Friday, December 14, 2012

CALIFORNIA WORKERS COMP DEVELOPMENT

SB 863 FALLOUT BEGINS TO SETTLE ON HAPLESS HEADS

It doesn't appear that DWC will have time to consider the comments submitted on DWC Forums and to that extent the request for comments seems to have been a charade. The idea now is to put the newly proposed regulations into effect on an emergency basis and then to consider comments later, weeks or months from now. Our information is that many current liens that are awaiting payment will be held until the Spring of 2013. In the meantime, the $150 IMR lien filing fee will go into effect for the Independent Medical Review system and so will the $325 IBR fee for the Independent Billing Review system.

The presumption is that these onerous requirements will drive many providers out of the system altogether. In due course DWC will adopt the requirements that it wants if the insurance companies don't object too strenuously. Insurance companies will be conveniently enabled to pay providers at 65 to 70% of the fee schedule. Then they'll dare the  provoked providers to try to collect the rest.  The requirement to pay as much as $475 for the right to challenge a wrongful denial of care and a rejected bill is expected to encourage providers to drop out of the workers' comp system.

In other states where similar reductions took place, so many doctors dropped out that the theorized dearth of physicians became real enough so that fees were restored and even raised (Hawaii is an example). The trouble is that the perpetrators of these adverse changes managed to destroy faith in the system so that many of the doctors didn't return. That created a permanent deficit of access to care. So far that looks to be where SB 863 is going.

Early lien filing may be the PTP's only option. It looks as though injured workers lose again even though Permanent Disability was given an infusion by SB 863. The trouble is that the infusion has been diluted. Our injured workers have been left worse off and now need a transfusion.

4 comments:

  1. “The requirement to pay as much as $475 for the right to challenge a wrongful denial of care and a rejected bill is expected to encourage providers to drop out of the workers' comp system.”
    These are two different issues it seems. Liens will no doubt become more difficult to file (if that is at all possible). Except in cases of documented fraud or conflict of interest, IBR will now be the end of the line for fee schedule disputes (after second review). That is, liens can no longer be filed for fee schedule disputes; instead providers will be forced to go to IBR on their dime. However, if those providers bill correctly the first time, they can reduce their denials and the likelihood they will need to file a lien. Submitting a bill correctly the first time actually reduces denials by 80% and submitting electronically speeds payment. DaisyBill (www.daisybill.com) is the only work comp billing solution that can do both of these things.

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  2. I don't see it as a good idea to put to much complicated discussions and proceedings about such medical issue. Healthcare and medical billing are better improved than to be subjected under seemingly political issues.

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