Recently George Parisotto, administrative director of the DWC, was interviewed by Insurance Journal on the Worker’s Comp landscape. Here are the main takeaways for doctors, doctor’s groups and surgery centers that perform. the bulk of Workers Comp treatments.
- New Pharmacy committee has created a new worker’s compensation drug formulary that went into effect at the beginning of 2018. If is based on the treatment guidelines found in the medical treatment utilization schedule Division of Workers Compensation documentation. Those treatment guidelines are taken from the American College of Occupational and Environmental Medicine, ACOEM.
- In addition to the Pharmacy committee there will therapeutics advisory committee as well. The two committees will work in concert to give the Department of Worker’s Compensation advice regarding the latest developments in evidence-based medicine, new drugs and how they are best used.
- These committees are made up of outside experts in an effort to bring in the very best talent to bear on new medications, how they are best used, whether or not these medications require utilization review.
California’s Workers Compensation system is as huge as it’s economy which is the 5th largest in the world behind the United States, China, Japan and Germany. Efforts are being made to improve efficiency, limit provider fraud and eliminate the backlog in the lien system.
- In the lien system a declaration is now required to make certain that only valid liens are being filed. See Supplemental Lien form and 4903.05(c) Declaration form (Supplemental Lien Declaration) as required by SB 1160. Not completing the required declaration can lead to lien being declared void.
- “Fast-track” utilization review (UR) process for workers’ comp was also implemented by SB 1160 and is speeding up the system.
- Medical treatment utilization schedules have been updated and the mechanism by which they are updated has been improved.
- Efforts to tighten up billing practices, specifically for medical legal fee schedule used by qualified medical examiners (QME), have elicited the most complaints. Past guidelines were considered to be “too open to interpretation” and were given more conservative interpretations. If you have comments they can be sent to: firstname.lastname@example.org. All efforts are in line with making the system better and more efficient.
At MBC Systems we stay abreast of all the statutory changes to the Workers Compensation system in order maximize the accuracy and the approval of your billing requests. If you’re looking for an expert workers compensation billing and collections company call (949) 863-0022 or use our Request a Call form.
For more information visit Insurance Journal