California Workers' Comp

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...

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...

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...

Data Reveal 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 reveal a staggering amount of reven...

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...

No Response? How to Deal with Ignored Bills

It happens far too often: providers treat an injured worker for a California employer, send the bill to the claims administrator, and then...nothing. Workers’ comp is ...

FYI: Workers’ Comp Telemedicine Reimbursed at Facility Rates

In California and elsewhere, telemedicine isn’t just the future — it’s the present. Of course, this shift to increasingly virtual services means unique new wrinkles in the wo...

Discount Dangers: The Provider’s Bill of Rights (Rights VI and VII)

Discount Dangers is a daisyBill series on the ways discount contracts unscrupulously lower work comp providers’ reimbursements. With this series, we shine a light on the wors...

Medical-Legal Complexity Factors: Provider Requirements

Recently, a DaisyBill client faced unreasonable demands from a bill review regarding complexity factors for medical-legal billing code ML104. Fortunately, our client’s refusa...

Medical-Legal: When to Bill For Report Preparation

Medical-legal billing is a special kind of tricky. This unique subset of California workers’ comp has its own rules, its own fee schedule, and its own unique complicat...

Medical-Legal Fee Schedule: DWC Proposes New Amendments

The California Division of Workers’ Compensation (DWC) announced proposed amendments to the Medical-Legal Fee Schedule yesterday, May 3. The amendments would make sign...