Most Recent Articles
Mar 1, 2017
2017 Work Comp Reimbursement Cheat Sheet
This post includes payment information for 2017 dates of service only. For reimbursement changes effective January 1, 2018 see ourUltimate 2018 Work Comp Reimbursement...
Jan 4, 2017
The DWC, the Physician Fee Schedule, and Align Networks
The start of the new year is always a hectic time in the world of California workers’ compensation. Often prior to January 1st, California’s Division of Workers’ Compensation...
Feb 26, 2014
California Specific Work Comp Codes
As providers still billing on paper begin to receive payments for their January 2014 dates of service, we’re receiving inquiries about the California specific codes that beca...
Jan 6, 2015
Once Again, Maximus Mis-Applies Work Comp Fee Schedules
Maximus IBR determination confuses physician-administered and physician-dispensed drug, again.
Jul 28, 2014
Major Reimbursement Changes to Pharmaceuticals Fee Schedule
Effective July 16, 2014, the DWC updated the dispensed pharmaceuticals fee schedule, removing over 21,000 distinct NDC numbers. In fact, the DWC removed over 170,000 total en...
Mar 31, 2015
Some Claims Administrators Continue to Pay at Old Fee Schedule Rates
On March 1st the new Physician OMFS for California workers’ comp took effect. daisyBill’s data indicates some claims administrators continue to reimburse bills ...
Aug 1, 2017
Hospital Outpatient Prospective Payment System: J1 Status Indicator Explained
Late last year, the Division of Workers’ Comp (DWC) drastically changed the reimbursement calculations used for Hospital Outpatient Departments and Ambulatory Surgical Center...
Jul 8, 2015
Work Comp Confusion: Interpreting 5307.11 Contracts
We get a lot of questions about 5307.11 contracts for workers’ compensation. In a nutshell, 5307.11 contracts allow providers and claims administrators to contract for reimbu...
Oct 2, 2014
MUEs Don't Apply to DME for Workers' Comp
There’s been a fair amount of confusion so let’s make this plain: medically unlikely edits (MUEs) do NOT apply to work comp durable medical equipment (DME) bills.On 9/...
Jan 26, 2018
Bill Review: What It Is, and Why It’s Hurting Workers’ Compensation
Bill review is very profitable. Sadly, that profit comes at the expense of other stakeholders in workers’ comp. Bill review is a huge part of the workers’ comp billing...
Mar 7, 2017
Telehealth Medicare Restrictions Not Adopted by DWC
Several weeks ago, we covered the emerging field of telehealth and its powerful ability to alter the California workers’ comp landscape. Reimbursement for these telehealth se...
Nov 29, 2018
CA OMFS Inpatient Hospital Fee Schedule Update
California’s Division of Workers’ Compensation (DWC) posted an adjustment to the Inpatient Hospital section of the Official Medical Fee Schedule (OMFS), effective for dischar...