Blog: Daisy News

News, data, & insights about workers' comp billing

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  • May 17, 2018

    No Response? What to Do When Claims Admin Ignores Your Bill

    It happens far too often: providers treat an injured worker for a California employer, send the bill to the claims administrator, and then...nothing.

    Workers’ comp is frustrating enough, but few things are more irritating than hearing crickets in response to a compliant original bill. Fortunately, California law offers remedies. Here’s how to obtain reimbursement (and address blatant non-compliance) when the claims administrator fails to respond to your bill.

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  • May 9, 2018

    Medical-Legal Complexity Factors: Provider Requirements

    Recently, a DaisyBill client faced unreasonable demands from a bill review regarding complexity factors for medical-legal billing code ML104. Fortunately, our client’s refusal to accept arbitrary requirements ultimately won out — proof that providers can succeed when empowered with knowledge of the rules.

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  • May 8, 2018

    Medical-Legal: When to Bill For Report Preparation


    Medical-legal billing is a special kind of tricky.

    This unique subset of California workers’ comp has its own rules, its own fee schedule, and its own complications. Among those complications is how and when to bill for time spent preparing medical-legal evaluation reports.

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  • May 4, 2018

    Medical-Legal Fee Schedule: DWC Proposes New Amendments

    The California Division of Workers’ Compensation (DWC) announced proposed amendments to the Medical-Legal Fee Schedule yesterday, May 3.

    The amendments would make significant changes to medical-legal billing practices. These changes include new limits on billing under the Official Medical Fee Schedule (OMFS), and new rules for the application of the ever-troublesome complexity factors for codes ML103 and ML104.

    The DWC will accept public comments until 5 pm on Friday, May 18. 

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  • 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. 

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  • 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.

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  • January 3, 2018

    Medical-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.

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  • 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.

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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.