Blog: Daisy News

News, data, & insights about workers' comp billing

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  • June 13, 2018

    Liable by Default: Failure to Deny A Claim Means the Claim is Accepted

    In California, when it comes to accepting or rejecting an injured employee’s claim, the claims administrator that neglects to issue a decision is still effectively making a decision.

    A recent Workers’ Compensation Appeals Board (WCAB) trial serves as a reminder that legally, claims administrators must timely either accept or reject liability. When the claims administrator fails to issue a timely decision, the claim is presumed accepted— even when the claim is deniable on its merits.

     

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  • May 18, 2018

    IBR vs Lien: Coding Disputes

    When the required Second Review appeal process fails to produce correct reimbursement, it's important for providers to understand the correct next step in the appeal process.

    With the passage of SB 863 (effective 1/1/2013), California law requires Independent Bill Review (IBR) “if the provider disputes the amount of payment made by the claims administrator.” To the extent the dispute is not about the amount of reimbursement, a provider may file a lien to contest incorrect bill payment.

    Generally, liens are reserved for matters of liability and legal duty. Sometimes, though, a provider may not be sure which option applies. For example, some argue that disputes over correct coding should be resolved by a lien rather than IBR.

    However, recent lien cases indicate that liens regarding coding disputes will be dismissed — at a potentially significant cost to the provider.

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  • April 5, 2018

    WCAB Resolves Lien Deadline Issue

    Lien claimants who filed required supplemental lien declarations on July 2 or 3 of 2017 wondered: would the Workers’ Compensation Appeals Board (WCAB) agree to adjudicate those liens? Recently, the WCAB finally made their decision.

    California’s Division of Workers’ Compensation (DWC) mass-dismissed over 292,000 previously filed liens in August, for failure to timely file the retroactive lien declarations by the deadline of July 1. In October, the DWC lifted the dismissal notice on liens for which claimants filed the declaration on July 2 or 3, since July 1 fell on a Saturday.

    The liens’ fates were unclear, until last week’s WCAB decision: if the claimant filed their declaration by 5pm on Monday, July 3, they were on time.

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  • March 1, 2018

    When is it Appropriate to File a Lien? 

    A second review appeal isn’t always enough. Sometimes, providers must take further action to secure proper reimbursement.

    When a second review appeal fails to produce the correct payment for medical treatment, Independent Bill Review (IBR) is sufficient to resolve most disputes. However, filing a lien may be appropriate for certain kinds of disputes. While both IBR and liens keep the onus on the provider to correct a payor error, these two resources represent the only way forward for payment disputes.

    Refer to the following guide to help determine which course of action is required.

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  • June 27, 2017

    Service Required For Retroactive Lien Filing Deadline

    As the July 1 deadline to file a retroactive lien declaration under Labor Code 4903.05 approaches, our Support Team is fielding questions left and right. Among the biggest causes for confusion: Whether lien claimants are required to “serve” other parties to a lien case when they submit their Supplemental Lien Form and declaration to the Workers' Compensation Appeals Board. An eleventh-hour DIR Newsline released on Monday offers some clarity: Yes, lien claimants must serve all parties on the case.¹

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  • June 6, 2017

    Ultimate Guide to New Lien Declaration Under SB 1160

    Last month, we reported that the California Workers’ Compensation Interpreters Association (CWCIA), along with several interpreting companies, filed a lawsuit to prevent the Workers’ Compensation Appeals Board (WCAB) from enforcing Senate Bill 1160’s new lien declaration requirements. Although that petition was summarily dismissed by the First District Court of Appeals in May, it prompted the Division of Industrial Relations (DIR) to file a brief and provide clarification on the new lien process. We already touched on how the DIR’s brief provides guidance to interpreters. Today, we’ll take a broader look and show how it offers valuable direction to all stakeholders in the new lien declaration process – not just interpreters. We’ll also teach you how to select the right lien declaration category every single time.

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  • May 10, 2017

    Interpreter Suit Dismissed, Concerns Clarified as Lien Deadline Looms

    In early March, we reported on the Workers’ Compensation Appeals Board (WCAB) adoption of its final Rules of Practice and Procedure to implement Senate Bill 1160. Chief among these rules were new regulations for liens. The rules officially slid into effect on March 26 of this year, but not without controversy. It appears that controversy is coming to an end: A petition from the California Workers’ Compensation Interpreters’ Association challenging the new rules was summarily denied by California’s First District Court of Appeal, prompting the Department of Industrial Relations to provide clarification.

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  • March 3, 2017

    New DWC Lien Rules Effective March 26, 2017

    Since the passage of Senate Bill 1160 last fall, questions have swirled around the landmark piece of legislation’s new lien declaration requirements. This week, the Workers’ Compensation Appeals Board (WCAB), moved us closer to answers – the organization adopted the final Rules of Practice and Procedure to implement SB 1160, effective March 26, 2017.

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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.