By law, claims administrators must remit payment for Medical-Legal services within 60 days of receiving the physician’s bill. As of this writing, payment to one physician from CNA is overdue by 149 days — despite nearly a dozen inquiries and complaints over the last several months.

This payer behavior is a clear consequence of a lack of consequences.

When payers fear no repercussions, they feel comfortable testing the limits of noncompliance. After all, the burden of enforcing the rules in workers’ comp is entirely on the provider.

Sharing the shame-light with CNA is Conduent, CNA’s bill review vendor, whose representatives have assured us on 9 occasions since December that payment is forthcoming. To paraphrase an old saying: fool a provider once, shame on you. Fool a provider 9 times, and it’s clear something is broken in the enforcement of workers’ comp rules and regulations.

CNA & Conduent: Partners in Law-Scoffing

California Labor Code Section 4622 gives claims administrators a generous 60 days to remit payment for Medical-Legal services. By comparison, claims administrators must pay bills for non-Medical-Legal services within 45 days if the bill is not submitted electronically, and 15 days if the bill is submitted electronically.

Given the timeframe, it is truly absurd that CNA is almost 5 months late in paying this bill. Yet, CNA’s behavior is logically sound. Why would CNA rush to pay the provider, when there are no repercussions when CNA fails to adhere to California laws?

It’s not as if CNA and Conduent are unaware of the issue: multiple calls to Conduent (whose representatives brand themselves “CNA Provider Relations”) resulted in a Groundhog’s Day scenario in which the same line is repeated over, and over, and over: “The bill is in process. Please call back in 7-14 days for an update.”

At one point, the CNA adjuster cited a “global outage” that allegedly left CNA’s billing system inaccessible for the preceding 4 weeks (!). One can only wonder how many revenue logjams, courtesy of CNA, occupy providers’ accounts receivable by now (assuming the excuse is factual, if not acceptable).

Below is a timeline of our campaign to collect due reimbursement on behalf of this provider:

The Non-Consequences of Noncompliance

As of this writing, CNA now owes the provider an additional $365.62 in penalties, and $134.29 in interest — and counting. Yet, penalty and interest are another instance where payers can comfortably ignore California laws, regulations and rules.

For Medical-Legal bills, CNA incurs a 10% penalty and 7% interest per annum, starting 61 days after CNA receives the bill. These penalties are “self executing,” meaning the payer is expected to increase the provider’s payment by the penalty and interest. The provider cannot actually bill CNA for penalty and interest (P&I).

Not surprisingly, just like other rules and regulations, payers systematically fail to adhere to this self-imposed increase in reimbursement. AND there is no law, regulation or rule that allows for a provider to enforce payment of penalty and interest that is due for late reimbursements.

Only with extreme persistence from the provider will CNA have to pay the piper. Without real enforcement from a higher authority, providers will continue to play a rigged game in which payers ignore California workers’ comp laws, regulations and rules.

Make RFAs, billing, and appeals easier than ever — and get paid faster. DaisyBill empowers providers to collect what’s owed in record time. Contact us to learn how we can help your practice.

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