Blog: Daisy News

Recently, a DaisyBill client reached out with questions regarding automatic authorization. The source of the confusion was a slideshow presentation from the California Coalition on Workers’ Compensation (CCWC)’s 15th annual conference, held last July. The presentation contained no outright falsehoods, but used puzzling language and left out a key point regarding billing deadlines.

Tellingly, the conference was sponsored by Sedgwick, the third-party claims administrator. Given claims administrators’ interest in keeping providers in the dark regarding the new rules, we thought we’d clear up some confusion.

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.

DaisyBill strives to make workers’ comp billing and payment smoother for both providers and payors.

We work with thousands of payors, including employers, insurers, and third-party administrators across California to electronically submit over 1.25 million compliant bills annually. We’ve seen good behavior and bad from payors. But we’ve never heard of a more frustrating experience than the one providers endure with York Risk Services — an experience we’ve endured ourselves.

When York fails to respond to bills for treating injured employees, providers report facing an infuriating uphill battle to track those bills. We strongly encourage medical billers to alert their providers about York’s unnecessary payment friction.

York can (and should) do better to help providers.

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.

Sometimes, a dispute over treatment necessitates medical-legal evaluations and reports. Typical of California workers’ compensation, there’s a forest of regulations to consider when obtaining these evaluations.

One question that pops up regularly is whether the Primary Treating Physician (PTP) is allowed to conduct medical-legal evaluation and issue a medical-legal report — and if so, under what circumstances.

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.

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.

Institutional billing for California workers’ comp can be a real pain in the ASC. We just made it a whole lot easier.

After exhaustive research, hours of programming, and thorough testing, our Billing Software now includes complete billing for ambulatory surgical center (ASC) services. All DaisyBill Billing Software clients can quickly generate compliant UB-04’s, complete with bill tracking, easy second review appeals, and more.

Providers can sign up for a free demonstration here.