Blog: DaisyBill News

Not one to avoid the spotlight, York Risk Services joins Sedgwick CMS in incorrectly applying the 2018 Physician Fee Schedule rates to services rendered in 2019. Our data show a consistent and demonstrated pattern of botched payments through at least the end of January.

Despite the vastly increased complexity of the California Physician Fee Schedule in 2019, most administrators are abiding by the changes and issuing checks for the appropriate amounts. A few stragglers remain who, for whatever reason, fail to follow the new schedule. Today, we turn our attention to York Risk Services.

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 System Assessments/Tests subsection of the Current Procedural Terminology (CPT®) 2019 eliminated CPT codes 96101 and 96102. The Current Procedure Terminology (CPT®) 2019 replaces these two codes with seven new replacement CPT codes.

This 2019 change has left many providers with many questions, so we made some handy charts to answer them!

California’s Division of Workers’ Compensation (DWC) posted an adjustment to the Inpatient Hospital section of the Official Medical Fee Schedule (OMFS), effective for discharges occurring on or after December 1, 2018.

This adjustment conforms to changes in the 2019 Medicare payment system as required by Labor Code section 5307.1.

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 DWC ordered changes to the Physician and Non-physician Practitioner fee schedule, as well as the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule.

The orders affect reimbursement for 5 codes in total, 4 for Physician Services and one for DMEPOS.

If your office looked to the Lockard Industrial Insurance Companies’ List to find contact information for workers’ comp payors, you’ll need to look elsewhere.

The green spiral-bound book containing addresses, phone and fax numbers, and email addresses for almost every insurance and third party administrator in California is no more. Previously released annually with new information, the directory’s last edition was published in 2016. Like vinyl records and VHS, Lockard’s List was much loved, but ultimately outpaced by the Digital Age.

All information previously available in Lockard (and more) is available through DaisyBill’s Work Comp Wizard.

The Division of Workers' Compensation (DWC) posted a video replay of their recent webinar on the newly effective drug formulary. The DWC hosted the webinar in December, following the formulary's official state approval. For those who could not attend the webinar, the DWC initially posted a written transcript.

Technical problems at third-party administrator York Risk Services left roughly 15,000 bills unprocessed. The error was discovered and resolved by York’s in-house bill review, which is currently processing the affected bills. According to York representatives, it may take up to 30 days from their discovery of the glitch to complete the processing.

The glitch affected bills submitted by providers between October 27, 2017, and November 15, 2017.

Several providers recently received incorrect denials of bills from California’s State Compensation Insurance Fund (SCIF), the state’s largest provider of work comp insurance. These original bills were denied for untimely submission, despite having been submitted within the required timeline. Senate Bill 1175 mandates a 12-month deadline for original bill submission.

A SCIF representative acknowledged the error, as the insurer moved quickly to resolve it.