California Workers' Comp
Jul 12, 2018
Acupuncture Remains Payable for CA Work Comp, Despite MUE
The Centers for Medicare and Medicaid Services (CMS) recently released a Medically Unlikely Edit (MUE) designating acupuncture billing codes 97810 through 97814 non-payable, ...
Jul 11, 2018
Workers’ Comp Billing Tip: Use a Detailed Cover Sheet
California’s Division of Workers’ Compensation (DWC) has many strict requirements as to what constitutes a “complete” bill for the treatment of injured workers. But given the...
Jun 29, 2018
CA OMFS Update: Physician Services and DMEPOS
California’s Division of Workers’ Compensation (DWC) posted update orders to two sections of the Official Medical Fee Schedule (OMFS), both effective July 1, 2018. The...
Jun 27, 2018
CA Providers: Appeal Denials for Treatment Preceding Liability Decision
Recently, we pointed out that California employers are liable for treatment that precedes the claims administrator’s decision to accept or deny a workers’ comp claim. Before ...
Jun 22, 2018
Conditional Authorization: How MPNs Cheat Workers’ Comp Providers
Medical Provider Networks (MPNs) are a drag on California workers’ compensation. Nominally designed to help employers control costs, MPNs rarely achieve more than throwing up...
Jun 21, 2018
Modifier 26 for Workers’ Comp Professional Services
Modifiers play a vital role in California workers’ compensation billing. But for all the value they add in allowing providers to more precisely specify the services rendered,...
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...