California Workers' Comp

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...

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 ...

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...

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,...

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...

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...

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....

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...

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...

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...

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...

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...