California Workers' Comp
Aug 31, 2017
Maximus Gets It Wrong in 99358 IBR Decision
Maximus Federal Services, the arbiter of Independent Bill Review (IBR) for the California Division of Workers’ Compensation (DWC), has denied payment to a provider due to an ...
Aug 29, 2017
Discount Dangers: The CA Provider's Bill of Rights (Rights I and II)
Discount Dangers is a daisyBill series on the various ways discount contracts incorrectly reduce providers’ reimbursements. With this series, we shine a light on the worst di...
Aug 25, 2017
Billers Beware! Submit Second Reviews to Appeal Incorrect Payments
Recently a claims administrator gave a daisyBill client some horrible advice about appealing an incorrect payment. A representative at Pacific Claims Management, a thi...
Aug 21, 2017
Just In Time: Your Guide to the SB 1175 Billing Deadline
Last year, SB 1175 joined SB 1160 in a one-two punch of workers’ comp reform. Amidst the continuing brouhaha about liens and fraud prevention, we want to remind providers abo...
Aug 18, 2017
Discount Dangers, Part I: The Silent PPO
Discount Dangers is a DaisyBill series on the various ways discount contracts cheat workers’ comp providers out of reimbursement. With this series, we shine a light on the wo...
Aug 16, 2017
DWC Closes Over 292,000 Liens per New Declaration Requirements
The California Division of Workers’ Compensation (DWC) just dismissed your lien if you did not comply with new Supplemental Lien Declaration requirements prescribed by last y...
Aug 14, 2017
In Case You Missed It: San Mateo and Sonoma Counties Change TPAs
Two California counties recently transferred their claims from Northern Claims Management to new administrators. Not surprisingly, communication about these changes was minim...
Aug 11, 2017
How MPNs Are Hurting Workers’ Comp
Last week on the blog, we argued that the RFA system in California workers’ comp is broken – it’s failing providers, and it’s restricting injured employees’ access to care. O...
Aug 9, 2017
Reminder: Secondary Treating Physician Reports Not Payable
Last month in this space, we covered reimbursement for the DWC Form PR-2, or the primary treating physician’s progress report. Since that time, we’ve received a number of que...
Aug 4, 2017
Why the RFA System Is Broken
Every day, we hear from frustrated providers across California who are struggling with their Requests for Authorization (RFAs). Their RFAs take too long to submit, and often ...
Aug 2, 2017
Hospital Outpatient Prospective Payment System: C-APC Explained
Yesterday on the blog, we described how Medicare’s adoption of Addendum B for the Hospital Outpatient Departments and Ambulatory Surgical Centers (ASCs) fee schedule moves th...
Aug 1, 2017
Hospital Outpatient Prospective Payment System: J1 Status Indicator Explained
Late last year, the Division of Workers’ Comp (DWC) drastically changed the reimbursement calculations used for Hospital Outpatient Departments and Ambulatory Surgical Center...