California Workers' Comp
Jun 20, 2018
Data Show MPNs Do Not Benefit Employers
Medical Provider Networks (MPNs) allow employers to limit where employees may seek treatment for work-related injuries. Theoretically, the purpose of MPNs is to direct care w...
Jun 15, 2018
Clearinghouses Under the Microscope: CorVel Corporation
Most claims administrators lack the technology to process electronic bills from providers. Instead, these claims administrators rely on clearinghouses. Since DaisyBill has di...
Jun 14, 2018
Discount Dangers: Providers Cheated for PR-2 Reports
It seems like claims administrators really, really want to cheat California workers’ comp providers by reducing payment for the Treating Physician’s Progress Report, or PR-2....
Jun 13, 2018
Liable by Default: Failure to Deny A Claim Means the Claim is Accepted
In California, when it comes to accepting or rejecting an injured employee’s claim, the claims administrator that neglects to issue a decision is still effectively making a d...
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...