Blog: Daisy News

News, data, & insights about workers' comp billing

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  • April 18, 2018

    When Can Primary Treating Physicians Conduct Medical-Legal Examinations?

    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.

    Read more →

  • February 2, 2018

    Ultimate 2018 Workers’ Compensation Reimbursement Cheat Sheet

    Here it is: your complete, downloadable go-to resource for California workers’ comp reimbursement rates in 2018. This guide features the Official Medical Fee Schedule (OMFS) reimbursements for the procedure codes providers use most, including:

    • Evaluation & Management (E/M)
    • Surgery
    • Radiology (Professional Services)

    ...and more, plus reimbursements for medical-legal services! All OMFS reimbursements are effective for dates of service on or after January 1, 2018. 

    Read more →

  • January 24, 2018

    Medical-Legal Cheat Sheet: Reimbursements

    Billing for medical-legal services is one of the trickiest aspects of workers’ comp revenue management. Further complicating the process is the time-based nature of many medical-legal billing codes, with providers and insurance claims administrators disputing which codes are billable by time, and what constitutes a single unit of time.

    Here, we offer a guide on compliant medical-legal billing, for your easy reference.

    Read more →

  • January 3, 2018

    Med-Legal Billing: How to Obtain Reimbursement for Diagnostic Tests

    The conditions under which claims administrators must pay medical-legal doctors for diagnostic tests are specific and narrow. To ensure reimbursement, it’s important to know the rules.

    Medical-legal billing has unique regulatory snags that only the intersection of medicine and law could produce. Among those complications is reimbursement for diagnostic services like x-rays and laboratory services. In some cases these diagnostics services are not reimbursable without prior authorization by the claims administrator.

    Know the regulations, and use the standard language included in this blog to denial-proof your medical-legal bill.

    Read more →

  • December 8, 2017

    Medical-Legal Billing Lacks Necessary Rules

    When it comes to medical-legal billing, the workers’ comp field is missing something.

    For medical-legal bills, no rules govern the billing form used or the method used to submit these bills. Technically, sending a medical-legal bill on a napkin via carrier pigeon is as compliant as sending the same bill on a CMS 1500 through the mail. This regulatory blind spot leads to unnecessary confusion and billing disputes, increasing friction and wasting the time of providers and payors alike.

    Read more →

  • October 13, 2017

    Are You Billing for Missed Work Comp Appointments?

    You should be.

    A provider’s time may be their most valuable resource. The complexity of workers’ comp billing drains an absurd amount of that time, decreasing the return on investment for treating injured workers. When a provider reserves their time for an appointment (and any related preparation), that time should be compensable whether the patient shows up or not.

    All providers should establish a written cancellation policy for workers’ comp patients and have the insurer’s claims administrator sign it. This protect the provider’s time, and their bottom line.

    Read more →

  • September 22, 2017

    Modifier 93 for Examinations Requiring Interpreter Services: A DaisyBill Guide

    Interpreters play a crucial role in workers’ comp treatment. By negating language barriers, interpreters remove a massive source of friction from an already friction-burdened field. When it comes to billing and payment, it’s important for providers to know how to obtain proper reimbursement when a visit requires an interpreter’s services.

    Here’s what providers need to know in order to properly apply modifier 93.

    Read more →

  • March 9, 2017

    QME Report Filing Deadlines Under DWC Scrutiny

    Per a recent report on the California Society of Industrial Medicine and Surgery (CSIMS) website, the Division of Workers’ Compensation (DWC) is taking new measures to enforce timely filing deadlines for medical-legal reports. Though the extent of any potential penalties remains ambiguous, CSIMS writes that the DWC Medical Unit has issued warnings to qualified and agreed medical evaluators (QMEs and AMEs) of “possible enforcement actions” should they fail to “serve medical-legal reports in a timely manner.”¹

    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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