Blog: Daisy News

News, data, & insights about workers' comp billing

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  • January 22, 2018

    2018 Authorization/Utilization Review: Major Changes Effective 1/1/2018 (Webinar 53: Fast-Track Utilization Review, 01.23.18)

    Senate Bill 1160 makes significant changes to the authorization and utilization review (UR) process, starting in 2018. New “fast-track” UR takes effect on January 1.

    Fast-track UR bypasses prospective utilization review by automatically approving the required treatment in many — but not all — circumstances. A set of specific conditions must exist in order for providers to bypass the usual UR process. The new process also changes the rules regarding authorization and billing for these encounters.

    DaisyBill will host a webinar on fast-track UR on February 6.

    Read more →

  • January 12, 2018

    Authorization 2018: New Billing and RFA Deadlines

    The new “fast-track” automatic authorization process took effect on January 1, 2018. Under certain circumstances, some providers may provide “automatically” authorized treatment without submitting a prospective Request for Authorization (RFA). Of course, this new process is subject to new rules and conditions — including new deadlines for submitting an RFA and for submitting the corresponding billing.

    Today, we explore the timeframe requirements for all fast-tracked treatments. We're also hosting a free webinar on the fast-track process on Tuesday, February 6. 

    Read more →

  • January 5, 2018

    Authorization: 6 Qualifying Conditions for Fast-track Automatic Authorization

    On January 1, 2018, the new “fast-track” automatic authorization takes effect. In certain cases, some providers will be able to provide treatment without first submitting a Request for Authorization (RFA) for utilization review, because the treatment is automatically authorized.  But like many things in workers’ compensation, this “automatic” authorization scheme comes with conditions, caveats, and important new rules.

    Today, we explore the 6 qualifying conditions when treatment is eligible for fast-track automatic authorization. We're also hosting a free webinar on the fast-track process on Tuesday, February 6. 

    Read more →

  • November 16, 2017

    5 Strategies to Prevent Denied Work Comp Bills

    California does not make it easy for work comp providers to get paid. The time and effort necessary to obtain proper reimbursement is an unfortunate reality of a system weighed against providers’ interests. But all is not hopeless. Work comp providers can ensure correct, timely payment for the treatment of injured workers.

    They just need to know how.

    Read more →

  • November 10, 2017

    How It Works: Independent Medical Review (IMR)

    When the claims administrator representing the insurance company, employer, or TPA denies a valid, compliant Request for Authorization (RFA), what’s a work comp provider to do?

    The RFA and Utilization Review (UR) process leaves much to be desired, as we’ve pointed out before. But if the claim’s administrator’s UR decision is unsatisfactory, there is recourse: Independent Medical Review (IMR). However, California work comp rules severely limit providers’ ability to pursue IMR, leaving it mostly to the patient. That said, the provider can play an active role.

    Read more →

  • November 9, 2017

    FYI: Claims Admin Not Required to Use RFA Form

    A provider’s office recently asked if claims administrators must sign and return the Division of Workers’ Compensation (DWC)’s official RFA form when approving the requested treatment.

    California regulations do not require the claims administrator to respond to an RFA using any particular form, but the regulations require a written utilization review decision to include specific information. Providers need know what constitutes an appropriate, compliant written utilization review response.

    Read more →

  • October 12, 2017

    Just in Time: RFA and Utilization Review Timeframe Requirements

    In California, proper authorization is one of the most important factors for compliance in workers’ comp billing and payment. Legally, “authorization” is the insurer’s acceptance of liability to pay for treatment. The request for authorization (RFA) and utilization review (UR) process informs everything that comes later in the billing and payment cycle.

    Everyone involved needs to get it right.

    The RFA and UR process is the means by which the insurer and the treating physician agree on the medical necessity of treatment. It is how injured employees get treated and back to work, and how providers obtain proper reimbursement. The rules and regulations regarding this process are vast and complex. That’s why we’ve created this handy guide, including our table of RFA and UR Timeframe Requirements mandated by California law.

    Read more →

  • April 4, 2017

    Billing Tip: Know Where to Send RFAs

    The first thing we tell a provider when they ask for workers’ compensation billing tips? Always, always, always submit a Request for Authorization (RFA) for the recommended treatment. RFAs are the single best five-minute investment a practice can make, because authorized treatment guarantees payment.  

    Beyond that, treating physicians are required to submit compliant RFAs.¹ Yet many physicians do not take the time to submit the official DWC Form RFA. Still others are unsure of where and how to submit the form. We often hear from providers who submit their RFAs along with their bills; in reality, this can lead to long delays in processing – or no processing at all.

    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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