Today, Assembly Bill 1278 is being considered by the Appropriations Committee. This bill will grant barely-regulated network entities almost complete control over Medical Provider Networks (MPNs) and the coordination of injured workers’ care.

If you need further proof of the abject payment chaos that network entities will unleash on workers’ comp if AB 1278 passes, look no further than Medical Services Quotes (MSQ), a self-described “Intelligent Healthcare'' entity.

Recently MSQ imposed a mind-numbing billing requirement on California providers who are contractually entangled with this network. To obtain payment, MSQ insists providers must upload bills directly to MSQ’s online portal, presumably in the format of MSQ’s choosing.

Unfortunately, for providers caught in this network entity’s web, California’s protective billing and payment regulations apparently do not apply to MSQ.

Even though California (like other states) has regulatory requirements mandating how bills for the treatment of injured workers must be submitted, received, and responded to, those requirements apply only to claims administrators.

Network entities seemingly get to make up their own rules, for their own convenience.

These entities can brashly ignore state requirements, because the network contracts signed by providers often waive all protections granted by California laws and regulations. If AB 1278 passes, payment chaos will abound as network entities take control of coordinating care and compel providers to waive their rights, in exchange for eligibility to treat injured workers.

Providers, see the details of MSQ’s absurd position below.

MSQ Makes Up Its Own Regulations

Recently, daisyBill was contacted by a California provider who reported that MSQ not only refuses to accept e-bills in the state-mandated formats, but won’t even accept bills via fax or mail.

Incredulous, we asked MSQ for details. While some California claims administrators do still fail to accept e-bills — in blatant violation of California Labor Code Section 4603.4, which has required all claims administrators to accept e-bills since 2012 — not accepting paper bills was a new one.

MSQ replied with the following, which states:

The only way that we will accept the bills is to have them uploaded to the MSQ portal directly. Please do not fax or email the bills at any time.

Come again?

Yep, MSQ, an only nominally regulated network entity can fabricate its own billing rules, including mandating portal submission of bills.

Worse, pending legislation in the California State Assembly will even further empower network entities like MSQ.

AB 1278: Payment Chaos Pending

As we write, the California State Assembly is considering Assembly Bill 1278, which will allow network entities to dictate scheduling and coordination of care through Medical Provider Networks (MPNs).

AB 1278 will strip injured workers of their choice of physician. Instead, network entities will dictate care within MPNs. With the bill’s passage into law, these network entities can compel physicians to accept lower contractual reimbursement rates dictated by the networks — bypassing the state’s Physician Fee Schedule.

Consequently, injured workers will likely have a harder time finding care, since physicians are generally averse to treating patients at unsustainable reimbursement rates.

While AB 1278 grants unlimited and largely unregulated power to coordinate injured worker care, AB 1278 will also empower network entities to unleash billing and payment chaos on providers who treat injured workers.

Like MSQ, these network entities will be able to impose frictious billing mandates on the providers still left in the system. In all likelihood, even more providers will cease to treat injured workers.

AB 1278 will not help injured workers access care, as its sponsors claim. It will only help network entities tighten their grip on the system, and extract further profits.

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