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New Original Bill Requirement Raises Lien Questions

January 16, 2017 by Catherine Montgomery

On a typically overcast San Francisco morning earlier this month, the California Workers’ Compensation Appeals Board (WCAB) held a public hearing. The subject? Proposed regulations for the implementation of Senate Bill 1160’s lien reforms. For an issue with such long-reaching implications, the audience was surprisingly sparse – only two speakers rose to present statements. Despite the public hearing, details about the new Division of Workers’ Compensation (DWC) lien forms are still scarce. And one question in particular has us perplexed: When it comes to filing a lien, what, exactly, constitutes an “original bill”?

Section 8 of SB 1160, which amends Labor Code 4903.05, includes the following line: “For liens filed on or after January 1, 2017, the lien shall also be accompanied by an original bill in addition to either the full statement or itemized voucher supporting the lien.”

So lien claimants now must file two separate supporting documents:

  1. An original bill
  2. Either the full statement or itemized voucher

The requirement to include an “original bill” gets murky quickly.

The DWC’s Medical Billing and Payment Guide provides very specific criteria for the appropriate billing forms to use in medical treatment. However, no such resource exists for medical-legal bills, copy services, or interpreters – the DWC has not adopted a standardized billing format for any of these services.

Medical Billing and Payment Guide Required Billing Forms

Billing Form

Used By

CMS 1500

Physicians and Professional Health Care Providers

Providers of DMEPOS
Pharmacies billing for DMEPOS

Clinical Laboratories

Ambulance Service Providers

UB-04

Inpatient Hospitals

Rehabilitation Hospitals

Hospital Outpatient Departments

Ambulatory Surgical Centers

NCPDP

Pharmacies (Except when billing for DMEPOS)

ADA Dental Claim Form

Dentists

Dental Clinics

Orthodontists

For medical treatment liens, we advise that you include a copy of the appropriate original billing form above, as required by the DWC Medical Billing and Payment Guide. Electronic billers, including DaisyBillers, need to provide the correspondent completed paper billing form. This is easy in DaisyBill – simply click ‘View CMS 1500’ or ‘View NCPDP’ for the bill in question and print it out for your lien.

For medical-legal liens, we suggest that you use and submit the CMS 1500 form – by default, this has become standard practice within the billing community. The correct course of action for interpreters and copy services remains unclear.

Speakers at the WCAB public hearing did ask for clarification on this subject. Perhaps in response, the WCAB announced an extension of the period for public comment on these regulations. The comment period now closes on Wednesday, January 18.

If you have any questions or concerns about the requirement to attach an “original bill” to your lien – and especially if you are a medical-legal biller, copy service, or interpreter – we strongly encourage you to submit a public comment to the WCAB. You may do so by emailing the contact person listed on this page before 5 PM on the 18th.


If you have questions about the new lien declaration requirements, we’re more than happy to help. Start with our FAQ Article about the new DWC lien forms, or watch our lien declaration webinar below. If you’re still confused, feel free to contact us directly.

Lien Declaration Webinar

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