Blog: Daisy News

News, data, & insights about workers' comp billing

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  • June 6, 2018

    Do Not Send RFAs With Bills

    When treating an injured worker, a provider must fax the Request for Authorization (RFA) to the fax number designated by the claims administrator. RFAs should almost never be sent with a bill.

    Often claims administrators delegate bill review and utilization review (UR) to different entities. A provider who fails to fax RFAs to the correct destination is out of compliance with RFA regulations which require providers to fax these requests using the fax number issued by the claims administrator.

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  • May 23, 2018

    IMR Unlikely to Overturn UR Decisions

    When a payor’s utilization review organization (URO) denies treatment recommended by an injured worker’s treating physician, the only recourse is for the injured worker to appeal the denial to Independent Medical Review (IMR), administered by Maximus Federal Services.

    A recent analysis of Maximus’ IMR decisions by California Workers’ Compensation Institute (CWCI) found that Maximus upheld the overwhelming majority of payors’ utilization review decisions.

    The notion of IMR as a largely futile pursuit works to the advantage of the CWCI, an insurers’ and employers’ group with the stated aim of analyzing data “to improve benefit delivery.”

     

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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

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  • 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.

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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.

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  • 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.

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  • 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 →

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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.