California Workers' Comp
Jun 8, 2018
CorVel Error: Incorrectly Reimbursed ASC Services
CorVel Corporation, a national third-party administrator, incorrectly reimbursed multiple California workers’ comp providers for Ambulatory Surgical Center (ASC) services, at...
Jun 6, 2018
Do Not Send RFAs With Bills
When treating an injured worker, a provider must fax the Request for Authorization (RFA) to the fax number designated by the claims administrator. RFAs should never be sent w...
Jun 1, 2018
Multiple Payors Reimbursing WC002 at 2017 Rates
We’re halfway through 2018, and claims administrators are still reimbursing your office at 2017 rates for 2018 dates of service.We’ve noticed this problem all year for...
May 31, 2018
Institutional Billing: How to Find Your Conversion Factor
For institutional billing, identifying the correct conversion factor is key to saving time and billing accurately.The Hospital Outpatient Departments and Ambulatory Su...
May 30, 2018
Work Comp Billing Error: Resubmit or Request Second Review?
Mistakes happen. When a provider accidentally submits an original bill that contains an error, taking the appropriate action is key to avoiding further delay in reimbu...
May 30, 2018
E/M Services Denied for Insufficient Documentation
Increasingly, claims administrators are no longer downcoding evaluation and management (E/M) services. Instead, many claims administrators are denying charges for E/M service...
May 25, 2018
Data Reveals Importance of Second Review Appeal for Providers
The claims administrator’s Bill Review does not always recommend the correct reimbursement on the first try. Our second review appeal data reveals a staggering amount of reve...
May 23, 2018
IMR Unlikely to Overturn UR Decisions
When a payor’s utilization review organization (URO) denies treatment recommended by an injured worker’s treating physician, the only recourse is for the injured worker to ap...
May 17, 2018
No Response? How to Deal with Ignored Bills
It happens far too often: providers treat an injured worker for a California employer, send the bill to the claims administrator, and then...nothing. Workers’ comp is ...
May 16, 2018
FYI: Workers’ Comp Telemedicine Reimbursed at Facility Rates
In California and elsewhere, telemedicine isn’t just the future — it’s the present. Of course, this shift to increasingly virtual services means unique new wrinkles in the wo...
May 11, 2018
Discount Dangers: The Provider’s Bill of Rights (Rights VI and VII)
Discount Dangers is a DaisyBill series on the ways discount contracts unscrupulously lower work comp providers’ reimbursements. With this series, we shine a light on the wors...
May 9, 2018
Medical-Legal Complexity Factors: Provider Requirements
Recently, a DaisyBill client faced unreasonable demands from a bill review regarding complexity factors for medical-legal billing code ML104. Fortunately, our client’s refusa...