Blog: Daisy News

News, data, & insights about workers' comp billing

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  • October 19, 2017

    How It Works: Independent Bill Review (IBR)

    Think about what workers' comp providers go through to obtain correct payment for treating injured workers. Compliant authorization and billing are taxing enough. Appealing incorrect reimbursements or denials with a request for Second Review means even more work. Then, when the Second Review appeal fails to produce proper compensation, the only recourse is to navigate yet another onerous process: Independent Bill Review (IBR).

    Fortunately, the IBR process — though extremely burdensome — is navigable, and usually the provider prevails.

    Read more →

  • September 14, 2017

    IBR Injustice: Maximus Mishandling 0232T Decisions

    A client of DaisyBill recently brought to our attention another poor Independent Bill Review (IBR) by Maximus Federal Services, the entity the California Division of Workers’ Compensation (DWC) contracts to review and decide on IBR requests submitted by providers. The IBR decision concerns procedure code 0232T for platelet-rich plasma injection. In the past, Maximus decided in favor of the doctor in the majority of IBRs submitted for 0232T. However, recently Maximus inexplicably changed the criteria for reviewing 0232T, and started to issue denials of payment for this procedure code.

    That’s because Maximus is making these important payment decisions without referencing California Labor Code, California Code of Regulations, or administrative rules.

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  • August 31, 2017

    Maximus Gets It Wrong in 99358 IBR Decision

    Maximus Federal Services, the arbiter of Independent Bill Review (IBR) for the California Division of Workers’ Compensation (DWC), has denied payment to a provider due to a an error on Maximus’ own part. The mistake, based on an outdated status code designation for CPT codes 99358 and 99359, is one DaisyBill anticipated. With Maximus behind the curve on changes to the Official Medical Fee Schedule (OMFS) effective this year, other providers may be in danger of the similar mistreatment.

    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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