PPO
Feb 7, 2023
Data: Zenith Pays Medicare Rates for E/M Services
According to data from over 10,000 e-bills submitted for 2022 dates of service via daisyBill, insurer The Zenith paid 76% of the reimbursement rates established by California...
Feb 6, 2023
Anthem PPO Contract Renders OMFS Meaningless
At first glance, recent updates to California’s Official Medical Fee Schedule (OMFS) for workers’ comp may seem like a raise for doctors. By establishing OMFS rates at roughl...
Jan 31, 2023
CA Physician Fee Schedule - 2023 Changes
Yesterday, California’s Division of Workers’ Compensation (DWC) announced reimbursement updates to the Physician and Non-Physician Practitioner Services section...
Dec 5, 2022
CA Providers Unite! Suggestions for the DWC
On December 6, 2022, California’s Division of Workers’ Compensation (DWC) invites stakeholders to a public meeting to share “ideas to improve the State’s worker...
Jun 8, 2022
CA OMFS: E/M Reimbursement vs Medicare Reimbursement
California workers’ comp allows discount networks to bleed the doctors who treat injured workers. Unfortunately for these workers and their employers, many of these financial...
May 10, 2022
PPO Discounts STILL NOT Applicable to Med-Legal
It’s hard to believe we still have to write this — or is it? California claims administrators may not apply Preferred Provider Organization (PPO) reductions to physici...
Apr 28, 2022
Mitchell Hustles for MPA, Insurance Co. of the West
California workers’ comp doctors, keep screening your phone calls. Mitchell International, on behalf of the Municipal Pooling Authority (MPA) and Insurance Company of the Wes...
Mar 22, 2022
PPO: No Provider Recourse for Unnamed Discounts
In California workers’ comp, the appeals process for disputing improper Preferred Provider Organization (PPO) reductions has a serious flaw.Routinely, Explanations of ...
Mar 16, 2022
How to Identify PPO Reductions (Part I)
Daily, we hear from workers’ comp providers requesting help with identifying whether Pilfering Provider Organizations (aka: PPOs) are hijacking the funds intended to pay for ...
Mar 14, 2022
PPOs Force Doctors to "Pay-to-Play"
Whether in business, politics, or sports, forcing professionals to pay for the privilege of simply doing their jobs (aka “pay-to-play”) is indefensible. But arguably, ...
Mar 8, 2022
Network CEO Exposes Triton/PCS Improper Discounts
In a revelation with severe implications for California workers’ comp, CEO Todd Breeden of America’s Choice Provider Network (ACPN) reported that Triton Healthc...
Mar 1, 2022
Triton Gouges Providers - Pays 78% of Medicare Rates
Triton Healthcare Partners and Apricus (formerly Preferred Care Solutions) are collaborating with other Preferred Provider Organization (PPO) entities to hijack payments from...