Fee Schedule

📬 Payer Responses: Guile, Waiting, and Crickets 🏏

Today we report on the responses from Sedgwick, Liberty Mutual, York, and State Compensation Insurance Fund (SCIF), following our posts detailing their systematic underpaymen...

Co-Surgery vs. Team Surgery: All You Need to Know

Surgery in workers’ compensation cases opens a Pandora’s box: reserves go up, nurse case managers get involved, and surgeons need to justify every detail of their billing to ...

Liberty Mutual Trifecta of Incorrect Payments

In this, our fourth story on the fiasco of 2019 workers’ comp payments, we turn to the errors of Liberty Mutual. By now, from reading about Sedgwick, York, and Sedgwick (agai...

The Payment Chaos Continues: Sedgwick Denies Appeal for Correct 2019 Reimbursements

Sedgwick’s payment mistakes multiply. First, Sedgwick incorrectly paid California providers by applying an old workers’ comp fee schedule. Now Sedgwick compounds its error by...

2019 Splinting & Casting Reimbursement Update

When navigating the seas of change, it’s refreshing to find an island of relative stability. Like California’s state-specific codes, the splinting and casting codes group (co...

California-Specific Codes Updated for 2019

With the flurry of new year fee schedule changes, California updated the Physician Fee Schedule reimbursement for its state-specific codes. These codes are explained in 8 CCR...

Sedgwick Still Reimbursing at 2018 Rates for California

Since the beginning of 2019, Sedgwick CMS has incorrectly used the 2018 Physician Fee Schedule to reimburse providers. Our data indicates that Sedgwick is consistently and in...

Good-bye CPT 96101 and CPT 96102

For 2019 beloved psychological testing codes 96101 and 96102 have vanished. Effective for dates of service on or after January 1, 2019, the Medicine/Central Nervous ...

CA OMFS Inpatient Hospital Fee Schedule Update

California’s Division of Workers’ Compensation (DWC) posted an adjustment to the Inpatient Hospital section of the Official Medical Fee Schedule (OMFS), effective for dischar...

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...

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...