Free Webinar Series: Part 3 of 8: Master Payment and EOR Requirements, Tuesday, October 16, 2018 1-2 PM PDT

Blog: Daisy News

News, data, & insights about workers' comp billing

header_illustration_blogDaisyBill

Bill "Auditing" Services Try to Bamboozle Providers

October 10, 2018 by Catherine Montgomery

Recently, MARS (Medical Audit and Review) made a very strange — and very dubious — offer to a California provider on behalf of the claims administrator, Farmers Insurance.

After Farmers denied the provider’s bill, the provider appropriately appealed with a request for second review. But before Farmers could return a decision and final Explanation of Review (EOR), MARS reached out to the provider with a proposed settlement, offering the provider roughly half the required reimbursement amount.

This is a classic example of a disturbing syndrome in workers’ comp, one of which providers should be very wary: excessive, redundant, and pointless bill “auditing.”

An Off-Putting Offer

In addition to the claims’ administrator’s standard bill review, services like MARS conduct superfluous “audits” of workers’ comp bills with the pretext of somehow finding extra savings for the payor. These services apply an (allegedly) finer-toothed comb to bills, catching (supposedly) hidden opportunities for denials and adjustments.

In theory, it sounds like a promising prospect for insurers, employers, and their respective claims administrators. In reality, it’s a waste of time, money, and effort.

In accordance with the California appeals process, the provider in question timely and compliantly appealed Farmers’ incorrect denial by submitting a request for second review. Upon receiving the second review appeal, Farmers was required to respond within 14 calendar days with a final EOR.

But before that deadline came, MARS swooped in with their own solution: an “agreement” and offer of a reduced reimbursement.

The required reimbursement per the Medical-Legal fee schedule was $5,430.21. MARS listed $2,650.94 as the “agreed amount” and included a firm deadline for the provider to accept the offer, as if it were some kind of opportunity not to be passed up.

As far as we can tell, this MARS offer is a ploy by a service desperate to show their client a win, even if it means resorting to backhanded attempts at intimidating a provider.

A Suspicious Tactic

DaisyBill reached out to Farmers’ bill review, CorVel, on behalf of the provider, reaffirming that a second review appeal was in process. CorVel assured our representative that Corvel intended to conduct second review as required by regulations (note that Farmers non-compliantly missed the required 14-day deadline to respond to the provider’s appeal).

For an interloper like MARS to suggest bypassing that established appeal procedure creates nothing but friction in an already friction-laden industry.

One thing is definite: services like MARS lowballing providers to avoid proper dispute resolution is a slippery slope, one that tilts towards a very dysfunctional workers’ comp landscape. This is nothing short of an attempt to bamboozle a provider.


Claims administrators don’t always get it right. Fortunately, DaisyBill’s Billing Software includes all the tools you need to pursue second review appeals and IBR. Schedule a free demonstration, and see how we can make workers’ comp easier for your office.

SCHEDULE DEMO

Search results for:

intercom_chat_bubble_icon