How Progress Reports Effectively Simplifies PTP Collection
A medical provider’s progress report is a critical document in California’s workers’ compensation system that tracks an injured employee’s treatment and recovery. The importance of reports in PTP collection cannot be overstated. It ensures all parties, including the employer, insurer, and the injured worker, are informed about the patient’s medical status and progress. This report […]
Navigating Retro UR: Ensuring Swift Workers’ Comp Payments
In California workers’ compensation, Utilization Review (UR) evaluates the medical necessity of treatments for injured workers based on the Request for Authorization (RFA) submitted by medical providers. UR can be prospective, beginning upon receipt of a DWC Form RFA, or retrospective, starting after a liability determination. Understanding the role of retro UR in workers’ comp […]
Overcoming Billing Challenges: IBR Victories for Medical Providers
An Independent Bill Review (IBR) is a process in California’s workers’ compensation system to resolve billing disputes between medical providers and claims administrators. Medical bills often get denied due to exceeding pre-authorized approvals or improper documentation, making it one of the key medical billing challenges providers face. According to the California Code of Regulations, Title […]
Common Tactics to Reduce Workers Comp Delays: A Guide for Providers
Resolving workers’ compensation claims in California can be a legal battle, often resulting in workers comp delays that impact providers’ timely billing and collection. A recent case involving a dedicated employee at a manufacturing plant exemplifies medical providers’ challenges in such situations. John’s severe back injury, caused by a mechanical malfunction at work, led to […]
Is the MPN Simplifying Workers’ Compensation or Complicating It?
In California’s workers’ compensation system, navigating the (MPN) is crucial yet challenging. Medical providers usually have to take the fall in these MPN personas. When an injured factory worker with a severe back injury needs care outside the MPN due to the absence of necessary specialists, instead of catering to the needs of the case, […]
Legal Basis Denial Dilemma
In worker’s compensation cases, providers often encounter obstacles in the billing and collection process. Insurance companies may decline coverage due to certain legal aspects, citing reasons such as post-term claim or statute for filing an injury. This situation can lead to patients grappling with substantial medical costs while providers have outstanding claims paid. A longtime […]
Using the RFA System to Our Client’s Benefit
In workers comp cases, the UR process can be confusing and slow, making it difficult for providers to get their dues cleared on time. Let’s delve into how we secured our client’s payment in this case through careful abidance to RFA guidelines. A warehouse worker sustains a wrist injury while operating heavy machinery at her […]
Simplify Lien Collection for Retrospective Denial of Treatment
In worker’s compensation claims, denials, and deferrals by administrators can hinder the collections of the medical providers and lead to legal disputes. When there’s a debate about which part of the body was injured at work, the request for treatment might be denied or deferred retroactively. In such cases, if the provider undertook the treatments, […]
