Billing Education
Jun 22, 2018
Conditional Authorization: How MPNs Cheat Workers’ Comp Providers
Medical Provider Networks (MPNs) are a drag on California workers’ compensation. Nominally designed to help employers control costs, MPNs rarely achieve more than throwing up...
Jun 21, 2018
Modifier 26 for Workers’ Comp Professional Services
Modifiers play a vital role in California workers’ compensation billing. But for all the value they add in allowing providers to more precisely specify the services rendered,...
Jun 8, 2018
CorVel Error: Incorrectly Reimbursed ASC Services
CorVel Corporation, a national third-party administrator, incorrectly reimbursed multiple California workers’ comp providers for Ambulatory Surgical Center (ASC) services, at...
May 31, 2018
Institutional Billing: How to Find Your Conversion Factor
For institutional billing, identifying the correct conversion factor is key to saving time and billing accurately.The Hospital Outpatient Departments and Ambulatory Su...
May 30, 2018
Work Comp Billing Error: Resubmit or Request Second Review?
Mistakes happen. When a provider accidentally submits an original bill that contains an error, taking the appropriate action is key to avoiding further delay in reimbu...
May 25, 2018
Data Reveals Importance of Second Review Appeal for Providers
The claims administrator’s Bill Review does not always recommend the correct reimbursement on the first try. Our second review appeal data reveals a staggering amount of reve...
May 17, 2018
No Response? How to Deal with Ignored Bills
It happens far too often: providers treat an injured worker for a California employer, send the bill to the claims administrator, and then...nothing. Workers’ comp is ...
May 16, 2018
FYI: Workers’ Comp Telemedicine Reimbursed at Facility Rates
In California and elsewhere, telemedicine isn’t just the future — it’s the present. Of course, this shift to increasingly virtual services means unique new wrinkles in the wo...
May 2, 2018
DME: Invoice Not Required for (Most) Durable Medical Equipment
Too often, we see claims administrators demand extraneous paperwork from providers, adding unnecessary friction to the workers’ comp billing and payment process. One example ...
Apr 13, 2018
“By Report” Billing Codes: Best Practices for Proper Reimbursement
When the Official Medical Fee Schedule (OMFS) assigns the reimbursement for a procedure code as “By Report” (BR), establishing the correct payment amount is one of the tricki...
Mar 28, 2018
PR-2 Report Made Easier: Fillable and Downloadable PR-2 Report Form
Last month, we highlighted the importance of the Treating Physician’s Progress Report, which providers must use to document services rendered. This crucial bit of paperwork, ...
Mar 23, 2018
Automatic Authorization: Late Bill Submission Does Not Bar Payment
Workers’ comp providers, be warned: payors are incorrectly denying bills for automatically authorized services due to untimely submission.Untimely submission is not gr...