A few questions have been asked as to what is permissible referrals
“Thus we have determined the restitution orders
were unfair and must be annulled.”
June 22, 2009
Richard J Boggan JD
It appears that some defense attorneys had a meeting and
some have found a new or reinvented an old strategy to
deny medical providers just compensation for medical
treatment rendered to an injured worker. I have seen a lot of
defense attorneys putting reimbursement as an issue for
court or filing a petition for reimbursement as retaliation for
www.workcompliens.com
medical providers seeking to get paid their fees under the
fee schedule and or usual and customary fees. In addition I
have seen this ploy work as some medical providers, get
upset and just withdraw their lien. The law does not favor
reimbursement unless it is a dupe payment.
American Psychometric Consultants Inc. v. Workers’
Compensation Appeals Bd., 36 Cal. App. 4th 1626, 43 Cal.
Rptr. 2d 254, 60 Cal. Comp. Cas. (MB) 559, (Cal. App. 2d
Dist. 1995)
“Approving restitution in these cases would set a precedent
which would have unfortunate consequences for the
workers’ compensation system. It would introduce the
possibility of continued transactional instability so negative
it would impact the number of medical providers willing
any longer to participate in the system by evaluating
workers with industrial injuries. No one can operate a
business on receipts only conditionally possessed, and
medical providers are no exception. Thus we have
determined the restitution orders were unfair and must be
annulled.”
“Thus we have determined the restitution orders
were unfair and must be annulled.”
June 22, 2009
Richard J Boggan JD
It appears that some defense attorneys had a meeting and
some have found a new or reinvented an old strategy to
deny medical providers just compensation for medical
treatment rendered to an injured worker. I have seen a lot of
defense attorneys putting reimbursement as an issue for
court or filing a petition for reimbursement as retaliation for
medical providers seeking to get paid their fees under the
fee schedule and or usual and customary fees. In addition I
have seen this ploy work as some medical providers, get
upset and just withdraw their lien. The law does not favor
reimbursement unless it is a dupe payment.
American Psychometric Consultants Inc. v. Workers’
Compensation Appeals Bd., 36 Cal. App. 4th 1626, 43 Cal.
Rptr. 2d 254, 60 Cal. Comp. Cas. (MB) 559, (Cal. App. 2d
Dist. 1995)
“Approving restitution in these cases would set a precedent
which would have unfortunate consequences for the
workers’ compensation system. It would introduce the
possibility of continued transactional instability so negative
it would impact the number of medical providers willing
any longer to participate in the system by evaluating
workers with industrial injuries. No one can operate a
business on receipts only conditionally possessed, and
medical providers are no exception. Thus we have
determined the restitution orders were unfair and must be
annulled.”
Looking for information on Major Diagnostic Categories (MDC) which are formed by dividing all possible principal diagnoses (from ICD-9-CM) into 25 mutually exclusive diagnosis areas.
With the change in LC 5307.1 is “Gould Case” allowing providers to get above fee schedule still good law?
Comments on Utilization Review and Authorization for Medical Treatment
SB 403 introduce to change LC 4903.5 to one year to file a lien from date provider recieved EOB
Please cite me the case law that supports the reimbursement of a medical legal that would be otherwise inadmissible because an AME had reviewed the report and had commented on it.
I would appreciate input very much
Tricia
An acupuncturist gave me a bunch of files to collect on in which the bills were origonally submitted to the payer, but the payer denied for lack of auth or MPN issues. The provider never filed a lien and the cases have settled. Can I still collect on this, or is it an automatic write off?
Comment by Crystal
Permissible referrals Section 139.3
A few questions have been asked as to what is permissible referrals