Most Recent Articles
Mar 6, 2018
Discount Dangers: The Provider’s Bill of Rights (Rights III and IV)
Discount Dangers is a daisyBill series on the ways discount contracts incorrectly reduce providers’ reimbursements. With this series, we shine a light on the worst discount p...
Mar 5, 2018
CPT 97750 for Functional Capacity Exams: Medically Unlikely Edits
Providers sometimes run into trouble when billing Current Procedural Terminology (CPT) Code 97750. Providers use this procedure code to bill for functional capacity exams, in...
Mar 2, 2018
FYI: $10k of Treatment Authorized Before Claim is Accepted or Denied
When an employee files a workers’ compensation claim, the employer or insurer is immediately liable for the cost of all medically necessary treatment provided before the clai...
Mar 1, 2018
When is it Appropriate to File a Lien?
A second review appeal isn’t always enough. Sometimes, providers must take further action to secure proper reimbursement.When a second review appeal fails to produce t...
Feb 28, 2018
Primary Treating Physicians: Keep Your PR-2 Reports on Point!
If you’re the primary treating physician (PTP) for an injured worker, you already know the Treating Physician’s Progress Report (on Form PR-2 or the narrative equivalent ther...
Feb 23, 2018
VPay Error Impacts Thousands of Sedgwick EORs
VPay, a payment processing company which issues explanation of reviews (EORs) and virtual credit card payments from claims administrators to providers, suffered a technical g...
Feb 21, 2018
Reminder: E/M Reimbursements Higher in 2018
*Update: The 2021 OMFS updates drastically changed how E/M codes are billed.*Some of the most commonly used billing codes by our providers, Evaluation an...
Feb 16, 2018
Authorization/Utilization Review: Why Peer-to-Peer Calls Are a Bad Idea
There’s been lots to say about authorization and utilization review (UR) this year, especially given the major changes to the process. However, one UR rule that remains the s...
Feb 15, 2018
How to Bill for Physician-Dispensed Pharmaceuticals
Payments for physician-dispensed drugs are some of the most misunderstood — and incorrectly denied — in workers’ compensation billing. Too often, the employer or insurer’s cl...
Feb 13, 2018
Providers: Don't Accept 2017 OMFS Rates for 2018 Dates of Service
Lately, we’ve noticed a problem. Some claims administrators are reimbursing providers incorrectly. Instead of paying the higher 2018 Official Medical Fee Schedule (OMFS), cla...
Feb 9, 2018
What’s New for Workers’ Comp in 2018: CA Senate Bill 1160
In 2016 California passed Senate Bill 1160, which heralded significant workers’ compensation reform. SB 1160 outlined major changes to authorization, utilization review, lien...
Feb 8, 2018
Treatments That Do NOT Qualify for Automatic Authorization in Workers’ Comp
Automatic authorization for California workers’ comp is in effect, but not all treatments qualify. In fact, the Division of Workers’ Compensation (DWC) has specificall...