Blog: Daisy News

News, data, & insights about workers' comp billing

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  • March 9, 2018

    Complete 2018 Automatic Authorization Guide for California Workers’ Comp

    Over the last several months, we blogged extensively (and hosted a free comprehensive webinar) on the new automatic authorization process for California workers’ comp.

    Here, we’ve assembled the most important rules and procedures into one convenient guide. Use this for quick and easy reference, and feel free to download and print the PDF version from our Webinar Library by clicking below:

    DOWNLOAD COMPLETE 2018 AUTHORIZATION GUIDE

    Read more →

  • February 16, 2018

    Authorization/Utilization Review: Why Peer-to-Peer Calls Are a Bad Idea

    There’s been lots to say about authorization and utilization review (UR) this year, especially given the major changes to the process. However, one UR rule that remains the same in 2018 also remains sadly overlooked: those conducting UR on behalf of employers or insurers should not telephone providers for further information needed to make a UR decision.

    This practice is non-compliant, wasteful, and has the potential to compromise the integrity of a decision to approve, modify, or deny the requested treatment.

    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 9, 2018

    What’s New for Workers’ Comp in 2018: CA Senate Bill 1160

    In 2016 California passed Senate Bill 1160, which heralded significant workers’ compensation reform. SB 1160 outlined major changes to authorization, utilization review, lien filing, billing deadlines, and more. Some changes took effect in 2017, while others are newly effective, as of January 1 this year.

    Let’s take a look at the major changes SB 1160 brings to workers’ comp in 2018.

    Read more →

  • February 8, 2018

    Treatments That Do NOT Qualify for Automatic Authorization in Workers’ Comp

    Automatic authorization for California workers’ comp is in effect, but not all treatments qualify.

    In fact, the Division of Workers’ Compensation (DWC) has specifically barred certain treatments from automatic authorization. In these cases, the usual Request for Authorization (RFA) and prospective utilization review (UR) remains required — with some exceptions. Since many of our recent webinar attendees asked about specific services, we thought a review of ineligible treatments was in order.

    For our complete downloadable guide to automatic authorization in 2018, click here.

    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.

    For our complete downloadable guide to automatic authorization in 2018, click here.

    Read more →

  • February 1, 2018

    Fast-Track UR for Workers’ Comp: New Rules for Entities Conducting UR

    We spent the last few weeks bringing readers up to speed on the new “automatic” authorization process for workers’ comp. While we’ve explored the new requirements for providers, there are also new mandated standards for entities that conduct UR. These entities ultimately determine whether the employer or insurer’s claims administrator authorizes a given treatment.

    This year’s overhaul includes new rules both to encourage consistency in UR decisions and to discourage financially incentivized bias. Today, we explore those rules and their potential impact.

    The new authorization rules became effective January 1, 2018. DaisyBill hosted a free, comprehensive webinar on automatic authorization and fast-track UR on February 6.

    For our complete downloadable guide to automatic authorization in 2018, click here.

    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.

    We recently hosted a comprehensive webinar on automatic authorization. Here, we explore the timeframe requirements for all fast-tracked treatments.  

    For our complete downloadable guide to automatic authorization in 2018, click here

    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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