Blog: Daisy News

News, data, & insights about workers' comp billing

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  • November 21, 2017

    Why Work Comp Providers Need Specialized RCM

    Workers’ compensation is different.

    It’s a labyrinth of legal and procedural twists, turns, and obstacles that don’t plague providers in other areas of medicine. When it comes to billing and payment, there’s no way around it: providers need help. If financial success is the goal, wading into workers’ comp without specialized Revenue Cycle Management (RCM) is like going into a blizzard with a raincoat; technically possible, but woefully inadequate.

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  • November 17, 2017

    Overpaid? Providers Under No Obligation to Return Payment to Claims Admin

    When an employer or insurer’s claims administrator incorrectly overpays a workers’ comp bill, the provider is under no legal obligation to return the payment. This issue came up due to incorrect payments per the ASC/Outpatient Fee Schedule. Mistakes regarding the complex new Status Indicators have left some claims administrators scrambling to recover erroneous payments — even to the point of threatening providers.

    In these situations, it’s important for all parties to be clear on the rules. California Labor Code does not require the restitution of mistakenly paid reimbursements.

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  • November 16, 2017

    5 Strategies to Prevent Denied Work Comp Bills

    California does not make it easy for work comp providers to get paid. The time and effort necessary to obtain proper reimbursement is an unfortunate reality of a system weighed against providers’ interests. But all is not hopeless. Work comp providers can ensure correct, timely payment for the treatment of injured workers.

    They just need to know how.

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  • November 15, 2017

    Coding Clinic: How to Bill for Evaluation & Management Services

    As the Centers for Medicare and Medicaid Services (CMS) like to say, “If it is not documented, it has not been done.” Of course, documenting can be just as painstaking as the doing, especially in workers’ comp. Sometimes — as in the case of Evaluation and Management (E/M) services — the documentation is frightfully complicated, making billing even more of a hassle than usual.

    E/M services billing requires providers to select the correct billing codes for the level of services rendered. Determining which level can be tricky. Fortunately, there’s a guide for that.

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  • November 10, 2017

    How It Works: Independent Medical Review (IMR)

    When the claims administrator representing the insurance company, employer, or TPA denies a valid, compliant Request for Authorization (RFA), what’s a work comp provider to do?

    The RFA and Utilization Review (UR) process leaves much to be desired, as we’ve pointed out before. But if the claim’s administrator’s UR decision is unsatisfactory, there is recourse: Independent Medical Review (IMR). However, California work comp rules severely limit providers’ ability to pursue IMR, leaving it mostly to the patient. That said, the provider can play an active role.

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  • November 9, 2017

    FYI: Claims Admin Not Required to Use RFA Form

    A provider’s office recently asked if claims administrators must sign and return the Division of Workers’ Compensation (DWC)’s official RFA form when approving the requested treatment.

    California regulations do not require the claims administrator to respond to an RFA using any particular form, but the regulations require a written utilization review decision to include specific information. Providers need know what constitutes an appropriate, compliant written utilization review response.

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  • November 3, 2017

    Why Work Comp e-Bills Require Multiple Clearinghouses

    Here’s a question we often get: “Our office sends our electronic bills to a clearinghouse. Why do so many of them never reach the insurance carrier?”

    Clearinghouses claim to scrub and electronically submit bills to all payors, theoretically making them easy to pay. In reality, clearinghouses often mismanage e-bill delivery, resulting in delayed or outright lost bills. We know this first-hand — not only do we hear constant “lost bill” stories from providers, we’ve had our own bad experience.

    This post is a cautionary tale about how providers cannot rely on a single clearinghouse.

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  • October 31, 2017

    Reports: The Metrics that Matter for Work Comp Providers

    At DaisyBill, we recognize that providers are running a business.

    For injured workers to get the care to which they’re entitled by California law, provider offices count on correct, timely payment. To that end, we track important metrics that shed light on what’s working — and what’s not — for our providers’ bottom lines. With so much data, and so many complex rules and regulations for billing and payment, deciding which analytics to focus on can be a challenge. Below are metrics that should matter to your office.

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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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