Most Recent Articles

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...

York Misses the Mark: Paying 2019 Bills at 2018 OMFS Rates

Not one to avoid the spotlight, York Risk Services joins Sedgwick CMS in incorrectly applying the 2018 Physician Fee Schedule rates to services rendered in 2019. Our data sho...

State Farm Workers’ Comp Claims Moved to Sedgwick CMS

Time to start counting your poultry -- State Farm’s workers’ compensation henhouse is now guarded by the third-party administrator (TPA) Sedgwick, effective October 21, 2018....

California-Specific Codes Updated for 2019

With the flurry of new year fee schedule changes, California updated the Physician Fee Schedule reimbursement for its state-specific codes. These codes are explained in 8 CCR...

Sedgwick Still Reimbursing at 2018 Rates for California

Since the beginning of 2019, Sedgwick CMS has incorrectly used the 2018 Physician Fee Schedule to reimburse providers. Our data indicates that Sedgwick is consistently and in...

2019 CA Workers’ Comp Evaluation & Management Cheat Sheet

The 2019 changes to California’s reimbursements got your head spinning? Here’s a handy reimbursement cheat sheet for the most frequently used Evaluation & Management codes.

Location-Based Adjustments (GPCIs) Now in Effect for California, as of January 1, 2019

For better or worse, location-based adjustments are here for California workers’ comp. Find out how they impact reimbursements in 2019. As our preliminary calculations...

Good-bye CPT 96101 and CPT 96102

For 2019 beloved psychological testing codes 96101 and 96102 have vanished. Effective for dates of service on or after January 1, 2019, the Medicine/Central Nervous ...