As daisyNews reported yesterday, a California doctor received an unsolicited "agreement" from Medical Audit & Review Solutions (MARS) pressuring the doctor to accept steep payment reductions or face continued "intervention."

The “agreement” from MARS (a MultiPlan company) didn't mention the injured worker's employer (the City of Newport Beach) or the claims administrator (Adminsure). So it was unclear why, or on whose behalf, MARS sent the vaguely threatening message.

daisyBill contacted Adminsure, which forwarded our query to the City of Newport Beach's bill review vendor, Lien On Me. Subsequently, Lien On Me contacted the doctor directly, claiming that the message was "auto-generated" and that neither Lien On Me nor Adminsure has "any connection" to MARS.

Lien On Me claimed to have "cleared up the entire matter" by contacting MARS and sending the practice a paper Explanation of Review (EOR). But this doctor's payment odyssey was far from over.

Lien On Me failed to process the bill correctly, forcing the doctor to submit a Second Review appeal. Lien On Me also failed to send the required electronic EOR (e-EOR) in response to the electronic bill (e-bill), for which payment was late.

Consider what this physician experienced after providing authorized treatment to an injured worker:

• A disturbing fax from a mystery entity
• A bureaucratic maze spanning at least four organizations
• A missed payment deadline and non-compliant EOR
• A burdensome appeal process just to receive correct payment

California employers pay some of the highest workers' comp premiums in the nation, for a system that treats providers so poorly that fewer and fewer are willing to participate.

The consequences ultimately fall on employers, who continue to fund a dysfunctional system, and their injured workers, who struggle to find care.

Lien On Me: MARS Message “Auto-Generated”

To recap: the MARS "agreement" made no mention of the claims administrator. Under "PAYOR/CLIENT (via MULTIPLAN)," it listed only "Workers Comp." The document expressly disclaimed that "MARS and MultiPlan are not payors or agents of any payor."

So who sent this doctor's bill to MARS?

daisyBill emailed Adminsure about MARS’ fax. Adminsure's representative claimed that they couldn't access the e-bill in question because Lien On Me handles the City of Newport Beach's bill review.

Adminsure contacted Lien On Me, which subsequently emailed the doctor directly, disavowing any involvement and claiming that MARS “auto-generated” the fax. Lien On Me asserted a total lack of “any connection” between itself, Adminsure, and MARS.

Yet somehow, this doctor’s bill ended up in MARS’ hands, and no one can (or will) explain how.

The Doctor’s Payment Odyssey Continues

Lien On Me also emailed daisyBill directly, asserting that they had "cleared up the entire matter" after contacting MARS and subsequently sending an EOR at the appropriate rates.

However, Lien On Me failed to properly process the doctor’s bill, which included three procedure codes that Adminsure authorized on behalf of the City of Newport Beach. The paper EOR from Lien on Me listed only two of the three billed procedure codes.

Further, the (incorrect) reimbursement was late per the 15-day deadline for e-bill payment, and Lien On Me failed to respond to the e-bill with the mandated e-EOR.

To receive proper payment for the treatment that Adminsure authorized, the doctor must now submit a Second Review appeal within 90 days.

Additionally, the EOR above also cites Coventry to justify Preferred Provider Organization discounts. While it remains unclear how MARS got involved, this is not the first time we’ve seen MARS’ parent company, MultiPlan, team up with Coventry to slash a provider’s reimbursement.

Heads: Payers Win, Tails: CA Employers Lose

It should not have taken daisyBill's “intervention” for Lien On Me to call off MARS/MultiPlan. It should not require a Second Review appeal for a doctor to receive correct payment for authorized treatment.

Yet, this is the struggle California providers repeatedly endure.

As we noted yesterday, MultiPlan is currently the subject of a federal lawsuit alleging predatory discount practices for commercial insurance bills. How MARS inserted itself into this workers' comp payment cycle remains a mystery, one that neither the claims administrator nor its bill review vendor will explain.

Payers that fail to adhere to state law and regulations face no meaningful consequences. Vendors who botch bills face no penalties. Shadowy parties with no discernible connection to the claim can threaten "intervention" with impunity.

The only party held accountable is the physician, who must navigate the entire billing and appeals gauntlet in perfect compliance to have any chance of getting paid.  

Until California protects providers, the system will continue to operate exactly as designed: heads the payer wins, tails employers lose access to care for their injured workers.

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