Most Recent Articles

IBR Accountability: Claims Admins Fail to Pay Providers

California regulations mandate that when Independent Bill Review (IBR) overturns a claims administrator’s incorrect bill denial or adjustment and finds in favor of the provid...

Med-Legal Misconceptions: 4 Ways NOT to Use Billing Code ML106

In California, physicians use code ML106 to bill for supplemental medical-legal examinations. However, what constitutes a supplemental medical-legal exam for billing purposes...

Maximus Blunders AGAIN with 99358 Decision and a Math Error

Maximus Federal Services, the entity responsible for conducting Independent Bill Review (IBR) on behalf of California’s Division of Workers’ Compensation (DWC), has once agai...

Time and Billable Units for CPT Codes 99358 and 99359

Changes have been made to the California OMFS since the publication of this article. Be sure to see the latest analyses here and here.2021 OMFS updates drastically cha...

CA Providers: Do Not Alter Bill When Submitting Second Review Appeal

To appeal incorrect reimbursements or bill denials, California providers must submit timely and compliant requests for second review. To date, DaisyBill clients have recovere...

CA Drug Formulary Update Effective October 1

California’s Division of Workers’ Compensation (DWC) issued an update to Medical Treatment Utilization Schedule (MTUS) drug formulary, effective October 1, 2018. The formular...

CA Pharmaceutical Fee File Corrected

Providers, take note: California’s Division of Workers’ Compensation (DWC) announced that the Medi-Cal pharmaceutical fee data file, updated weekly, was replaced for the week...

CA: Location-Based Adjustments Set to Take Effect in 2019

In April, the California Division of Workers’ Compensation (DWC) held a hearing regarding the inclusion of the Medicare Geographic Practice Cost Indices (GPCI) in the Physici...

CA Claims Admins Fail to Comply With IBR Rules

When the Independent Bill Review (IBR) process overturns a claims administrator’s incorrect denial or adjustment, the claims administrator is legally bound to timely pay what...

CA Pathology/Clinical Laboratory Billing: NCCI Edits Do Not Apply

Medicare’s National Correct Coding Initiative (NCCI) complicates California workers’ comp billing, to say the least. NCCI edits are the source of much confusion, as pr...

Data: Excessive Workers’ Comp Claim Denials Backfire

An industry study tells an interesting story about workers’ compensation claims. A significant upward trend in denials ultimately cost employers and their claims administrato...

Don't Rely on Claims Administrators. Providers Must Know The Rules.

Repeatedly, we hear some version or another of the same story: a provider reaches out to a claims administrator for information regarding workers’ comp billing and payment. T...