Blog: Daisy News

News, data, & insights about workers' comp billing

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  • April 13, 2018

    “By Report” Billing Codes: Best Practices for Proper Reimbursement

    When the Official Medical Fee Schedule (OMFS) assigns the reimbursement for a procedure code as “By Report” (BR), establishing the correct payment amount is one of the trickier aspects of California workers’ compensation billing.

    For codes designated a BR reimbursement, the Division of Workers’ Compensation (DWC) does not assign a specific reimbursement amount. Instead, the provider must determine and request a reasonable amount for these procedures from the employer or insurer’s claims administrator.

    To help providers determine and obtain the correct reimbursement for these codes, we’ve put together this “By Report” reimbursement guideline.

    Read more →

  • April 6, 2018

    Interpreter Fee Schedule: An Imperfect Step in the Right Direction

    California’s Division of Workers’ Compensation (DWC) proposed new interpreter fee schedule regulations this week. The changes would create a uniform fee schedule, replacing the more haphazard “market rate”-based current system. The draft rules also require the use of more highly qualified “certified” interpreters whenever possible.

    The proposed rules may reduce the friction that characterizes billing for interpreter services, but come with complications of their own. The DWC is accepting comments on its public forum until 5pm Friday, April 13.

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  • April 4, 2018

    CA Physician Fee Schedule Update Adds New Billing Codes, NCCI Edits

    A new order from the Administrative Director of California’s Division of Workers’ Compensation (DWC) updates the Physician and Non-physician practitioner services portion of the Official Medical Fee Schedule (OMFS).

    The changes, effective April 1, 2018, include the addition of 16 new billing codes, as well as over 200 new National Correct Coding Initiative (NCCI) edits.

    Read more →

  • March 30, 2018

    Location-Based Reimbursement in CA? DWC Plans Hearing on OMFS Changes

    California workers’ comp providers may soon face another layer of complexity in calculating reimbursements: Geographic Practice Cost Indices (GPCI), which would raise or lower reimbursement rates based on the location of service.

    The Division of Workers’ Compensation (DWC) contends that GPCI will result in more appropriate reimbursements. Other stakeholders worry GPCI will not accurately reflect the cost of providing services in certain areas. Some wonder if further complicating reimbursement will court fraud, and cause new billing disputes regarding substantiation of the location of service.

    A public hearing is scheduled for April 17.

    Read more →

  • March 15, 2018

    Outpatient/ASC Fee Schedule: DWC Issues (Then Corrects) Reimbursements

    The California Division of Workers’ Compensation (DWC) ordered new adjustments to the Official Medical Fee Schedule (OMFS), effective March 15, 2018. The orders update fees for hospital outpatient departments and Ambulatory Surgical Center (ASC) services.

    Pursuant to California Labor Code § 5307.1, DWC Acting Administrative Director George P. Parisotto’s update orders brought the outpatient/ASC fee schedule into conformity with CMS’ HOPPS rules. Most recently, the DWC issued an order correcting an error in a previous order’s update to California Code of Regulations (CCR) Section 9789.34’s Table A.

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  • February 21, 2018

    Reminder: E/M Reimbursements Higher in 2018

    Some of the most commonly used billing codes by our providers, Evaluation and Management (E/M) codes are still being paid at 2017 rates for 2018 dates of service. While the difference for each code may be a matter of a few percentage points, all those extra dollars and cents add up!

    Providers, review your bills to make sure your office is being reimbursed in full.

    Read more →

  • February 15, 2018

    How to Bill for Physician-Dispensed Pharmaceuticals

    Payments for physician-dispensed drugs are some of the most misunderstood — and incorrectly denied — in workers’ compensation billing. Too often, the employer or insurer’s claims administrator denies payment based on inapplicable Physician Fee Schedule status code rules. Beyond that, the Division of Workers’ Compensation (DWC) and state legislature seem keen to discourage physician dispensing.

    Regardless, physicians have permission to dispense pharmaceuticals, and to bill according to the Pharmacy Fee Schedule.

    Read more →

  • February 13, 2018

    Providers: Don’t Accept 2017 OMFS Reimbursement Rates for 2018 Dates of Service

    Lately, we’ve noticed a problem. Some claims administrators are reimbursing providers incorrectly. Instead of paying the higher 2018 Official Medical Fee Schedule (OMFS), claims administrators are paying last year’s lower 2017 reimbursement rates for services rendered this year. This is not acceptable. In these cases, it’s up to the provider to protect their revenue.

    Fortunately, there are tools for providers to calculate — and obtain — proper reimbursement.

    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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