A special thanks to Judge Paige Levy for going the extra mile. She talked about lien litigation issues, and delivered a California Bar ethics program for workers' comp legal practitioners after the seminar ended.
One attendee dropped us an email last week that said:
"I wanted to thank you for all the work and effort all of you put into this last weekend!! It was very helpful and valuable!! I apprecate the ease and comfort you provided for the seminar and the topics were perfect for us at our office!! - J.W.
FEB. 3 WEBINAR TOPIC
How to Control the Cost of MSAs
What you don't know can hurt you. That is the message from Kim Wiswell, a Maryland-based specialist in compliance with the Secondary Payer Act. Kim will deliver a webinar on Friday, Feb. 3 that answers these and other questions:
1. Why are MSA allocation proposals being rejected?
2. How do I avoid delays with Medicare Set-Asides submitted for approval?
3. If my proposed allocation is rejected, can I appeal the decision by CMS?
4. What has CMS (Centers for Medicare/Medicare Services) said about off-label use of Rx drugs?
One attendee dropped us an email last week that said:
"I wanted to thank you for all the work and effort all of you put into this last weekend!! It was very helpful and valuable!! I apprecate the ease and comfort you provided for the seminar and the topics were perfect for us at our office!! - J.W.
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How to Control the Cost of MSAs
What you don't know can hurt you. That is the message from Kim Wiswell, a Maryland-based specialist in compliance with the Secondary Payer Act. Kim will deliver a webinar on Friday, Feb. 3 that answers these and other questions:
1. Why are MSA allocation proposals being rejected?
2. How do I avoid delays with Medicare Set-Asides submitted for approval?
3. If my proposed allocation is rejected, can I appeal the decision by CMS?
4. What has CMS (Centers for Medicare/Medicare Services) said about off-label use of Rx drugs?
The webinar begins at 1 p.m. and 1 continuing-education credit is available through the California Bar Association and for California Claims Professionals. The webinar is free, and being sponsored by the The Grossman Burn Centers (web site). Register online. You must create a WorkCompCentral school account for online registration. Call 805-484-0333, ext. 113 or 133 for registration assistance.
A clarification went out last week from the Division of Workers' Compensation stating there is no requirement that medical-legal bills be submitted on a CMS 1500 form. Here is an excerpt from the Newsline sent on Friday, Jan. 13:
"The Division of Workers’ Compensations has received complaints from qualified medical evaluators (QMEs) that bills are being rejected by claims administrators because they are not on the standardized forms. By statute, medical providers are required to bill using standardized paper billing forms effective Oct. 15, 2011. This is a new requirement for medical treatment bills only. It does not apply to medical-legal bills.
The “Medical Billing and Payment Guide 2011” specifically states: “The following forms [which include the Centers for Medicare & Medicaid Services, (CMS) 1500] are the only forms to be used for paper billing of California workers’ compensation medical treatment services and goods unless there is a written contract agreed by the parties specifying something different.” (Medical Billing and Payment Guide, page 11, Appendix A Standard Paper Forms.)
However, the requirement to use the standardized paper billing forms does not apply to medical-legal billings, such as those performed in panel QME or other official QME or agreed medical evaluator, (AME) cases. Therefore, it is not appropriate to reject or object to a medical-legal bill because it was not submitted on a standardized form."
Read the full text of the Jan. 13 Newsline by clicking here.
The DWC also issued a Jan. 12 Newsline regarding discounted payments for pharmacy drugs, saying that "pharmacy fees incurred by non-contracted pharmacies, prior to notification that the payor utilizes a pharmacy network, should be paid at the fee schedule amount, absent any legitimate billing objections."
The entire text can be read at the DWC web site.
At our invitation, Southern California-based workers' comp attorney and author Michael Sullivan will host a webinar on Feb. 8 about the gigantic California workers' comp system. If anybody can explain clearly the California system in under 2 hours, it's Mike. He spent almost five years writing and editing the "Sullivan on Comp" workers' comp legal and practice series for California. He is a frequent speaker at industry events, and his programs are clear and concise. See for yourself and register early.
His webinar is titled, "Demystifying Workers' Comp Claims in California." Cost is $119 and two hours of continuing education credit is available for Claims Professionals and California Bar members.
Registration
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Med-Legal, Contracted Rx Drug Billings Clarified
A clarification went out last week from the Division of Workers' Compensation stating there is no requirement that medical-legal bills be submitted on a CMS 1500 form. Here is an excerpt from the Newsline sent on Friday, Jan. 13:
"The Division of Workers’ Compensations has received complaints from qualified medical evaluators (QMEs) that bills are being rejected by claims administrators because they are not on the standardized forms. By statute, medical providers are required to bill using standardized paper billing forms effective Oct. 15, 2011. This is a new requirement for medical treatment bills only. It does not apply to medical-legal bills.
The “Medical Billing and Payment Guide 2011” specifically states: “The following forms [which include the Centers for Medicare & Medicaid Services, (CMS) 1500] are the only forms to be used for paper billing of California workers’ compensation medical treatment services and goods unless there is a written contract agreed by the parties specifying something different.” (Medical Billing and Payment Guide, page 11, Appendix A Standard Paper Forms.)
However, the requirement to use the standardized paper billing forms does not apply to medical-legal billings, such as those performed in panel QME or other official QME or agreed medical evaluator, (AME) cases. Therefore, it is not appropriate to reject or object to a medical-legal bill because it was not submitted on a standardized form."
Read the full text of the Jan. 13 Newsline by clicking here.
The DWC also issued a Jan. 12 Newsline regarding discounted payments for pharmacy drugs, saying that "pharmacy fees incurred by non-contracted pharmacies, prior to notification that the payor utilizes a pharmacy network, should be paid at the fee schedule amount, absent any legitimate billing objections."
The entire text can be read at the DWC web site.
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Author Mike Sullivan Accepts a Monumental Challenge!
At our invitation, Southern California-based workers' comp attorney and author Michael Sullivan will host a webinar on Feb. 8 about the gigantic California workers' comp system. If anybody can explain clearly the California system in under 2 hours, it's Mike. He spent almost five years writing and editing the "Sullivan on Comp" workers' comp legal and practice series for California. He is a frequent speaker at industry events, and his programs are clear and concise. See for yourself and register early.
His webinar is titled, "Demystifying Workers' Comp Claims in California." Cost is $119 and two hours of continuing education credit is available for Claims Professionals and California Bar members.
Registration
About Mike Sullivan:
He is an experienced attorney in the fields of workers' compensation and insurance fraud litigation. He completed his Juris Doctorate at University of California, Hastings College of the Law and obtained his Bachelor of Arts at Loyola Marymount University. While attending Hastings, he garnered a competitive internship with the Department of Industrial Relations. After graduation, Mr. Sullivan was an Associate at the law firm of Gilbert, Kelly, Crowley & Jennett, where he specialized in insurance fraud litigation and workers' compensation.
Mike started his own law firm in the mid-1990s to offer a more responsive client relationship while maintaining high quality legal work. He has written and lectured exclusively on the subject of workers’ compensation and completed in January 2011, “Sullivan on Comp”, a workers’ compensation treatise. The treatise is a 12 volume, 16 chapter complete body of California workers’ compensation law set in bound print edition plus the content is hosted as an online subscription at WorkCompCentral.
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Lien and Ethics Programs Go Online Next Week
The lien seminar led by Judge Paige Levy, attorneys Jon Brissman and Frank Russo was recorded and for replay as an online seminar. Call the WorkCompCentral office at 805-484-0333, ext. 113/133 to enroll. Judge Levy's ethics for workers' comp attorneys course will be available Jan. 26, too.
California Bar Association members: This counts as 1 MCLE hour toward ethics. The Bar requires members to complete four hours of ethics training every three years. MCLEs for Group 2 are due Feb.1.
You can always find what's new at www.workcompschool.com.
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In the News
Okla. High Court Overturns Portions of Reforms (12/22)
Set-Aside Pros Say CMS' Pilot Portal Cut Review Times by a Month (12/23)
Fla. Regulators Liquidate PEO Insurer (12/27)
2011 in Review: Opioids Take Center Stage in Policy Debate (12/28)
NY Claimants' Bar Prioritizes Guide Changes (12/29)
Longshore Act Exemptions Finalized (1/3)
S. Carolina Commission Agrees to Push Ahead With Mediation Mandate
Santa Barbara Doctor Arrested on Drug Trafficking Charges (1/6)
WCRI Study Finds Fee Schedules Lead to Lowest Outpatient Charges (1/11)
S.C. Comp Commission Considering Regs for Mandatory Mediation (1/13)
News articles can be read with a subscription or purchased individually.
Almost Finished ...
www.workcompschool.com
Coming up March 24 is a live MCLE seminar about WCAB litigation tips with Judge Paige Levy of Marina del Rey and Judge Colleen Casey of San Francisco. Call 805-484-0333, ext. 113 for info.
We're planning the AMA Guides event of the year for California on April 28 at the Sportsmen's Lodge in Studio City. We're assembling an all-star cast of presenters, including Don Barthel and Ken Kingdon.
