Sometimes, seeking correct reimbursement for treating injured workers doesn’t require a battle between providers and payers.

Claims administrators and their vendors can act in good faith by choosing to honor state fee schedules and acknowledge and remedy their errors. For a great example, look to bill review service acūrrō, which adjudicates bills for several different claims administrators.

Earlier this year, acūrrō failed to update its reimbursement rates to reflect a Physician Fee Schedule increase effective April 1. Often, an error like this—especially on a large scale—burdens providers, who must submit Second Review appeals to dispute the erroneous payment amounts.

But acūrrō took a different approach: When daisyBill alerted acūrrō to the problem, the company simply reprocessed every affected bill and instructed its claims administrator clients to issue the balances owed. No appeals, no hassles, no problems.

Contrast this with the behavior of Third-Party Administrator Sedgwick. Sedgwick not only failed to apply the fee schedule update, forcing providers to submit thousands of Second Review appeals but subsequently improperly denied those appeals as “duplicate” bills—leading daisyBill to submit Audit Complaints reporting 17,225 violations of California payment requirements.

It’s a tale of two companies: one that sees a better, more efficient system as a win-win for injured workers, providers, and payers—and one that simply ignores compliance because they can.

acūrrō Goes Above and Beyond

The Division of Workers’ Compensation (DWC) issued an updated order for the Physician Fee Schedule, increasing reimbursements for all service dates on or after April 1, 2024.

As expected, some claims administrators continued to pay at the previous, lower rates even when the service date was April 1 or later. On April 29, daisyBill representatives contacted acūrrō to report that its claims administrator clients were erroneously reimbursing at the old rates.

Within days, acūrrō responded by reporting that they’d updated their systems and identified all bills for which additional reimbursement was owed.

Shortly after that, acūrrō asked daisyBill for help identifying the affected bills. Once acūrrō had what they needed, their representative reassured daisyBill that acūrrō was on top of the issue, stating:

“...looking to prioritize e-bills for [reprocessing] and make sure we get all daisyBill submissions completed and [electronic Explanations of Review] generated as a top priority. Thanks again for your follow up and willingness to work together on these types of items.”

As acūrrō continued to work on the problem, their representatives shared the details of their efforts—including the number of affected bills identified, to confirm that their number matched daisyBill’s expectations.

acūrrō also worked with clearinghouse Data Dimensions to ensure providers received new electronic Explanations of Review reflecting the additional payments.

Throughout the process, acūrrō maintained constant contact with daisyBill to apprise us of their progress, request help when needed, and reassure our representatives that “top priority” was not an idle choice of words.

By late May, additional payments were on their way to providers. On June 20, acūrrō submitted a complete report to daisyBill detailing every correction made to the affected bills.

Hats off to acūrrō and their clients. This bill review took decisive action to fulfill their obligation to providers. Workers' comp would endure significantly less friction if more payer-side entities looked to providers as partners in doing things right.

daisyBill tracks responses to your bills, appeals, and RFAs — so your practice knows action is needed. Click below to learn more, or request a demonstration.

LEARN MORE