medical-legal
ESIS: 10 Audit Complaints Filed With CA DWC
Aug 11, 2022
ESIS: 10 Audit Complaints Filed With CA DWC
California law requires claims administrators to send an Explanation of Review (EOR) and payment to the physician within 60 days of receiving a bill for Medical-Legal service...
Warning: ESIS (Still) Ignoring CA Medical-Legal Bills
Aug 11, 2022
Warning: ESIS (Still) Ignoring CA Medical-Legal Bills
How else can we put this? Sometimes ESIS, a Third-Party Administrator (TPA), just flat-out ignores bills for Medical-Legal services. Below, daisyBill documents how ESI...
(Free, Transparent) CA Med-Legal Fee Schedule Data
Aug 4, 2022
(Free, Transparent) CA Med-Legal Fee Schedule Data
As the California Workers’ Compensation Institute (CWCI) peddles paid access to its insurer-derived data and white-tie webinars, daisyBill would like to offer an update on th...
CA Med-Legal Fees, QMEs Under Attack
Jul 27, 2022
CA Med-Legal Fees, QMEs Under Attack
A recent study on the current Medical-Legal Fee Schedule (MLFS) has triggered a wave of pearl-clutching by payer advocates. So what has the payer-side pundits groping for the...
DWC Seeks QMEs for October Exam
Jul 13, 2022
DWC Seeks QMEs for October Exam
California’s Division of Workers’ Compensation (DWC) is accepting applications from physicians for the October 2022 Qualified Medical Evaluator (QME) exam.The in-perso...
Med-Legal: Cannon Cochran Denies Payment for Interpreter Services
May 10, 2022
Med-Legal: Cannon Cochran Denies Payment for Interpreter Services
Medical-Legal physician evaluators, be advised: a disturbing payment denial tactic is catching on among California claims administrators. When responding to physician ...
Free: CA Med-Legal "Superbills"
May 10, 2022
Free: CA Med-Legal "Superbills"
Medical-Legal billing for California workers’ comp is fraught with complications, contradictions, and — of course — threats to physician revenue from less-than-scrupulous ent...
PPO Discounts STILL NOT Applicable to Med-Legal
May 10, 2022
PPO Discounts STILL NOT Applicable to Med-Legal
It’s hard to believe we still have to write this — or is it? California claims administrators may not apply Preferred Provider Organization (PPO) reductions to physici...
CA Med-Legal How-To: Collect Penalty & Interest Payments
Apr 27, 2022
CA Med-Legal How-To: Collect Penalty & Interest Payments
California physician evaluators, be advised: when claims administrators are late in paying for Medical-Legal services, penalty and interest payments apply. However, inadequat...
CA Med-Legal: $76 Million Owed For Record Review in First Year
Apr 27, 2022
CA Med-Legal: $76 Million Owed For Record Review in First Year
It’s been just over a year since California adopted the new Medical-Legal Fee Schedule (MLFS). Effective April 1, 2021, the new MLFS represented the first incre...
Med-Legal IBR: Maximus Denies Documented Interpreter Reimbursement
Apr 19, 2022
Med-Legal IBR: Maximus Denies Documented Interpreter Reimbursement
In a perfect example of California’s failing Independent Bill Review (IBR) process, Maximus (California’s designated IBR organization) abandoned all semblance of lawfulness a...
CA Med-Legal: How to Appeal Unpaid AME Modifier -94
Apr 7, 2022
CA Med-Legal: How to Appeal Unpaid AME Modifier -94
Regularly, California workers’ comp claims administrators incorrectly deny Medical-Legal Fee Schedule (MLFS) modifier -94 for Agreed Medical Evaluator (AME) services. In this...