-rays and laboratory services. In some cases these diagnostics services are not reimbursable without prior authorization by the claims administrator.

    Know the regulations, and use the standard language included in this blog to denial-proof your medical-legal bill.

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  • December 7, 2017

    CA Appeals Court: Providers Do Not Need to Return Overpayments

    Our recent blog post on overpayments generated a number of requests from providers for verification that, absent fraud, refunds are not due to employers or insurers, even in cases where the claims administrator overpaid. In that post, we explained that there are no legislative statutes addressing the return of funds; therefore, legally, no refunds are due.

    We wrote that previous post in response to some reported aggressive behavior from claims administrators attempting to recover monies already paid, including threats of legal action against providers.

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  • December 1, 2017

    2018 Authorization/Utilization Review: Major Changes Effective 1/1/2018

    Senate Bill 1160 makes significant changes to the authorization and utilization review (UR) process, starting in 2018. New “fast-track” UR takes effect on January 1.

    Fast-track UR bypasses prospective utilization review by automatically approving the required treatment in many — but not all — circumstances. A set of specific conditions must exist in order for providers to bypass the usual UR process. The new process also changes the rules regarding authorization and billing for these encounters.

    DaisyBill hosted a free webinar on fast-track UR on February 6.

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  • November 30, 2017

    Billing Tip: Cumulative Trauma Date of Injury

    Compliant billing is crucial for providers to obtain proper reimbursement for treating injured workers. One important, but occasionally tricky, aspect of compliant billing is filling out the form correctly. The billing forms require the correct information, or the bill risks denial.  

    Case in point: The correct way to report the official Date of Injury (DOI) for a cumulative trauma injury is to report the start date of the cumulative trauma.

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  • November 29, 2017

    Outpatient/ASC Coding: J1 Combinations and C-APC

    No one said work comp billing was easy. In fact, we say just the opposite, all the time. That’s why we created DaisyBill, and why we do our best to offer as many helpful tips and tricks as possible through this very blog. One issue that’s come up repeatedly in recent months is when to apply the Comprehensive APC (C-APC) Status Indicator.

    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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