Most Recent Articles

ML106: Liberty Mutual Must Learn the Rules

California’s all-new Medical-Legal Fee Schedule (MLFS) debuted back in April, but some claims administrators are still a few steps behind. To bill for supplemental Med...

IBR Hall of Shame: Sedgwick Sets New Standard of Noncompliance

Sedgwick failed to comply with an Independent Bill Review (IBR) ruling for almost four months. Worse, the payor’s brazenness is likely to go unpenalized by the state.T...

OMFS Update: 59 Codes Newly Billable

California’s Division of Workers’ Compensation (DWC) issued an update to the Physician and Non-Physician Practitioner portion of the Official Medical Fee Schedule (OMFS) for ...

SB 537 Reveals Murky World of Discount Contracts

In 2019, California passed Senate Bill 537. Among the changes to take effect on July 1st is a disclosure mandate requiring discount contracting entities to disclose to the cl...

Med-Legal Bill Denied for Liability? Request IBR

Certain California workers’ comp payers deny reimbursement for Medical-Legal evaluations by claiming lack of liability for the initial injury. With this twisted, circular log...

CA DWC Lets SCIF Skirt IBR for Incorrect GPCI

In a baffling decision, the California Division of Workers’ Compensation (DWC) declared a straightforward billing dispute ineligible for Independent Bill Review (IBR) — despi...

Zurich - An Example of California's MPN Shell Game

Where opacity and obfuscation reign, injustice thrives. There may be no better example of this than California’s Medical Provider Network (MPN) system. T...

Sedgwick Defies DWC COVID Rules; DWC Washes Hands

Sedgwick defied California workers’ comp regulations, costing a provider thousands in due reimbursement. Unfortunately, the Division of Workers’ Compensation (DWC) has declin...

MPNs: The Jekyll and Hyde of Workers' Comp

We’ve argued that MPNs are mostly a drag on the workers’ compensation system. But as some employers demonstrate, they don’t have to be.When employers use MPNs to maint...

Anthem: PPO Discount Payments BELOW Medicare

Q: How much can a workers’ comp provider lose by signing a Preferred Provider Organization (PPO) agreement?A: Much, much more than the provider probably realizes.

Download: Med-Legal Graphic Workflow (With Modifiers)

Effective April 1, 2021, the Division of Workers’ Compensation adopted an all-new Medical-Legal Fee Schedule, complete with new billing codes and modifiers. Like many things ...

CNA Repeatedly Ignores California Law

By law, claims administrators must remit payment for Medical-Legal services within 60 days of receiving the physician’s bill. As of this writing, payment to one physician fro...