CA OMFS Update: Pathology/Clinical Lab Fee Schedule for 7/1/2019
Jul 9, 2019
On July 8, 2019, California’s Division of Workers’ Compensation (DWC) ordered an update to the Pathology and Clinical Laboratory section of the Official Medical Fee Schedule ...
CA Physician MUE Reimbursement Change as of 7/1/2019
Jun 25, 2019
In Newsline No.: 2019-46, the California Division of Workers’ Comp (DWC) announced changes to the Official Medical Fee Schedule for Physician Services / Non-Physician Practit...
CA Physician Reimbursements INCREASE as of 7/1/2019
Jun 19, 2019
In Newsline No.: 2019-46, the California Division of Workers’ Comp (DWC) announced changes to the Official Medical Fee Schedule for Physician Services / Non-Physician ...
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...