IBR
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...
Jul 15, 2021
Sedgwick Violates LACoFD Employer Contract, IBR Drops Ball
A physician agreed to serve as Independent Medical Examiner (IME) for the Labor Management Committee (LMC) representing the Los Angeles County Fire Department (LACoFD) and Lo...
Jul 12, 2021
Sedgwick Denies Second Review Appeals as "Duplicates"
Sedgwick has a Second Review problem.On too many occasions, Sedgwick incorrectly denies providers’ Second Review appeals as “duplicate submissions” of the original bil...
Jul 9, 2021
ML106: Liberty Mutual Must Learn the Rules
California’s all-new Medical-Legal Fee Schedule (MLFS) debuted back in April, but some claims administrators are still a few steps behind. To bill for supplemental Med...
Jul 6, 2021
IBR Hall of Shame: Sedgwick Sets New Standard of Noncompliance
Sedgwick failed to comply with an Independent Bill Review (IBR) ruling for almost four months. Worse, the payor’s brazenness is likely to go unpenalized by the state.T...
Jun 29, 2021
Med-Legal Bill Denied for Liability? Request IBR
Certain California workers’ comp payers deny reimbursement for Medical-Legal evaluations by claiming lack of liability for the initial injury. With this twisted, circular log...
Jun 28, 2021
CA DWC Lets SCIF Skirt IBR for Incorrect GPCI
In a baffling decision, the California Division of Workers’ Compensation (DWC) declared a straightforward billing dispute ineligible for Independent Bill Review (IBR) — despi...
Jun 4, 2021
Sedgwick Defies DWC COVID Rules; DWC Washes Hands
Sedgwick defied California workers’ comp regulations, costing a provider thousands in due reimbursement. Unfortunately, the Division of Workers’ Compensation (DWC) has declin...
Apr 5, 2021
City & County of San Francisco's Misleading Reply in PPO Dispute
Recently, a DaisyBill provider disputed a reduction in reimbursement from the City and County of San Francisco (CCSF) for treating an injured employee. In the Explanation of ...
Mar 30, 2021
Zurich Denies Liability After Accepting Liability
Zurich recently denied liability for an injured workers’ treatment, claiming the 2003 injury was not work-related — despite the fact that Zurich already authorized the treatm...