Download: Med-Legal "Superbill"
Dec 8, 2021
Medical-Legal billing for California workers’ comp is like…well, anything in California workers’ comp: a big mess.It’s convoluted, and physicians get nearly zero help ...
Berkshire Hathaway Refuses 892 Second Review Appeals
Dec 7, 2021
Berkshire Hathaway hath a way of defying California workers’ comp regulations, and refusing to pay doctors for authorized treatment provided to in...
JT2 Plays IBR Chicken (and Wins)
Dec 6, 2021
As we pointed out in 10 Ways to Fix CA Workers’ Comp (see item #5), it can seem as if payers play a twisted game of IBR Chicken with doctors, reflexively denying bills and Se...
10 Ways to Fix CA Workers' Comp
Nov 30, 2021
Today, the California Division of Workers’ Compensation (DWC) will host a virtual public meeting “to hear ideas to improve the efficiency and quality of care provided to inju...
Lien Chaos Returns: DWC Rules for Anthem (Part III)
Nov 17, 2021
California’s Division of Workers’ Compensation (DWC) has a duplicity problem. In the third chapter of our series on The Zenith and Anthem Blue Cross, we discover that ...
PPO Punishment: Zenith Boots Doctor From MPN per Anthem (Part II)
Nov 16, 2021
Our tale of one doctor’s struggle with the Anthem Blue Cross Preferred Provider Organization (PPO) took a disturbing — if predictable — turn.Despite a doctor’s request...
How Zenith & Anthem Swiped a Doctor's Revenue (Part I)
Nov 15, 2021
This is Part I of our three-part series on one California doctor’s struggle to protect practice revenue from an unsubstantiated Anthem PPO discount.Anthem Blue Cross e...
The Hartford Ignores TWO California Laws
Nov 11, 2021
By insisting The Hartford owed no payment for authorized treatment provided outside the Medical Provider Network (MPN), The Hartford pooh-poohed a clear-cut Cal...
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PPO vs Network: Who's Taking Your Money?
Nov 10, 2021
We’ve told the story many times: a doctor signs a discount contract, hoping to bring in more patients. Almost immediately, revenue for treating injured workers is down across...
WCIRB: "Frictional" Workers' Comp Costs Soar in CA
Nov 10, 2021
Workers’ comp is wildly inefficient in California, according to the Workers’ Compensation Insurance Rating Bureau (WCIRB). The WCIRB used hard data to clearly d...
AIG & Coventry (and California) Squeeze QME
Nov 4, 2021
California Medical-Legal physician evaluators, be advised: some payers still attempt to improperly apply Preferred Provider Organization (PPO) discounts to Medical-Legal bill...
E/M: Not the PTP? How to Bill for Required Reports
Nov 3, 2021
For Evaluation and Management (E/M) in California workers’ comp, Primary Treating Physicians (PTP) must submit with the bill a progress report using either the ...