California Workers' Comp
Sep 16, 2021
Med-Legal Reports: Always Include Page Count Verification!
California’s new Medical-Legal Fee Schedule (MLFS), effective from April 2021, brought with it new rules for reporting, billing, and payment. Among those rules: when submitti...
Sep 15, 2021
SCIF Hacks IBR by Switching (Incorrect) Denial Reason
There’s a serious inequity in the appeals process by which California workers’ comp providers can dispute incorrect reimbursement for authorized treatment. State Compensation...
Sep 14, 2021
A Doctor's Warning: PPOs "Helped Close Our Doors"
Recently we received an email from a retired California doctor. This doctor, after 35 years treating injured workers, was unable to sell his practice — because no other provi...
Aug 25, 2021
AIG: Improper (but Logical) Med-Legal Underpayment
AIG improperly reduced a California Medical-Legal bill by 88%, providing a dramatic example of how California law incentivizes payers to incorrectly reimburse physicians who ...
Aug 19, 2021
CA Cheat Sheet: Required Reports & Supporting Documentation for Workers' Comp Bills
In California, when submitting a bill for treating an injured worker, it’s imperative to include the correct documentation to support the treatment. If the provider fails to ...
Aug 19, 2021
Med-Legal Diagnostic Testing Is Reimbursable
FAQ: Is diagnostic testing, as part of a Medical-Legal evaluation, separately reimbursable?A: Yes, as long as the testing is necessary to complete the evaluation.<...
Aug 16, 2021
WorkCompEDI Acquired by Data Dimensions
WorkCompEDI (WCEDI) has a new owner. The clearinghouse, which processes millions of provider electronic bills annually, was acquired by Data Dimensions, an automation ...
Aug 11, 2021
Sedgwick: Sketchy EOR Math for LA Unified School District
Sedgwick recently returned an Explanation of Review (EOR) that failed to fulfill a crucial requirement: showing how Sedgwick actually calculated the reimbursement amount paid...
Aug 10, 2021
City of Pasadena: CompIQ Saves the Day
Following a switch to a new third-party claims administrator (TPA), the City of Pasadena violated California law by suddenly failing to accept electronic bills for the treatm...
Aug 9, 2021
2021 Telehealth Billing Guide for CA Workers' Comp
With COVID-19 hardly in the rearview mirror just yet, California workers’ comp providers can still utilize telehealth as a safer alternative to in-person treatment. But of co...
Aug 5, 2021
Disneyland Churns Out Incorrect e-Bill Rejections
Providers billing Disneyland Resorts, be warned: your electronic bills might be erroneously rejected.Recently, we reported on Disneyland Resorts’ switching its bill re...
Aug 4, 2021
Audit Complaint: PacificComp Fails to Process e-Bills
In California workers’ comp, a provider’s failure to adhere to the billing regulations allows the payer to refuse payment for treatment of the injured worker. But all too oft...