Most Recent Articles

Assistant at Surgery: All You Need to Know

Last week, we opened Pandora’s box on co-surgeons and team surgery. Notably left in the box was a discussion on assistant(s) at surgery. Typically this arises when physicians...

📬 Payer Responses: Guile, Waiting, and Crickets 🏏

Today we report on the responses from Sedgwick, Liberty Mutual, York, and State Compensation Insurance Fund (SCIF), following our posts detailing their systematic underpaymen...

2018 Average Med-Legal Days to Pay

In 2018, for California medical-legal bills submitted using DaisyBill software, the average processing time is 13 business days to receive payment for the top 20 claims admin...

Co-Surgery vs. Team Surgery: All You Need to Know

Surgery in workers’ compensation cases opens a Pandora’s box: reserves go up, nurse case managers get involved, and surgeons need to justify every detail of their billing to ...

2018 Average Days to Payment for Medical Treatment Bills

In 2018, for California medical treatment bills submitted using DaisyBill software, the average processing time is 11 days for the top 20 claims administrators by volume. We’...

SCIF (CA) Incorrectly Paying 2018 Fee Schedule for 2019 DOS

It’s SCIF’s turn. The California State Compensation Insurance Fund (SCIF) is also incorrectly reimbursing providers using the 2018 Physician Fee Schedule instead of the corre...

IBR Appeal Analysis for CPTs 99358 & 99359

**Update: The 2021 OMFS updates drastically changed how E/M codes are billed.*Reimbursements for CPTs 99358 & 99359 are tricky because payers frequently deny reimburse...

Liberty Mutual Trifecta of Incorrect Payments

In this, our fourth story on the fiasco of 2019 workers’ comp payments, we turn to the errors of Liberty Mutual. By now, from reading about Sedgwick, York, and Sedgwick (agai...

Reminder: Timely Bills Are Mandatory

Late bills will not be paid. Period. Timely billing has been in effect in California workers’ compensation since January 1, 2017, but we still see providers missing th...

Maximus Confirms Using Second Review Appeals to Correct Billing Errors

Correcting a coding error is as simple as submitting a Second Review appeal explaining the error. Last year, we discussed the convoluted process to correct billing err...

The Payment Chaos Continues: Sedgwick Denies Appeal for Correct 2019 Reimbursements

Sedgwick’s payment mistakes multiply. First, Sedgwick incorrectly paid California providers by applying an old workers’ comp fee schedule. Now Sedgwick compounds its error by...

2019 Splinting & Casting Reimbursement Update

When navigating the seas of change, it’s refreshing to find an island of relative stability. Like California’s state-specific codes, the splinting and casting codes group (co...