Blog.daisybill.com

SCIF, EK Health Use "ODG" Guidelines to Deny Care daisyBill

WebSCIF and EK Health repeatedly cite ODG guidelines in UR decisions sent to physicians. Worse, these entities have used the ODG to deny surgery recommended by …

Actived: 1 days ago

URL: https://blog.daisybill.com/odg-guidelines-deny-care

Prime Health PPO: 2024 Medicare Cuts May Decrease Workers'

WebThe Centers for Medicare and Medicaid Services (CMS) announced it will cut reimbursement rates for physician services in 2024 by 3.4%.. This Medicare …

Category:  Health Go Health

How to Identify PPO Reductions (Part I) daisyBill

WebThe EOR below from SCIF demonstrates how SCIF made a mockery of the state fee schedule via PPO Savings that took $78.96 from the provider. This PPO …

Category:  Health Go Health

How It Works: Independent Medical Review (IMR) daisyBill

WebDaisyBill’s Billing Software. Our software allows providers to generate compliant RFA’s quickly, and tracks the response times, alerting providers when a …

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Discount Dangers, Part I: The Silent PPO daisyBill

WebDiscount Dangers is a DaisyBill series on the various ways discount contracts cheat workers’ comp providers out of reimbursement. With this series, we …

Category:  Health Go Health

The 5 Point Checklist for CPT Codes 99358 and 99359 daisyBill

WebCPT Code 99358 is for the first hour of non-face-to-face services and may be billed before or after direct patient care. CPT 99359 is an add-on code, only billable in …

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SCIF Inept UR #3: IMR Offers No Hope for Injured Worker

WebIn California workers’ comp, the insurer has the final say over an injured worker's medical care. So what if the insurer gets it wrong? What if the insurer denies …

Category:  Medical Go Health

San Francisco MTA Switches Bill Review daisyBill

WebAttn: Medical Bill Processing - SFMTA. 2351 Sunset Blvd. Ste 170-893. Rocklin, CA 95765. Providers should submit RFAs to EK Health at: Fax number 408-912 …

Category:  Medical Go Health

E/M Data: CPT 99214 Reimbursement 2022 daisyBill

WebCPT 99214: 2022 Data Summary. Below is a summary of the data collected from the 239 claims administrators to which daisyBill doctors submitted bills with E/M code CPT …

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SCIF Inept UR #5: EK Health Ignores MTUS, Denies Surgery

WebUtilization Review Standards: SCIF must respond with a Utilization Review (UR) decision within five (5) business days of receipt of the completed RFA – on or …

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Provider Alert: Broadspire Contorts Work First Casualty

Web2351 Sunset Blvd, Suite 170-893. Rocklin, CA 95765. If a provider fails to adhere to the Broadspire convoluted and contorted billing instructions, then the …

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Good-bye CPT 96101 and CPT 96102 daisyBill

WebEffective for dates of service on or after January 1, 2019, the Medicine/Central Nervous System Assessments/Tests subsection of the Current …

Category:  Medicine Go Health

Just In Time: Your Guide to the SB 1175 Billing Deadline

WebSB 1175 Section 1. Labor Code §4603. Submit bills for medical services within 12 months of the date of service (DOS), for all DOS on or after January 1, 2017. …

Category:  Medical Go Health

Hospital Outpatient Prospective Payment System: J1 Status

WebStatus Indicator T means that the HCPCS is reimbursable. When multiple codes are assigned Status Indicator T and appear on a single bill which, the …

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Why Specificity Matters: ICD-10 Billing for Workers’ Comp

WebFor California workers’ comp billing, an incorrect 4th, 5th, and 6th character--the part of the ICD-10 code that indicates increased specificity--cannot lead to a denial of …

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Institutional Billing: How to Find Your Conversion Factor

WebASC Conversion Factors. County-specific conversion factors are located in Table A of CCR § 9789.34. The table is downloadable as a PDF or CSV file from the …

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Zoom Privacy, Security Issues May Affect Telehealth daisyBill

WebHealth care providers using (or considering) teleconferencing software Zoom, heed this important warning: serious security, privacy, and data protection issues …

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“By Report” Billing Codes: Best Practices for Proper daisyBill

WebThe OMFS designates the reimbursement amount for a procedure code as “BR” in the following situations: Is not subject to California Code of Regulations (CCR) § …

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