For California workers’ comp providers, no billing strategy produces more revenue with less effort than consistently submitting Second Review appeals.

This is especially true for language interpreters, as evidenced by the astounding data from an interpreter service that joined daisyBill this year. Since February, this service has doubled its revenue for services provided to injured workers—simply by clicking the ‘Second Review’ button in daisyBill.

You read that correctly. The amount the interpreter service collected by disputing incorrect payment denials and reductions was roughly equal to the amount collected from original bill payments.

The bad news is that these numbers reflect how California has successfully rigged its workers’ compensation payment regulations to incentivize claims administrators to incorrectly reimburse providers. Claims administrators consistently underpay language interpreters (and all providers).

The good news is that technology makes it easy to successfully dispute these errors (or “errors,” as the case may be).

Second Review: Must-Use Strategy for CA Providers

Below are the ‘Payment by Post Month’ analytics for the interpreter service, from daisyBill software. ‘Payment by Post Month’ is just one of 11 different analytics reports (including a drill-down on appeal payments specifically) that practices can use to get a clear picture of their workers’ comp revenue streams.

For this interpreter, the data show that for payments posted since February 1st (the month the interpreter became a daisyBiller):

• Claims administrators collectively paid the interpreter service $270,630 for original bills.
• The same claims administrators subsequently paid the interpreter an additional $269,825 in response to Second Review appeals sent to dispute incorrect reimbursements.

As of August 21st, the difference between the original bill payment total and the Second Review payment total is only $805, or one tenth of one percent. In other words, this interpreter service made about the same amount by appealing incorrect payments as they did by sending the bills in the first place.

Since starting with daisyBill in February:

• The interpreter service submitted 815 Second Review appeals in total.

• Second Review appeals to dispute incorrect reimbursements represent an astounding 48% of the client’s bill submissions
• On average, the interpreter collected $1,232 from each appeal.

California mandates that if this interpreter service had failed to submit these hundreds of Second Review appeals within 90 days of receiving the incorrect payments, the claims administrators would no longer be obligated to reimburse the service correctly. Rather than penalizing claims administrators for improperly paying providers, California financially rewards inappropriate denials and reductions.

Note that California courts have determined that interpreters may submit Second Review appeals even though interpreter services are not covered under the Official Medical Fee Schedule (OMFS).

While California regulations state that Second Review applies only when a state fee schedule exists for the services in question, an appeals court determined that the interpreter fees listed in California Code of Regulations Section 9795.3 serve as the “state fee schedule” in this context. So appeal away, interpreters!

Remember: All Providers Must Appeal

The ugly reality of workers’ comp is that claims administrators will short you. The Division of Workers’ Compensation (DWC) does next to nothing to discourage non-compliance with payment laws and regulations, and many providers lack the knowledge and resources to demand correct reimbursement.

The result is that claims administrators adopt a “deny first” strategy, counting on providers not to appeal. This interpreter payment data clearly reveals that all providers who do not submit Second Review appeals are enriching claims administrators (and their private equity owners), which are taking advantage of this rigged system.

See the video below to learn how easy it can be to consistently appeal each and every incorrect payment denial or reduction.

With tools for quicker, easier appeals, daisyBill gets you full reimbursement with just a few clicks. Learn more below:

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