California Workers' Comp
Jul 6, 2021
IBR Hall of Shame: Sedgwick Sets New Standard of Noncompliance
Sedgwick failed to comply with an Independent Bill Review (IBR) ruling for almost four months. Worse, the payor’s brazenness is likely to go unpenalized by the state.T...
Jul 5, 2021
OMFS Update: 59 Codes Newly Billable
California’s Division of Workers’ Compensation (DWC) issued an update to the Physician and Non-Physician Practitioner portion of the Official Medical Fee Schedule (OMFS) for ...
Jun 30, 2021
SB 537 Reveals Murky World of Discount Contracts
In 2019, California passed Senate Bill 537. Among the changes to take effect on July 1st is a disclosure mandate requiring discount contracting entities to disclose to the cl...
Jun 21, 2021
Zurich - An Example of California's MPN Shell Game
Where opacity and obfuscation reign, injustice thrives. There may be no better example of this than California’s Medical Provider Network (MPN) system. T...
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May 20, 2021
MPNs: The Jekyll and Hyde of Workers' Comp
We’ve argued that MPNs are mostly a drag on the workers’ compensation system. But as some employers demonstrate, they don’t have to be.When employers use MPNs to maint...
May 19, 2021
Anthem: PPO Discount Payments BELOW Medicare
Q: How much can a workers’ comp provider lose by signing a Preferred Provider Organization (PPO) agreement?A: Much, much more than the provider probably realizes.
May 12, 2021
CNA Repeatedly Ignores California Law
By law, claims administrators must remit payment for Medical-Legal services within 60 days of receiving the physician’s bill. As of this writing, payment to one physician fro...
Apr 21, 2021
Mob Rule: SCIF/Anthem Hold Patient(s) Hostage
On paper, Medical Provider Networks (MPNs) are a simple workers’ comp quality/cost-control measure. Employers designate an MPN, and injured workers choose from among the MPN ...
Apr 8, 2021
2021 CA Med-Legal Billing Codes Pocket Guide
California has a new Medical-Legal Fee Schedule (MLFS), effective April 1. To help medical-legal evaluators and their staff navigate these (drastic) changes, we created a dow...
Apr 7, 2021
Broadspire Pays Provider 47% Below CA OMFS
It happens every year: Reimbursement rates for workers’ compensation services in California change, and payers reimburse providers at the lesser, previous rates.It hap...
Apr 5, 2021
City & County of San Francisco's Misleading Reply PPO Dispute
Recently, a DaisyBill provider disputed a reduction in reimbursement from the City and County of San Francisco (CCSF) for treating an injured employee. In the Explanation of ...
Apr 2, 2021
Broadspire Knows No Law But Its Own
Broadspire continues to break the rules, seemingly confident that California regulators will not hold the claims administrator to account. For months, we reported on B...