Blog: Daisy News

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) has pulled the trigger: Geographic Practice Cost Indices (GPCI) will take effect on January 1, 2019. GPCI will divide the state of California into 32 distinct pricing regions, adjusting reimbursements for Physician and Non-Physician Practitioner services based on specific location.

The plan is an effort to more fairly compensate workers’ comp providers with respect to the widely varying costs associated with running a practice in different areas.

California’s Division of Workers’ Compensation (DWC) ordered updates to the Hospital Outpatient and Ambulatory Surgical Center (ASC) portion of the Official Medical Fee Schedule (OMFS), effective October 1, 2018. The updates bring the OMFS into line with changes to the Medicare payment system.

The update lowers reimbursements for 193 billing codes.

California’s Division of Workers’ Compensation (DWC) proposed significant changes to the Pharmaceutical Fee Schedule. The proposals would bring pharmaceutical reimbursement calculations for workers’ comp into line with revisions to Medi-Cal’s payment system, on which the Pharmacy Fee Schedule is based.

If approved, the proposed changes will be effective January 1, 2019. The DWC will accept public comments via their online forum until Monday, October 8.

California’s Division of Workers’ Compensation (DWC) ordered updates to the Physician and Non-Physician Practitioner portion of Official Medical Fee Schedule (OMFS), effective October 1, 2018.

The order adopts several changes to the Medicare payment system, including quarterly updates to Relative Value Units (RVU) and National Correct Coding Initiative (NCCI) edits. In addition, the order includes the September 15 monthly Medi-Cal Rates file update for physician-administered drugs, biologicals, vaccines or blood products.

The order adds a total of 14 new billing codes for various Evaluation and Management (E/M) and injection services.

Since an update to California’s Official Medical Fee Schedule (OMFS) made non-face-to-face services reimbursable again in 2017, there’s been confusion aplenty about how to properly bill and pay for billing codes 99358 and 99359. Even now, providers and payors continue to struggle with the rules regarding these tricky time-based codes.

Recently, a DaisyBill client alerted us to one bill review service’s mistake regarding the relationship between the time the provider spends on non-face-to-face services and the number of units the provider may bill for code 99359. We’re happy to clear up the confusion.

Providers, take note: California’s Division of Workers’ Compensation (DWC) announced that the Medi-Cal pharmaceutical fee data file, updated weekly, was replaced for the week of September 5, 2018.

The DWC encourages any providers who downloaded this file to update it with the replacement file, and to recalculate any reimbursements based thereon.

In April, the California Division of Workers’ Compensation (DWC) held a hearing regarding the inclusion of the Medicare Geographic Practice Cost Indices (GPCI) in the Physician and Non-Physician Practitioner portion of the Official Medical Fee Schedule (OMFS).

Now, it appears the DWC will almost certainly move forward with the plan to adjust reimbursement based on provider location.

The DWC issued a notice of proposed modifications to the Physician fee schedule, effective on January 1, 2019, which include GPCI calculations. A 15-day public comment period ends on September 14.