OMFS
May 17, 2019
Alert: More Unreasonable Physician Reporting Demands
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...
May 2, 2019
SB 537: Say NO to Medicare Reimbursements
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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Mar 28, 2019
SCIF to Correct Payment Errors
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. ...
Mar 4, 2019
Assistant at Surgery: All You Need to Know
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...
Mar 1, 2019
📬 Payer Responses: Guile, Waiting, and Crickets 🏏
Today we report on the responses from Sedgwick, Liberty Mutual, York, and State Compensation Insurance Fund (SCIF), following our posts detailing their systematic underpaymen...
Feb 26, 2019
Co-Surgery vs. Team Surgery: All You Need to Know
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 ...
Feb 6, 2019
2019 Splinting & Casting Reimbursement Update
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...
Feb 6, 2019
York Misses the Mark: Paying 2019 Bills at 2018 OMFS Rates
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...
Feb 4, 2019
California-Specific Codes Updated for 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...
Feb 1, 2019
Sedgwick Still Reimbursing at 2018 Rates for California
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...
Feb 1, 2019
2019 CA Workers’ Comp Evaluation & Management Cheat Sheet
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.
Jan 30, 2019
Location-Based Adjustments (GPCIs) Now in Effect for California, as of January 1, 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...