Blog: Daisy News

News, data, & insights about workers' comp billing

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  • July 17, 2018

    Acupuncture Remains Payable for CA Work Comp, Despite MUE

    The Centers for Medicare and Medicaid Services (CMS) recently released a Medically Unlikely Edit (MUE) designating acupuncture billing codes 97810 through 97814 non-payable, effective July 1, 2018. However, these codes remain reimbursable under California’s Official Medical Fee Schedule (OMFS) for workers’ comp services.

    While National Correct Coding Initiative (NCCI) edits, including MUEs, are incorporated into the OMFS automatically “by reference,” specific OMFS rules designating 97810-97814 reimbursable take precedence.

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  • June 29, 2018

    CA OMFS Update: Physician Services and DMEPOS

    California’s Division of Workers’ Compensation (DWC) posted update orders to two sections of the Official Medical Fee Schedule (OMFS), both effective July 1, 2018.*

    The DWC ordered changes to the Physician and Non-physician Practitioner fee schedule, as well as the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule.

    The orders affect reimbursement for 5 codes in total, 4 for Physician Services and one for DMEPOS.

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  • June 8, 2018

    CorVel Error: Incorrectly Reimbursed ASC Services

    CorVel Corporation, a national third-party administrator, incorrectly reimbursed multiple California workers’ comp providers for Ambulatory Surgical Center (ASC) services, at rates established by Medicare’s ASC fee schedule.

    Medicare ASC reimbursement rates are not applicable to California workers’ comp. Fortunately, DaisyBill clients alerted us to the problem.

    We reached out to CorVel, whose representatives acknowledged the error. Working proactively with DaisyBill, CorVel updated their payment practices and agreed to reprocess all bills with dates of service 3/15/2018 through 5/22/2018.

    Where applicable, CorVel will send providers additional payment for incorrectly processed bills.

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  • June 1, 2018

    Multiple Payors Reimbursing WC002 at 2017 Rates

    We’re halfway through 2018, and claims administrators are still reimbursing your office at 2017 rates for 2018 dates of service.

    We’ve noticed this problem all year for various billing codes. We’ve called on claims administrators to update their systems to reflect California’s current Official Medical Fee Schedule (OMFS). Now, inexplicably, we see a particular code (WC002) paid at 2017 rates for 2018 dates of service — even as other codes on the same bill are paid correctly.

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  • May 31, 2018

    Institutional Billing: How to Find Your Conversion Factor

    For institutional billing, identifying the correct conversion factor is key to saving time and billing accurately.

    The Hospital Outpatient Departments and Ambulatory Surgical Centers Fee Schedule is a testament to just how convoluted California workers’ comp billing can be — even the schedule’s title is long and messy. Among its many complications are the county and hospital-specific wage-adjusted conversion factors, which providers must include when calculating reimbursement amounts.

    These conversion factors can be tough to identify, and are always subject to change.

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  • May 16, 2018

    FYI: Workers’ Comp Telemedicine Reimbursed at Facility Rates

    In California and elsewhere, telemedicine isn’t just the future — it’s the present. Of course, this shift to increasingly virtual services means unique new wrinkles in the workers’ comp billing and payment process.

    One common point of confusion is “where” telemedicine takes place for billing purposes; i.e. in a facility or non-facility. Fortunately, the Official Medical Fee Schedule (OMFS) provides a simple answer: place of service code 02.

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  • May 3, 2018

    OMFS Update: DWC Orders Changes to Pathology/Clinical Lab Fee Schedule

    The DWC posted an update order bringing the Pathology and Clinical Laboratory section of the Official Medical Fee Schedule (OMFS) into line with Medicare.

    The order removes three Current Procedural Terminology (CPT) codes from the schedule, adds one new CPT code, and significantly increases reimbursement for one CPT code. Importantly, this update is RETROACTIVE to dates of service April 1, 2018.

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  • May 2, 2018

    DME: Invoice Not Required for (Most) Durable Medical Equipment

    Too often, we see claims administrators demand extraneous paperwork from providers, adding unnecessary friction to the workers’ comp billing and payment process. One example is requests for invoices for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).

    Some claims administrators insist that an invoice accompany the bill to substantiate charges for DMEPOS. With a single exception, this is an incorrect demand.  

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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.