Blog: Daisy News

News, data, & insights about workers' comp billing

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  • April 13, 2018

    “By Report” Billing Codes: Best Practices for Proper Reimbursement

    When the Official Medical Fee Schedule (OMFS) assigns the reimbursement for a procedure code as “By Report” (BR), establishing the correct payment amount is one of the trickier aspects of California workers’ compensation billing.

    For codes designated a BR reimbursement, the Division of Workers’ Compensation (DWC) does not assign a specific reimbursement amount. Instead, the provider must determine and request a reasonable amount for these procedures from the employer or insurer’s claims administrator.

    To help providers determine and obtain the correct reimbursement for these codes, we’ve put together this “By Report” reimbursement guideline.

    Read more →

  • March 28, 2018

    PR-2 Report Made Easier: Fillable and Downloadable PR-2 Report Form

    Last month, we highlighted the importance of the Treating Physician’s Progress Report, which providers must use to document services rendered. This crucial bit of paperwork, on Form PR-2 (or the narrative equivalent thereof), is not only separately billable. It substantiates every charge on a given bill, helping ensure correct reimbursement.

    Since then, we’ve gotten several requests for a downloadable, fillable PR-2 form for providers to use. Well, you ask — we deliver!

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  • March 23, 2018

    Automatic Authorization: Late Bill Submission Does Not Bar Payment

    cog-single-gear-GIF-approve.gifWorkers’ comp providers, be warned: payors are incorrectly denying bills for automatically authorized services due to untimely submission.

    Untimely submission is not grounds for denial of payment under California’s new automatic authorization system. While the deadlines for bill submission are much shorter for automatically authorized services, no provision whatsoever bars payment when providers miss said deadlines.

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  • March 13, 2018

    How Workers’ Comp Payments By Credit Card Hurt CA Providers

    Accepting credit cards from patients for co-pays and deductibles is one thing, but it makes zero financial sense for California providers to accept credit card payments from claims administrators for workers’ comp patients.

    This practice may be convenient for the payor, but it places a significant — and pointless —  financial burden on California providers, with no discernible improvement in payment times.

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  • March 5, 2018

    CPT 97750 for Functional Capacity Exams: Medically Unlikely Edits

    Providers sometimes run into trouble when billing Current Procedural Terminology (CPT) Code 97750. Providers use this procedure code to bill for functional capacity exams, including physical performance tests and measurements, with written reports. However, a pesky Medically Unlikely Edit (MUE) complicates the matter by limiting the number of billable units.

    Knowing the limits MUEs impose on codes like CPT 97750 is key to accurate billing.

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  • March 2, 2018

    FYI: $10k of Treatment Authorized Before Claim is Accepted or Denied

    When an employee files a workers’ compensation claim, the employer or insurer is immediately liable for the cost of all medically necessary treatment provided before the claim is accepted or denied. In other words, even if the employer or insurer ultimately denies a claim, treatment provided up to $10,000 is authorized before the claims administrator issues that denial.

    This important rule guarantees that liability for medically necessary treatment is never in question while an employer or insurer considers a claim — whether the claim is accepted or not.

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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.

    Read more →

  • 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.

    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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