Most Recent Articles

Co-Surgery vs. Team Surgery: All You Need to Know

Surgery in workers’ compensation cases opens a Pandora’s box: reserves go up, nurse case managers get involved, and surgeons need to justify every detail of their billing to ...

2018 Average Days to Payment for Medical Treatment Bills

In 2018, for California medical treatment bills submitted using DaisyBill software, the average processing time is 11 days for the top 20 claims administrators by volume. We’...

SCIF (CA) Incorrectly Paying 2018 Fee Schedule for 2019 DOS

It’s SCIF’s turn. The California State Compensation Insurance Fund (SCIF) is also incorrectly reimbursing providers using the 2018 Physician Fee Schedule instead of the corre...

IBR Appeal Analysis for CPTs 99358 & 99359

**Update: The 2021 OMFS updates drastically changed how E/M codes are billed.*Reimbursements for CPTs 99358 & 99359 are tricky because payers frequently deny reimburse...

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...