California Work Comp News, Issues, Articles
Daily
April 18, 2014: Article:
Usual and Customary Fees for California Hospitals
(Facilities): Per Diem Outlier (Exceeds Average Length of
Stay) Awarded an additional Amount of $58,971.22
above Fee schedule


Part 2  of a 10 Part Series on Usual and Customary
Fees for Hospitals / Facilities


April 17, 2014: Article:
Usual and Customary Fees for California Hospitals
(Facilities): Above Fee Schedule, Exempt from Fee
Schedule, Day Outlier for Extended in Patient Stays,
Distinct Rehab Units, Rehabilitation Hospitals, PPO
Contracts (Stop Loss Provisions) where they are in 2014.

April 15, 2014: DWC News:
DWC Posts Adjustments to Official Medical Fee
Schedule (Physician Services / Non-Physician Practitioner
Services)

April 14, 2014: Panel Decision:
The fact that the record does not contain an express
designation of Dr. Mays as the primary treating
physician should not defeat a legitimate claim for medical
treatment services.

April 11, 2014: Panel Decision in line with En Banc
Simmons: Proper mechanism for objecting to medical
determinations by a primary treating physician where
liability to at least one body part has been accepted.

April 09, 2014: Panel Decision:
Letter correctly addressed and properly mailed is
23 presumed to have been received in the ordinary course
of mail (Evid. Code, § 641).

April 08, 2014: Article:
Article: Second Bill Review Process Gateway to Dispute
Resolution do it Right or do not get paid

April 07, 2014: Education:
Highlighted Sections of WCAB Policy and Procedures \

April 07, 2014: DWC News:
CALIFORNIA WORKERS COMPENSATION COLLECTIONS PUBLICATIONS
AND INFORMATION FOR MEDICAL PROVIDERS AND LIEN CLAIMANTS
Become a Subscriber / Member for Full Access
$225.00 per year Reg and Receive  E-Book 2014
Guidebook Free
All States Work Comp News,
Issues, Articles Daily
April 14, 2014; Texas News:
Delay of Texas Workers’
Compensation Transition to ICD-10
Code Set

April 14, 2014: South Carolina
News:
•The Commission will conduct a
Claims Administration Workshop on
Thursday, May 8, 2014 at S.C.
Department of Archives & History,
Columbia. Details and registration
available April 16, 2014.


April 14, 2014: Georgia News:
Georgia Workers’ Compensation
Medical Fee Schedule’s effective date
will be May 1, 2014. Please disregard
the effective date of April 1, 2014
printed on the binder cover of the fee
schedule.

April 14, 2014: Connecticut News:
Case Law: A claimant must present a
reasonable inference between his
activities at work and his injury in
order to receive benefits under Chapter
568. The test is not one of “leniency”
or “humanitarianism”; it’s a test based
on considering the totality of the
evidence presented and determining
whether it is more reasonable than not
that the claimant’s injuries arose from
their employment.

April 07, 2014: News:
These adopted amendments align the
workers’ compensation medical billing
requirements with changes in the
newly updated CMS-1500.

April  07, 2014: Idaho News:
Proposed Rules for 2014 Legislative
Session
Member Sample Pleadings
Member Important Case Law
California Work Comp Educational Articles
March 31, 2014: En Banc
Defective UR to WCAB Failure to review all
medicals

January 16, 2014: Panel Decision:
The WCJ's determination "must be based on
admitted evidence in the record."

Labor Code section 5313 requires the WCJ to
"make and file findings upon all facts involved
in the controversy

January 14, 2014: Panel Decision:
“It appears that lien claimant does not fully  
understand its evidentiary burden. Under Labor
Code section 5705, "The burden of proof rests
upon the party or lien claimant holding the
affirmative of the issue."

January 12, 2014: Panel Decision:
"...we strongly admonish applicant's counsel for
citing medical reports that are not in evidence,
thereby failing to "fairly state all of the material
evidence relative to the point or points at issue
[,]"

January 06, 2014: Panel Decision:
As all of the requirements have been met, it is
appropriate for Dr. Newman to bill for his
evaluation and reports as a medical-legal
expense, rather than services payable pursuant
to the OMFS. Here, Dr. Newman was
designated by the primary treating physician -

December 19, 2013: Panel Decision:
Failure of PTP to incorporate does not mean
the secondary / consultant does not get paid

December 13, 2013: Panel Decision
Dr. Massey had not yet adopted Dr. Newman's
findings does not mean the latter physician's
reports were not reasonable and necessary at
the time the expenses for the reports were
incurred

December 03, 2013: Panel Decision:
January 17, 2014: Education:
25 Procedures for Collection Dispute Files from Birth to Death

January 15, 2014: Article:
SB 863 Laws Lying in Wait, One Thing Not Tolerated in 2014
is the Wait and See Approach

January 13, 2014: Education:
Summary of New Fee Schedule

January 10, 2014: Article:
Providers Creating Garbage Piles of Receivables and No one is
Stopping Them

January 09, 2014: Education:
Corrected Diagram under SB 863 Denied Liability

January 08, 2014:Article:
Preparing for Lien Trials at the WCAB What Lien Claimants
are Missing.

January 03, 2013: Article:
Mistakes in Organizing for Collection disputes That Fall under
SB 863    
    

December 31, 2013: Article:
What We Saw in 2013 and What to Expect in 2014, Work
Comp Provider Collections Disputes

December 30, 2013:  Article:
Another Rain of Sanctions and Dismissals are Coming for Lien
Claimants: The Laws Passed in 2012 and SB 863 was to
Shorten the Live Span of A Collection Dispute File Either
Voluntarily of by Operation of Law.


December 25, 2013: Article:
The Secret of Success in Work Comp Collections Why we
Plan for Failure Instead of Success.

December 23, 2013: Article:
The Ability to Change: Billing, Collections and Appearances at
The WCAB , 2012 and 2013 Laws /SB863
MR Flowchart Modified:

Education / Flowchart;
Complete one Page IMR /IBR / Lien
Processes

Education / Flowcharts
Defense of Post Termination Defense:

Flowchart/ Education
Contested Liability Issues

Education / Outline:
Working Un-collectible Files
Education / Templates
Set of 4 Sample Settlement Offer
Letters: Fee Schedule and MPNS

Sample: Response to Petition for
Restitution
RESPONSE TO DEFENDANTS’
PETITION FOR RESTITUTION
AND  PETITION FOR DISMISSAL
OF  DEFENDANTS PETITION WITH
PREJUDICE

Sample: Appealing IBR Decision
“PETITION APPEALING
ADMINISTRATIVE DIRECTOR’S
INDEPENDENT BILL REVIEW
DETERMINATION”
SECTION 9792.5.14

Sample: Appealing Eligibility of Request
for IBR
APPEAL OF AN  ELIGIBILITY
DETERMINATION BY THE
ADMINISTRATIVE DIRECTOR
8CCR § 9792.5.9 (E)

Sample and Instructions for Petition of
Medical Information
“PETITION BY NON-PHYSICIAN
LIEN CLAIMANT FOR MEDICAL
INFORMATION.”
IN ACCORDANCE WITH
LABOR CODE 4903.6(d)

Sample: Petition Enforce IBR Decision
“PETITION TO ENFORCE IBR
DETERMINATION.”
FROM IBR DECISIONS ISSUED
JUNE 01, 2013

Sample: Trial: Brief with Request for
Sanction 10770.1
Important Posted IBR Decisions
April 14, 2014: IBR Decisions;
DME awarded additional monies by
submitted proof of  usual and customary
documents

March 20, 2014: IBR Book:

March 10, 2014: IBR Decision for Provider
CPT 72100 additional fund s awarded

February 27, 2014: CPT Code 97799:
Unlisted Physical Medicine Service or
Procedure  modifier 86 - when services exceed
OMFS authorized  services

February 24, 2014: Functional Restoration
Program:
Award for Provider Fee Schedule  $5,1000.00

February 16, 2014: CPT Code 99358
Review of Medical Records under
2014 physician fee schedule CPT code
99358

February 09, 2014: IBR Decision:
Additional  $35,075.80 awarded to provider

February 02, 2014: IBR Decision:
CPT Coding 97799 Modifier 86

February 02, 2014: IBR Decision:
CPT Coding 93307; 93320; 93325

February 02, 2014: IBR Decision:
Dispute: CPT Coding 99086; 99085; 99080;
17999.

February 02, 2014: IBR Decision:
Dispute CPT Coding 17034 NS 17999
MODIFIER 59

January 26, 2014: IBR Decision:
Additional Reimbursement of $667.27 for
CPT 99354 and CPT 99358
January 20, 2014: IBR Decision: A
Important Posted IMR Decisions
April 14, 2014: Recorded Lecture on
process

March 31, 2014: En Banc
Defective UR to WCAB Failure to review
all medicals

March 10, 2014: IMR Decision:
Spinal Fusion not Medically  Necessary

February 16, 2014: IMR Decision:
Urgent PET scan of the brain is not
medically necessary and appropriate.

January 27, 2014: IMR Decision:
Determine Psychiatric Evaluation and
Treatment necessary for spinal injury

January 26, 2014: DWC Presentation
on Authorization, UR and IMR

January 20, 2014: IMR Decision:
24 post operative physical therapy  not
medically necessary

January 16, 2014: IMR Decisions:
Found Spinal Fusion not Medically
Necessary

January 01, 2014: IMR Decision:
Held lumbar discogram not medically
necessary.

December 26, 2013: IMR Decision:
12 Acupuncture and 12 Chiropractic
Sessions determined medically necessary
and appropriate

December 16, 2013: IMR Decision:
(1) Northern California Functional
Restoration Program for 20 days (6
weeks) is medically necessary and
appropriate.
Training can help Prevent Mistakes and Lost Receivables
New Product Working Manuals
3 Books for SB 863 Collections /2013 / 2014
with 30 recorded Training Lectures
Email Contact Information:
Richard@workcompliens.com
Diagram Medical Legal Process
2014  From Injury to WCAB   
Workers’ Compensation
Treatment and Collections
Dispute Guidebook
350 pages of easy to understand application
of rules and regulations
$175. 00 Hard Copy Mailed Only