California Workers' Comp
Feb 5, 2020
CPTs 99358 & 99359 - 2020 CA Reimbursement Cheat Sheet
Changes have been made to the California OMFS since the publication of this article. Be sure to see the latest analyses here and here.2021 OMFS updates drastically cha...
Dec 2, 2019
CA Interpreters: No Second Review = No Payment
Providers — interpreters in particular — be advised: a California appeals court ruled that claims administrator Meadowbrook Insurance is not required to pay a disputed fee fo...
Nov 21, 2019
Hanover –> What the H*llover is Going On?
We have yet another tale of a payer flagrantly ignoring its duty to compliantly process provider bills for treatment of injured workers. This account of payer friction highli...
Oct 15, 2019
SB 537: California RFA and Utilization Review Data
Last week Gavin Newsom, who serves as Governor of California, signed SB 537 into law, thereby adding a new section 138.8 to the Labor Code. This new §138.8 requires the Depar...
Oct 14, 2019
The Zenith Unsucessfully Attempts to Undermine IBR Request
Claims administrators continue to innovate new techniques that make it harder for providers to receive proper reimbursement. In this installment, we tell a tale of the length...
Oct 10, 2019
CA OMFS: DMEPOS Fee Schedule Update Effective 10/1/2019
In Newsline No.: 2019-75, the California Division of Workers’ Compensation (DWC) announced updates to the Official Medical Fee Schedule for Durable Medical Equipment, Prosthe...
Oct 8, 2019
CA OMFS: Pathology/Clinical Lab Fee Schedule Update Effective 10/1/2019
On October 4, 2019, California’s Division of Workers’ Compensation (DWC) ordered an update to the Pathology and Clinical Laboratory section of the Official Medical Fee Schedu...
Sep 20, 2019
Huntington Hospital & City of Beverly Hills Change TPAs
Attention providers: two California employers switched third-party administrators (TPAs).Huntington Hospital transferred claims from Sedgwick to AthensCity of B...
Sep 19, 2019
York (aka Sedgwick) Fails Math: EORs Literally Don't Add Up
York Risk Services, which was acquired this month by Sedgwick, has significant math troubles. York recently returned Explanations of Review (EORs) which obfuscated the effect...
Sep 6, 2019
IBR Stats Show Why Fighting Incorrect Reimbursement Is Worth It
In California, it can be entirely too difficult for providers to collect proper reimbursement for treating injured workers. Among the many reasons for this unfortunate realit...
Sep 5, 2019
Claims Admins EXPLOIT Lack of Regulations in Timely Filing Law
In 2016, California State Bill 1160 was signed into law, instituting new timely filing requirements for workers’ comp medical treatment bills. Since 2017, Labor Code Section ...
Aug 26, 2019
Technical Difficulties Trouble San Diego Bill Review Switch
The City of San Diego, a self-insured, self-administered California employer, is in the process of switching bill review services from Genex to Medata. The transition, though...