Alert: More Unreasonable Physician Reporting Demands
May 17, 2019
When it comes to billing complications, some California payers are demanding documentation for time-based procedure codes; a demand that is unsubstantiated by California work...
SB 537: Say NO to Medicare Reimbursements
May 2, 2019
A proposed California bill, though seemingly benign, may establish Medicare rates as a standard for workers’ comp reimbursements, which would be a mistake. The bill, w...
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SCIF to Correct Payment Errors
Mar 28, 2019
California’s State Compensation Insurance Fund (SCIF) stepped up and promised to fix all bills affected by its mistaken use of the 2018 Official Medical Fee Schedule. ...
Assistant at Surgery: All You Need to Know
Mar 4, 2019
Last week, we opened Pandora’s box on co-surgeons and team surgery. Notably left in the box was a discussion on assistant(s) at surgery. Typically this arises when physicians...
📬 Payer Responses: Guile, Waiting, and Crickets 🏏
Mar 1, 2019
Today we report on the responses from Sedgwick, Liberty Mutual, York, and State Compensation Insurance Fund (SCIF), following our posts detailing their systematic underpaymen...
Co-Surgery vs. Team Surgery: All You Need to Know
Feb 26, 2019
Surgery in workers’ compensation cases opens a Pandora’s box: reserves go up, nurse case managers get involved, and surgeons need to justify every detail of their billing to ...
2019 Splinting & Casting Reimbursement Update
Feb 6, 2019
When navigating the seas of change, it’s refreshing to find an island of relative stability. Like California’s state-specific codes, the splinting and casting codes group (co...
York Misses the Mark: Paying 2019 Bills at 2018 OMFS Rates
Feb 6, 2019
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 sho...
California-Specific Codes Updated for 2019
Feb 4, 2019
With the flurry of new year fee schedule changes, California updated the Physician Fee Schedule reimbursement for its state-specific codes. These codes are explained in 8 CCR...
Sedgwick Still Reimbursing at 2018 Rates for California
Feb 1, 2019
Since the beginning of 2019, Sedgwick CMS has incorrectly used the 2018 Physician Fee Schedule to reimburse providers. Our data indicates that Sedgwick is consistently and in...
2019 CA Workers’ Comp Evaluation & Management Cheat Sheet
Feb 1, 2019
The 2019 changes to California’s reimbursements got your head spinning? Here’s a handy reimbursement cheat sheet for the most frequently used Evaluation & Management codes.
Location-Based Adjustments (GPCIs) Now in Effect for California, as of January 1, 2019
Jan 30, 2019
For better or worse, location-based adjustments are here for California workers’ comp. Find out how they impact reimbursements in 2019. As our preliminary calculations...