Blog: DaisyBill News

When navigating the seas of change, it’s refreshing to find an island of relative stability. Like California’s state-specific codes, the splinting and casting codes group (commonly referred to as “Q codes”) is not subject to the Geographic Practice Cost Index (GPCI) adjustment and is only adjusted quarterly with the DWC adoption of the Medicare rates.

Not one to avoid the spotlight, York Risk Services joins Sedgwick CMS in incorrectly applying the 2018 Physician Fee Schedule rates to services rendered in 2019. Our data show a consistent and demonstrated pattern of botched payments through at least the end of January.

Despite the vastly increased complexity of the California Physician Fee Schedule in 2019, most administrators are abiding by the changes and issuing checks for the appropriate amounts. A few stragglers remain who, for whatever reason, fail to follow the new schedule. Today, we turn our attention to York Risk Services.

With the flurry of new year fee schedule changes, California updated the Physician Fee Schedule reimbursement for its state-specific codes. These codes are explained in 8 CCR §9789.12.14 by the Division of Workers’ Compensation (DWC) and reimbursement is updated annually. Thankfully, the reimbursement formula is straightforward and not subject to variation by locality.

In the Physician Fee Schedule, the state-specific codes cover services for which there are no appropriate CPT codes, such as the Primary Treating Physician’s Progress Report (DWC form PR-2). Annually, the California DWC establishes a single new statewide reimbursement for each of the services covered by these ‘WC’ codes.

For better or worse, location-based adjustments are here for California workers’ comp. Find out how they impact reimbursements in 2019.

As our preliminary calculations indicate, net reimbursements will decrease by 3-4% for many areas, whereas the most expensive locations will receive at least a 10% increase over 2018 reimbursements.

California’s Division of Workers’ Compensation (DWC) proposed significant changes to the Pharmaceutical Fee Schedule. The proposals would bring pharmaceutical reimbursement calculations for workers’ comp into line with revisions to Medi-Cal’s payment system, on which the Pharmacy Fee Schedule is based.

If approved, the proposed changes will be effective January 1, 2019. The DWC will accept public comments via their online forum until Monday, October 8.

California’s Division of Workers’ Compensation (DWC) ordered updates to the Physician and Non-Physician Practitioner portion of Official Medical Fee Schedule (OMFS), effective October 1, 2018.

The order adopts several changes to the Medicare payment system, including quarterly updates to Relative Value Units (RVU) and National Correct Coding Initiative (NCCI) edits. In addition, the order includes the September 15 monthly Medi-Cal Rates file update for physician-administered drugs, biologicals, vaccines or blood products.

The order adds a total of 14 new billing codes for various Evaluation and Management (E/M) and injection services.

In May of this year, California’s Division of Workers’ Compensation (DWC) announced proposed changes to the state Medical-Legal Fee Schedule (MLFS), and welcomed public comment via the division website’s online forum. The response to these proposals was impassioned, to say the least, as medical-legal professionals reckoned with the potential impact.

Now, the DWC will hold a public meeting to further discuss these significant changes. The meeting is scheduled for Wednesday, October 17 at 10:00 am in Oakland.

A recently adopted Medicare Medically Unlikely Edit (MUE) assigned a value of “0” to many common workers’ comp billing codes, including those for acupuncture services. Providers were understandably shocked, and wondered whether the incorporation of this MUE into the Official Medical Fee Schedule (OMFS) meant an end to reimbursement for the services in question.

Now, the Division of Workers’ Compensation (DWC) has resolved the matter, revising the most recent OMFS update to exclude all codes with an MUE assigned value of “0” from the workers’ comp MUE file.