California Workers' Comp
May 30, 2018
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...
May 25, 2018
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...
May 23, 2018
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...
May 17, 2018
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 ...
May 16, 2018
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...
May 11, 2018
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...
May 9, 2018
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...
May 8, 2018
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...
May 4, 2018
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...
May 3, 2018
DWC Orders Changes to OMFS Pathology/Clinical Lab Fees
The DWC posted an update order bringing the Pathology and Clinical Laboratory section of the Official Medical Fee Schedule (OMFS) into line with Medicare.The order rem...
May 2, 2018
DME: Invoice Not Required for (Most) Durable Medical Equipment
Too often, we see claims administrators demand extraneous paperwork from providers, adding unnecessary friction to the workers’ comp billing and payment process. One example ...
Apr 27, 2018
CA Workers' Comp Alert: MTUS Drug Formulary Update
California’s Division of Workers’ Compensation (DWC) ordered an update to the state’s drug formulary, effective May 15. The update adds 20 drugs to the formulary and r...