California Workers' Comp

Gallagher Bassett Flips UR Decision, Confusion Reigns
Nov 9, 2023
Gallagher Bassett Flips UR Decision, Confusion Reigns
To an injured worker denied the care their treating physician deems necessary, California’s Utilization Review (UR) process can seem arbitrary, even cruel. This percep...
DWC's New MPN List Helps No One
Oct 30, 2023
DWC's New MPN List Helps No One
California’s Medical Provider Network (MPN) system is an unmitigated disaster — and the latest “solution” from the Division of Workers’ Compensation (DWC) is laughable in its...
JT2: 1,906 Audit Complaints Filed With CA DWC
Oct 27, 2023
JT2: 1,906 Audit Complaints Filed With CA DWC
California workers’ comp has many complex laws, regulations, and rules regarding billing and payment. But one law is straightforward: claims administrators must accept e-bill...
CA OMFS Update: Physician Services (Q4 2023)
Oct 6, 2023
CA OMFS Update: Physician Services (Q4 2023)
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 ...
Obituary: Major CA Practice Quits Workers' Comp Treatment
Oct 4, 2023
Obituary: Major CA Practice Quits Workers' Comp Treatment
RIP RehabOne Medical Group, 2004-2023California workers’ comp will lose a pillar of the provider community, effective at the close of this year. RehabOne will have pro...
SCIF Inept UR #6: Non-MTUS Guidelines Strike Again
Sep 29, 2023
SCIF Inept UR #6: Non-MTUS Guidelines Strike Again
Once again, State Compensation Insurance Fund (SCIF) and EK Health denied surgery for an injured worker by citing unadopted, alternative treatment guidelines outside of Calif...
Berkshire Hathaway: 10,735 Audit Complaints Filed With CA DWC
Sep 28, 2023
Berkshire Hathaway: 10,735 Audit Complaints Filed With CA DWC
Berkshire Hathaway Homestate Companies (BHHC) is backsliding into old, bad habits.Over the summer, BHHC failed to send thousands of electronic Explanations of Review (...
SCIF Inept UR #5: EK Health Ignores MTUS, Denies Surgery
Sep 27, 2023
SCIF Inept UR #5: EK Health Ignores MTUS, Denies Surgery
Why is it so difficult to get treatment for a work-related injury? At least in California, most of the answer is a broken UR system that allows insurers to withhold potential...
ProPublica/NPR: Fees & Discounts Gutting Provider Revenue
Sep 26, 2023
ProPublica/NPR: Fees & Discounts Gutting Provider Revenue
ProPublica and NPR recently published an exposé on entities that impose fees on doctors who accept electronic funds transfer (EFT) payments. These fees c...
daisyBill Account Analytics: Appeal Payments!
Sep 19, 2023
daisyBill Account Analytics: Appeal Payments!
If no one tracks your workers’ comp bills, you’re probably missing critically important information about your practice’s revenue.The sad fact is that between i...
SCIF Inept UR #4: IMR Rules Favor Insurers
Sep 15, 2023
SCIF Inept UR #4: IMR Rules Favor Insurers
In recent articles, we’ve shared the details of State Compensation Insurance Fund (SCIF)’s denial of continued care for an injured worker on false grounds, and ...
FYI: Inaccurate DWC IBR Form May Cost Your Practice
Sep 14, 2023
FYI: Inaccurate DWC IBR Form May Cost Your Practice
California’s Division of Workers’ Compensation (DWC) has strict and specific requirements for providers who wish to dispute incorrect payment amounts through Independent Bill...