California Workers' Comp
Mar 7, 2019
SCIF IBR Disputes Are Further Proof of Provider Reimbursement Chaos
We are again chronicling the reimbursement pandemonium inflicted on providers by the current California Second Review appeal and Independent Bill Review (IBR) processes.<...
Mar 5, 2019
2018 Average Days to Payment for Interpreter & Copy Services
Last year, more than 107,000 interpreter and copy service bills were processed by DaisyBill. The top 20 claims administrators took an average of 10 business days to process t...
Mar 4, 2019
Assistant at Surgery: All You Need to Know
Last week, we opened Pandora’s box on co-surgeons and team surgery. Notably left in the box was a discussion on assistant(s) at surgery. Typically this arises when physicians...
Mar 1, 2019
📬 Payer Responses: Guile, Waiting, and Crickets 🏏
Today we report on the responses from Sedgwick, Liberty Mutual, York, and State Compensation Insurance Fund (SCIF), following our posts detailing their systematic underpaymen...
Feb 27, 2019
2018 Average Med-Legal Days to Pay
In 2018, for California medical-legal bills submitted using DaisyBill software, the average processing time is 13 business days to receive payment for the top 20 claims admin...
Feb 26, 2019
Co-Surgery vs. Team Surgery: All You Need to Know
Surgery in workers’ compensation cases opens a Pandora’s box: reserves go up, nurse case managers get involved, and surgeons need to justify every detail of their billing to ...
Feb 22, 2019
2018 Average Days to Payment for Medical Treatment Bills
In 2018, for California medical treatment bills submitted using DaisyBill software, the average processing time is 11 days for the top 20 claims administrators by volume. We’...
Feb 20, 2019
SCIF (CA) Incorrectly Paying 2018 Fee Schedule for 2019 DOS
It’s SCIF’s turn. The California State Compensation Insurance Fund (SCIF) is also incorrectly reimbursing providers using the 2018 Physician Fee Schedule instead of the corre...
Feb 14, 2019
Reminder: Timely Bills Are Mandatory
Late bills will not be paid. Period. Timely billing has been in effect in California workers’ compensation since January 1, 2017, but we still see providers missing th...
Feb 12, 2019
Maximus Confirms Using Second Review Appeals to Correct Billing Errors
Correcting a coding error is as simple as submitting a Second Review appeal explaining the error. Last year, we discussed the convoluted process to correct billing err...
Feb 8, 2019
The Payment Chaos Continues: Sedgwick Denies Appeal for Correct 2019 Reimbursements
Sedgwick’s payment mistakes multiply. First, Sedgwick incorrectly paid California providers by applying an old workers’ comp fee schedule. Now Sedgwick compounds its error by...
Feb 6, 2019
2019 Splinting & Casting Reimbursement Update
When navigating the seas of change, it’s refreshing to find an island of relative stability. Like California’s state-specific codes, the splinting and casting codes group (co...