IBR
Jan 11, 2022
IBR Chicken: SCIF Blinks Too Late
You win some, you lose some. That’s the lesson the State Compensation Insurance Fund (SCIF) must take from the latest round of California workers’ comp claims administ...
Jan 10, 2022
Intact Insurance Plays (Double) IBR Chicken
Welcome to another round of IBR Chicken! The rules are simple. To avoid reimbursing a doctor for authorized workers’ comp services, a California claims administrator m...
Dec 7, 2021
Berkshire Hathaway Refuses 892 Second Review Appeals
Berkshire Hathaway hath a way of defying California workers’ comp regulations, and refusing to pay doctors for authorized treatment provided to in...
Dec 6, 2021
JT2 Plays IBR Chicken (and Wins)
As we often point out, it can seem as if payers play a twisted game of IBR Chicken with doctors, reflexively denying bills and Second Review appeals only to change their mind...
Nov 17, 2021
Lien Chaos Returns: DWC Rules for Anthem (Part III)
California’s Division of Workers’ Compensation (DWC) has a duplicity problem. In the third chapter of our series on The Zenith and Anthem Blue Cross, we discover that ...
Oct 14, 2021
Zurich Refuses to Pay for Emergency Treatment
In a medical emergency, a doctor treats first and asks questions later. But in response to a medical emergency, Zurich refused to pay a doctor for suturing a lacerated finger...
Sep 22, 2021
Liberty Mutual Stiffs QME - Attorneys Required
Hello California Workers’ Comp Attorneys, Medical-Legal physicians in this state need your help. Payers like Liberty Mutual have found a way to skirt the Independent ...
Sep 15, 2021
SCIF Hacks IBR by Switching (Incorrect) Denial Reason
There’s a serious inequity in the appeals process by which California workers’ comp providers can dispute incorrect reimbursement for authorized treatment. State Compensation...
Aug 23, 2021
ESIS Fails to Pay IBR Fee on Behalf of ABM Industries
Ask yourself — what happens if you’re a year late paying a bill?Your credit score tanks? Your car is repossessed? Your home foreclosed on? In most walks of life...
Aug 17, 2021
Med-Legal: PPO Discounts Do NOT Apply to MLFS
Preferred Provider Organization (PPO) and other network discounts do not apply to the Medical-Legal Fee Schedule (MLFS). Period.In other words, the MLFS and OMFS are c...
Aug 12, 2021
Med-Legal ML106: IBRs Leave No Doubt
If it wasn’t clear before, it certainly is now. Physicians should bill for supplemental Medical-Legal reports requested before April 1, 2021 with billing code ML106, regardle...
Aug 2, 2021
CA Med-Legal: ML200 Missed Appointment Payable
An Independent Bill Review (IBR) case affirmed one of the biggest changes to California’s Medical-Legal Fee Schedule (MLFS): an established reimbursement for missed Medical-L...