California Workers' Comp

CA Claims Admin Delays Payment, Skirts IBR Rules

When the Independent Bill Review (IBR) process overturns a claims administrator’s incorrect denial or adjustment, the claims administrator is legally bound to timely pay what...

CA: Employers 100% Responsible for UR Mistakes

In a much-anticipated ruling, California’s Supreme Court ruled that a secondary injury derived from an incorrect Utilization Review (UR) decision is compensable under workers...

Bill "Auditing" Services Try to Bamboozle Providers

Recently, MARS (Medical Audit and Review) made a very strange — and very dubious — offer to a California provider on behalf of the claims administrator, Farmers Insurance.

No Response to Second Review Request? A Lien Is the Only Option

A recent refusal by Travelers Insurance to respond to a provider’s second review appeal, and subsequent denial of the provider’s request for Independent Bill Review (IBR), pe...

It's Official: GPCI Reimbursement Adjustments Coming to CA Workers' Comp

California’s Division of Workers’ Compensation (DWC) has pulled the trigger: Geographic Practice Cost Indices (GPCI) will take effect on January 1, 2019. GPCI will divide the...

CA OMFS Update: Outpatient/ASC Changes Effective October 1

California’s Division of Workers’ Compensation (DWC) ordered updates to the Hospital Outpatient and Ambulatory Surgical Center (ASC) portion of the Official Medical Fee Sched...

CA DWC Proposes Pharma Fee Schedule Changes, Seeks Public Comment

California’s Division of Workers’ Compensation (DWC) proposed significant changes to the Pharmaceutical Fee Schedule. The proposals would bring pharmaceutical reimbursement c...

CA OMFS: New Billing Codes for Physician Fee Schedule

California’s Division of Workers’ Compensation (DWC) ordered updates to the Physician and Non-Physician Practitioner portion of Official Medical Fee Schedule (OMFS), effectiv...

DWC Will Hold Meeting on Controversial Medical-Legal Rule Proposals

In May of this year, California’s Division of Workers’ Compensation (DWC) announced proposed changes to the state Medical-Legal Fee Schedule (MLFS), and welcomed public comme...

IBR Accountability: Claims Admins Fail to Pay Providers

California regulations mandate that when Independent Bill Review (IBR) overturns a claims administrator’s incorrect bill denial or adjustment and finds in favor of the provid...

Med-Legal Misconceptions: 4 Ways NOT to Use Billing Code ML106

In California, physicians use code ML106 to bill for supplemental medical-legal examinations. However, what constitutes a supplemental medical-legal exam for billing purposes...

Maximus Blunders AGAIN with 99358 Decision and a Math Error

Maximus Federal Services, the entity responsible for conducting Independent Bill Review (IBR) on behalf of California’s Division of Workers’ Compensation (DWC), has once agai...