IBR

Sedgwick Loses IBR (But Still Wins "IBR Chicken")

You can’t say we didn’t try.Earlier this month, we offered Third-Party Administrator (TPA) Sedgwick Claims Management Services, Inc. 100% free use of our daisyWizard f...

CPT 99358 & 99359: How to Appeal Payment Denials

In workers’ comp billing, some procedure codes are trickier than others.Two of the best examples are CPT codes 99358 and 99359, used by providers to report prolonged n...

Med-Legal IBR Data: A Bad Look for Sedgwick & CA

California appears to turn a willfully blind eye to what seems like an abuse of the Independent Bill Review (IBR) system for Medical-Legal disputes.Data ...

Med-Legal Data: IBR Is the QME/AME's Friend

California workers’ comp presents serious challenges to physicians — and Medical-Legal physicians are no exception. Despite a recently simplified Medical-Legal Fee Sch...

CA QME Calls Out Cannon Cochran "Abuse and Insults"

A California Qualified Medical Evaluator (QME) has had quite enough nonsensical reimbursement games from Cannon Cochran Management Services, Inc. (CCMSI).The Third-Par...

CA Providers Unite! Suggestions for the DWC

On December 6, 2022, California’s Division of Workers’ Compensation (DWC) invites stakeholders to a public meeting to share “ideas to improve the State’s worker...

CA SCIF Baits & Switches MD Out of Payment

Once again, California’s State Compensation Insurance Fund (SCIF) may profit by exploiting a flaw in California’s Independent Bill Review (IBR) system.SCIF initially d...

IBR: Sedgwick Ordered to Pay QME $20k+ for False Med-Legal Denial

Sedgwick Claims Management Services just set a dubious new record. Maximus, the entity which conducts Independent Bill Review (IBR) on behalf of California’s Division of Work...

SCIF: Med-Legal IBR Chicken Champion

Welcome to another round of IBR Chicken, where California claims administrators (falsely) deny payment for the treatment of injured workers for implausible reasons — and keep...

SCIF Stiffs Doc by Paying AFTER Request for IBR

In a classically underhanded move, California’s State Compensation Insurance Fund (SCIF) twice denied payment for the authorized treatment of an injured worker, but then sudd...

Sedgwick Asserts CA "Loosened" Appeal Process

California workers' comp is — supposedly — governed by laws, enacted by the state legislature, and carried out by the Division of Workers’ Compensation (DWC). For disputes ov...

CA: Employer Authorization Is Ultimately Worthless

California law mandates that once an employer authorizes treatment for an injured worker, that authorization may not be rescinded “for any reason,” theoretically guaranteeing...