Blog: Daisy News

News, data, & insights about workers' comp billing

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  • 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 →

  • February 7, 2018

    “Automatic” Authorization, but Denied Bill? How to Appeal the Denial

    The new “automatic” authorization process for workers’ comp is in effect, as of January 1. We’ve discussed this new system extensively on our blog and in our recent webinar, covering everything from eligibility to timeliness to new utilization review requirements. But what happens if the employer or insurer’s claims administrator denies payment for automatically authorized services rendered? Does the usual second review appeal process apply?

    In short, authorized is authorized, automatically or otherwise — but in this case, there is a twist.

    Read more →

  • October 19, 2017

    How It Works: Independent Bill Review (IBR)

    Think about what workers' comp providers go through to obtain correct payment for treating injured workers. Compliant authorization and billing are taxing enough. Appealing incorrect reimbursements or denials with a request for Second Review means even more work. Then, when the Second Review appeal fails to produce proper compensation, the only recourse is to navigate yet another onerous process: Independent Bill Review (IBR).

    Fortunately, the IBR process — though extremely burdensome — is navigable, and usually the provider prevails.

    Read more →

  • October 18, 2017

    The Parity Problem: How Work Comp Favors Insurers Over Providers

    In disputes over payment in the California workers’ compensation system, insurers have an unfair advantage over providers.

    At every stage of the billing process, the burden of seeking proper reimbursement falls on the provider. The penalty for provider non-compliance is immediate and automatic: they don’t get paid. Yet, the insurer suffers no consequences for payment non-compliance.

    This lack of parity reveals exactly what value is placed on the role of doctors and other health care workers in the work comp system: very little, indeed.

    Read more →

  • October 6, 2017

    The Provider’s Burden: Appealing Improper Reimbursements

    Worker’s comp billing is hard enough.

    Four years ago, California passed strict requirements that providers must follow to appeal incorrect reimbursements from insurers. These requirements are burdensome to the point of being prohibitive — and insurers know it. Since most providers lack the resources to appeal incorrect payments, insurers and their claims administrators can underpay without fear of consequence.

    With the burden of proof on their shoulders, providers remain vulnerable to the systemic abuse enabled by the Second Review process.

    Read more →

  • September 15, 2017

    Claims Administrator Rectifies SBR Error

    Pacific Claims Management responded to our August blog regarding misinformation about requests for Second Bill Review. DaisyBill spoke with a Pacific representative, with whom we also discussed concerns regarding changes to Pacific’s processing of electronic bills. Happily, not only did Pacific rectify both issues, they displayed a level of transparency and responsiveness that does the claims administrator credit.

    We believe that Pacific’s willingness to engage in discussions like these ultimately benefits Pacific, the providers that send bills, and the workers’ comp system as a whole.

    Read more →

  • August 25, 2017

    Billers Beware! Submit Second Reviews to Appeal Incorrect Payments

    Recently a claims administrator gave a DaisyBill client some horrible advice about appealing an incorrect payment.

    A representative at Pacific Claims Management, a third party administrator, reportedly instructed the DaisyBill client not to bother using an SBR-1 form to appeal an incorrect payment. Fortunately, our client reached out to us to ask why Pacific Claims Management gave these inaccurate instructions.

    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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