Blog: Daisy News

News, data, & insights about workers' comp billing

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  • April 23, 2018

    Filter and Search CA MTUS Drug Formulary With New Tool

     

    California’s new drug formulary isn’t exactly user-friendly. For that reason, we developed a new tool to make authorization for pharmaceuticals much, much easier.

    The drug formulary, included in the Medical Treatment Utilization Schedule (MTUS) since January 1 of this year, is simply a massive list of available drugs, each designated either “exempt” from utilization review or “non-exempt.” The list, as provided by the DWC, cannot be filtered or searched in any way.

    So we fixed it.

    Read more →

  • April 19, 2018

    Audit Complaints Show Workers’ Comp Providers Face Uphill Battle

    In California, workers’ compensation providers face a labyrinth of billing and payment rules, and struggle with an enforcement structure that favors employers and insurers. As our clients’ experiences demonstrate, provider compliance does not guarantee proper reimbursement.

    Each year DaisyBill clients submit thousands of audit complaints to the DWC regarding  employers’ and insurers’ non-compliant payment behaviors. Subsequent action from the DWC can be inconsistent, however, demonstrating the disadvantage providers face.

    Read more →

  • April 10, 2018

    DIR Director Baker Makes Surprise Retirement Announcement

    Christine Baker, Director of California’s Department of Industrial Relations (DIR), unexpectedly announced her retirement on Friday, March 30.

    With no immediately apparent reason for the sudden departure, many in the workers’ comp community are surprised — and left to speculate on the well-regarded Director’s timing.

    Read more →

  • March 30, 2018

    Location-Based Reimbursement in CA? DWC Plans Hearing on OMFS Changes

    California workers’ comp providers may soon face another layer of complexity in calculating reimbursements: Geographic Practice Cost Indices (GPCI), which would raise or lower reimbursement rates based on the location of service.

    The Division of Workers’ Compensation (DWC) contends that GPCI will result in more appropriate reimbursements. Other stakeholders worry GPCI will not accurately reflect the cost of providing services in certain areas. Some wonder if further complicating reimbursement will court fraud, and cause new billing disputes regarding substantiation of the location of service.

    A public hearing is scheduled for April 17.

    Read more →

  • March 29, 2018

    “Secret Settlements” Demonstrate Double Standard for IMR Rules

    Since the introduction of Independent Medical Review (IMR), claims administrators working on behalf of employers and insurers haven’t always played fair. In seeking to uphold denials of authorization, payors have skirted IMR regulations — and tried to hide their misdeeds from the public through settlements which include dissembling limited disclosure agreements.

    These “secret settlements” demonstrate a double standard for compliance, as employers and insurers escape not only financial penalties, but public scrutiny.

    Read more →

  • October 27, 2017

    DWC’s Proposed Denial of Claims Notice Lacks Clarity

    When an employer denies an employee’s workers’ comp claim, California law mandates that the employer must inform the employee of their right to seek medical treatment outside the workers’ comp system. This week the California Division of Workers’ Compensation (DWC) unveiled new proposed language that the employer must include when notifying the employee of the denied claim.

    Having reviewed the proposed language, we worry that it is misleading. The DWC will welcome public comment until October 31st.

    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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