Blog: DaisyBill News

Planning on attending the 2019 HIMSS Expo next week? Come visit your DaisyBill friends at Booth 1367.

The Healthcare Information and Management Systems Society (HIMSS) Global Conference & Exhibition kicks off Tuesday, February 12 through Thursday, February 14, 2019 at the Orange County Convention Center in Orlando, Fla.

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. Prior to this change, State Farm managed the administration of its workers’ comp claims.

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 §9789.12.14 by the Division of Workers’ Compensation (DWC) and reimbursement is updated annually. Thankfully, the reimbursement formula is straightforward and not subject to variation by locality.

In the Physician Fee Schedule, the state-specific codes cover services for which there are no appropriate CPT codes, such as the Primary Treating Physician’s Progress Report (DWC form PR-2). Annually, the California DWC establishes a single new statewide reimbursement for each of the services covered by these ‘WC’ codes.

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.

Use this to start grappling with Medicare Geographic Practice Cost Indices (GPCIs), newly implemented for the workers’ comp Official Medical Fee Schedule (OMFS) as of 1/1/2019.

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 incorrectly reimbursing providers for 2019 dates of service.

While the California Physician Fee Schedule is infinitely more complex in 2019, many claims administrators are correctly reimbursing providers. But some are not.

On a regular basis, this blog will bring to light the claims administrators that repeatedly and non-compliantly reimburse providers the wrong amount for services rendered in 2019. Today, we commence with Sedgwick.

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 indicate, net reimbursements will decrease by 3-4% for many areas, whereas the most expensive locations will receive at least a 10% increase over 2018 reimbursements.

Greetings to the DaisyBill blog readership! My name is James Carey and I’m happy to join the DaisyBill team as a staff blogger. Some of you may recognize me because we’ve worked together in the past, usually on the payer side of the equation.

For those of you who don’t know me, I am a 17-year industry veteran; I’ve worked as an adjuster and as a supervisor for workers’ comp insurance carriers, third-party claims administrators, and self-insured employers in California, as well as a consultant for entities across multiple jurisdictions.

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 System Assessments/Tests subsection of the Current Procedural Terminology (CPT®) 2019 eliminated CPT codes 96101 and 96102. The Current Procedure Terminology (CPT®) 2019 replaces these two codes with seven new replacement CPT codes.

This 2019 change has left many providers with many questions, so we made some handy charts to answer them!