Blog: Daisy News

News, data, & insights about workers' comp billing

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  • July 12, 2018

    RFA for Emergency Treatment in California Workers’ Comp

    First, let’s be clear that providers never have to wait for authorization before providing emergency treatment for an acute medical condition.

    Never.

    However, the provider must ultimately obtain authorization for all services, even when the injury is time-sensitive or a medical emergency. While the authorization and utilization review (UR) process should never be an obstacle to such treatment, there are mandated procedures and timelines for submitting the official Request for Authorization (RFA).  

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  • July 11, 2018

    Workers’ Comp Billing Tip: Use a Detailed Cover Sheet

    California’s Division of Workers’ Compensation (DWC) has many strict requirements as to what constitutes a “complete” bill for the treatment of injured workers. But given the complexity of workers’ comp billing and payment rules, even a bill that’s complete by DWC standards could use a little extra clarification.

    That’s why DaisyBill recommends providers include a cover sheet —  like the ones we provide for our billing clients — with all bills.

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  • June 27, 2018

    CA Providers: Appeal Denials for Treatment Preceding Liability Decision

    Recently, we pointed out that California employers are liable for treatment that precedes the claims administrator’s decision to accept or deny a workers’ comp claim. Before making this liability decision, the employer is always responsible for medically appropriate treatment up to $10,000.

    If the employer’s claims administrator denies a bill for treatment when the treatment was provided before the liability decision, the provider should appeal for full payment — even if liability is subsequently denied.

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  • June 22, 2018

    Conditional Authorization: How MPNs Cheat Workers’ Comp Providers

    Medical Provider Networks (MPNs) are a drag on California workers’ compensation. Nominally designed to help employers control costs, MPNs rarely achieve more than throwing up obstacles to the treatment of injured workers, and cheating providers out of reimbursement — even for authorized services.

    Authorization, of course, is supposed to be final. But when claims administrators grant authorization on the condition that the treating physician be included in the employer’s MPN, they create opportunities to deny payment.

     

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  • 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. 

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  • 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.

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  • 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.

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  • May 31, 2018

    Institutional Billing: How to Find Your Conversion Factor

    For institutional billing, identifying the correct conversion factor is key to saving time and billing accurately.

    The Hospital Outpatient Departments and Ambulatory Surgical Centers Fee Schedule is a testament to just how convoluted California workers’ comp billing can be — even the schedule’s title is long and messy. Among its many complications are the county and hospital-specific wage-adjusted conversion factors, which providers must include when calculating reimbursement amounts.

    These conversion factors can be tough to identify, and are always subject to change.

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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.