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CALIFORNIA WORKERS COMPENSATION COLLECTIONS
PUBLICATIONS, EDUCATION AND INFORMATION FOR TREATMENT AND
COLLECTIONS DISPUTES
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July 2014 Collections
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Mid July 2014
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Feb -2015 Collections
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Jan -2015 Collections
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California Workers' Comp
West Virginia Workers'
February 04, 2015: Alabama MAXIMUM FEE
SCHEDULE FOR PHARMACEUTICS
February 04, 2015: Alaska Fees for Out-of-State Medical
Treatment and Services
February 04, 2015: Arizona: Commission to Consider
Adoption of Treatment Guideline Process
February 04, 2015: Arkansas Case Law :"..compensable
injury combines with a preexisting disease or condition or
February 04, 2015: Colorado For Hospital Inpatient
Discharges Dates of Service on and After 1/1/2015
February 04, 2015:    Connecticut WCC Official Hospital
and Ambulatory Surgical Center Fee Schedule Memorandum
February 04, 2015: Iowa Case Law: The words “arising out
of” referred to the cause or source of the injury.  The words
“in the course of” refer to the time, place, and circumstances
of the injury.
February 04, 2014  Kansas The January 1, 2015 edition of
the Schedule of Medical Fees
February 04, 2014 Kentucky: Parties Impacted by the 2013
Workers’ Compensation Schedule of Fees for Physicians
February 04,2014 Louisiana Approval of Routine Evaluation
and Management Visits/Therapeutic Exercises -
Clarifications--
February 04, 2014: Main Medical Fee Schedule Annual
Update The Board has completed its annual update of the
medical fee schedule
February 04, 2014 Massachusetts Filing a Lien/Claim For
Payment of Services
February 04, 2015: Michigan:  R 418.101101 Calculation
and revision of payment ratio for Michigan hospitals.  Rule
1101. (1)
February  02, 2015: Delaware Workers' Compensation Health
Care Payment Rates for Physicians and Hospitals (the "Fee
Schedule").
February 02, 2015: Florida Workers’ Compensation
Health Care Provider Reimbursement Manual
2015 Book on Authorization, Utilization Review With 1000 IMR Decisions to Show Why
Treatment is not Being Authorized. Not only did the formalities of the WCAB and the IBR
process change but also the detail requirements in the request for authorization and to get UR
reversal by IMRs. A missed word and a left out explanation, a lack of documents, changes if the
treatment is authorized or if reversed and certified by IMR
Also receive 1500 IBR Decisions summarized
and indexed
8 WEEK 24 LESSON COURSE  IN WORK COMP TREATMENT AND
COLLECTIONS for $325.00 (INDIVIDUAL OR ENTIRE STAFF)
8 WEEK 24 LESSON COURSE  IN WORK COMP
TREATMENT AND COLLECTIONS for $325.00
(INDIVIDUAL OR ENTIRE STAFF)
Or will come to your location for 4 hour for
same fee as course,  for  lecture and
organizing  you collection and treatment
disputes
Getting Treatment Authorized: Guidelines / Common errors element What Must Be shown  In Medical Reports -As Required BY The IMRs to Get Services Treatment Authorized
LUMBAR SPINE POSTERIOR INTERBODY
FUSION = Guidelines = Elements Required in
Documentation =Common Errors= Authorized
URINE DRUG SCREEN    = Guidelines = Elements Required in
Documentation =Common Errors= Authorized
ONDANSETRON ODT TABLETS 8 MG #60
ONE TUBE OF MEDROX PAIN RELIEF OINTMENT
OPANA
ORPHENADRINE
ORTHOVISC
OXYCONTIN
OXYCONTIN  AND 2) HYDROMOPHONE
PANTOPRAZOLE
PERCOCET
PRILOSEC
PROBIOTICS
PROTONIX
RELPAX
REPLAX
RESTORIL
SENAKOT, GABAPENTIN AND PRILOSEC
SENTRA
SODIUM
SOMA
SYNAPRYN
SYNOVACIN
SYNVISC ONE INJECTION
TABRADOL 1
TEROCIN PAIN PATCH BOX
THERAMINE
TIZANIDINE
TOPIRAMATE
TORADOL
TRAZADONE
TRAZODONE/DESYREL
TYLENOL NO
TYLENOL NO. 3
ULTIMATE SCAR CREAM
ULTRAM
VALIUM
VASCUTHERM
VIAGRA
VICODIN
VISCOSUPPLEMENTATION
VOLAREN GEL
WELLBUTRIN XR
XANAX
ZANAFLEX
ZOFRAN

ZOLPIDEM
ISSUE IN DISPUTE Provider is dissatisfied with denial of
codes 72070 and 72110
ISSUE IN DISPUTE The reimbursement of CPT 17999
for date of service 1/31/2014
ISSUE IN DISPUTE:  Provider is dissatisfied with down
-coding of 99204 to 99203 and reimbursement for
multiple injured workers with separate dates of service.
ISSUE IN DISPUTE : Provider seeking remuneration for
the following medications and
compound medications: NDC 38779187105, NDC
38779273904 , NDC 38779039503,
NDC 38779038803, NDC 38779008202 , NDC
00591367105, NDC 76218121901,
NDC53746011005 and NDC 60505006601 dispensed to
Injured Worker on 05/05/2014
ISSUE IN DISPUTE: Provider seeking remuneration for
97530-59 x 4 Units Physical
Medicine services performed on 02/26/2014–03/05/2014
ISSUE IN DISPUTE :Provider seeking additional
remuneration for WC004 PR4 report
up to 15 pages.Upon second bill review, no additional
payment for WC004 was issued
ISSUE IN DISPUTE: Provider seeking full
remuneration for 82145, 80154,82520
,83925,83925-59,82145-59 Laboratory services
performed on 04/02/2014
ISSUE IN DISPUTE: Provider is dissatisfied with
reimbursement of DRG 454, Inpatient
Services.
ISSUE IN DISPUTE: Provide r seeking remuneration for
Lab Services CPT Codes, 82205, 82520, 83840, 83992 ,
83992, 83925, 83925 - 59, 82145 and 82055 (G4034) for
date of service 01/28/2014
6 Month  24 LESSON
COURSE  IN WORK COMP
TREATMENT AND
COLLECTIONS for $325.00
(INDIVIDUAL OR ENTIRE
STAFF)
Or will come to your location for 4 hour for
same fee as course,  for  lecture and
organizing  you collection and treatment
disputes
ISSUE IN DISPUTE  Provider is dissatisfied with
reimbursement of code 72148
ISSUE IN DISPUTE: Provider seeking full remuneration for  99499 Unlisted Evaluation
and Management services representing Functional Restoration Program for service dates
04/07/2014 04/11/2014.
ISSUE IN DISPUTE: Provider questioning Claims Administrator’s re-coding of 99214
Evaluation and Management service provided to Injured Worker on 01/29/214 and $0.00
reimbursement for 99070 -NDC#68453095010 submitted charge.
AMBIEN = Guidelines = Elements Required in Documentation =Common Errors= Authorized
ANAPROX  = Guidelines = Elements Required in Documentation =Common Errors= Authorized
ATIVAN = Guidelines = Elements Required in Documentation =Common Errors= Authorized
CAPSAICIN 0.025%, FLURBIPROFEN 20%, TRAMADOL 10%,MENTHOL 2%, CAMPHOR 2%=
Guidelines = Elements Required in Documentation =Common Errors= Authorized
CARAFATE = Guidelines = Elements Required in Documentation =Common Errors= Authorized
CARISOPRODOL = Guidelines = Elements Required in Documentation =Common Errors= Authorized
CELEBREX= Guidelines = Elements Required in Documentation =Common Errors= Authorized
CLONAZEPAM  = Guidelines = Elements Required in Documentation =Common Errors= Authorized
COLACE= Guidelines = Elements Required in Documentation =Common Errors= Authorized
COMPOUND CREAM= Guidelines = Elements Required in Documentation =Common Errors= Authorized
COMPOUND GABAPENTIN POWDER= Guidelines = Elements Required in Documentation =Common
Errors= Authorized
CYCLOBENZAPRINE= Guidelines = Elements Required in Documentation =Common Errors= Authorized
CYMBALTA= Guidelines = Elements Required in Documentation =Common Errors= Authorized
DENDRACIN= Guidelines = Elements Required in Documentation =Common Errors= Authorized
DIAZEPAM (VALIUM)= Guidelines = Elements Required in Documentation =Common Errors= Authorized
DICLOFENAC  = Guidelines = Elements Required in Documentation =Common Errors= Authorized
DICOPANOL (DIPHENHYDRAMINE)= Guidelines = Elements Required in Documentation =Common
Errors= Authorized
DICYCLOMINE HCL 2= Guidelines = Elements Required in Documentation =Common Errors= Authorized
DILAUDID= Guidelines = Elements Required in
Documentation =Common Errors= Authorized
CARDIAC CLEARANCE   = Guidelines = Elements Required
in Documentation =Common Errors= Authorized
CARDIOLOGY CONSULT = Guidelines = Elements
Required in Documentation =Common Errors= Authorized
CONSULT WITH PAIN MANAGEMENT = Guidelines =
Elements Required in Documentation =Common Errors=
Authorized
CT SCAN = Guidelines = Elements Required in
Documentation =Common Errors= Authorized
EKG = Guidelines = Elements Required in Documentation
=Common Errors= Authorized  EKG
ELECTROENCEPHALOGRAPHY (EEG) = Guidelines =
Elements Required in Documentation =Common Errors=
Authorized
ELECTROMYOGRAM    = Guidelines = Elements
Required in Documentation =Common Errors= Authorized
EMG/NCS   = Guidelines = Elements Required in
Documentation =Common Errors= Authorized
GROUP THERAPY = Guidelines = Elements Required in
Documentation =Common Errors= Authorized
HOME HEALTH CARE = Guidelines = Elements Required
in Documentation =Common Errors= Authorized
SLEEP EVALUATION WITH TESTING= Guidelines =
Elements Required in Documentation =Common Errors=
Authorized
INTRATHECAL PUMP = Guidelines = Elements Required in
Documentation =Common Errors= Authorized
MANIPULATION UNDER ANESTHESIA = Guidelines =
Elements Required in Documentation =Common Errors=
Authorized
NEUROLOGICAL CONSULTATION   = Guidelines =
Elements Required in Documentation =Common Errors=
Authorized
NEUROSTIMULATION THERAPY = Guidelines =
Elements Required in Documentation =Common Errors=
Authorized
REFERRAL TO NEUROSURGEON = Guidelines =
Elements Required in Documentation =Common
Errors= Authorized
NUCLEAR STRESS TEST = Guidelines = Elements
Required in Documentation =Common Errors= Authorized
OCCUPATIONAL THERAPY= Guidelines = Elements
Required in Documentation =Common Errors=
Authorized
PAIN MANAGEMENT    = Guidelines = Elements Required in
Documentation =Common Errors= Authorized
PLATELET RICH PLASMA INJECTION  = Guidelines =
Elements Required in Documentation =Common Errors=
Authorized
PNEUMATIC INTERMITTENT COMPRESSION   =
Guidelines = Elements Required in Documentation =Common
Errors= Authorized
INTERMITTENT COMPRESSION DEVICE= Guidelines =
Elements Required in Documentation =Common Errors=
Authorized
PRE-OP TESTING = Guidelines = Elements Required in
Documentation =Common Errors= Authorized
PSYCHE TREATMENT= Guidelines = Elements Required in
Documentation =Common Errors= Authorized
PSYCHIATRIC MEDICATIONS MANAGEMENT   = Guidelines = Elements Required in Documentation
=Common Errors= Authorized
PSYCHIATRY VISITS   = Guidelines = Elements Required
in Documentation =Common Errors= Authorized
PSYCHOLOGICAL EVALUATION = Guidelines = Elements
Required in Documentation =Common Errors= Authorized
PSYCHOPHARMACOLOGY MANAGEMENT    =
Guidelines = Elements Required in Documentation
=Common Errors= Authorized
PSYCHOTHERAPY      = Guidelines = Elements
Required in Documentation =Common Errors=
Authorized
SKILLED NURSING  = Guidelines = Elements
Required in Documentation =Common Errors=
Authorized
SPINAL SURGICAL CONSULTATION= Guidelines =
Elements Required in Documentation =Common Errors=
Authorized
DEBRIDEMENT OF THE RIGHT SHOULDER =
Guidelines = Elements Required in Documentation
=Common Errors= Authorized
TRIGGER POINT AND TENDER SPOT INJECTIONS =
Guidelines = Elements Required in Documentation =Common
Errors= Authorized
LUMBAR FUSION W/ INSTRUMENTATION, USE
AUTOGRAFT AND/OR ALLOGRAFT:= Guidelines =
Elements Required in Documentation =Common Errors=
Authorized
SHOULDER OPEN ROTATOR CUFF REPAIR = Guidelines =
Elements Required in Documentation =Common Errors=
Authorized
KNEE ARTHROSCOPY= Guidelines = Elements
Required in Documentation =Common Errors=
Authorized
SHOULDER ARTHROSCOPY = Guidelines = Elements
Required in Documentation =Common Errors= Authorized
WORK HARDENING VISITS = Guidelines = Elements
Required in Documentation =Common Errors= Authorized
DUEXIS= Guidelines = Elements Required in Documentation =Common Errors= Authorized
EFFEXOR= Guidelines = Elements Required in Documentation =Common Errors= Authorized
FENTANYL= Guidelines = Elements Required in Documentation =Common Errors= Authorized
FEXMID = Guidelines = Elements Required in Documentation =Common Errors= Authorized
FLECTOR= Guidelines = Elements Required in Documentation =Common Errors= Authorized
FLEXIRIL= Guidelines = Elements Required in Documentation =Common Errors= Authorized
FLURBIPROFEN CREAM,= Guidelines = Elements Required in Documentation =Common Errors= Authorized
FLURIFLEX (FLURBIPROFEN/CYCLOBENZAPRINE 15/10 %) CREAM 1= Guidelines = Elements
Required in Documentation =Common Errors= Authorized
GABAPENTIN= Guidelines = Elements Required in Documentation =Common Errors= Authorized
HYDROCODONE= Guidelines = Elements Required in Documentation =Common Errors= Authorized
DME Varies  = Guidelines = Elements Required in
Documentation =Common Errors= Authorized  EKG
IBUPR= Guidelines = Elements Required in Documentation =Common Errors= Authorized
KETOPROFEN= Guidelines = Elements Required in Documentation =Common Errors= Authorized
KLONOPIN= Guidelines = Elements Required in Documentation =Common Errors= Authorized
LIDOCAINE PAD= Guidelines = Elements Required in Documentation =Common Errors= Authorized
LIDODERM PATCH= Guidelines = Elements Required in Documentation =Common Errors= Authorized
LINZESS= Guidelines = Elements Required in Documentation =Common Errors= Authorized
LORTAB ELIXIR= Guidelines = Elements Required in Documentation =Common Errors= Authorized
LYRICA= Guidelines = Elements Required in Documentation =Common Errors= Authorized
MELOXICAM (MOBIC)= Guidelines = Elements Required in Documentation =Common Errors= Authorized
METHODERM OINTMENT= Guidelines = Elements Required in Documentation =Common Errors=
Authorized
MENTHODERM= Guidelines = Elements Required in Documentation =Common Errors= Authorized
MORPHINE SULFATE= Guidelines = Elements Required in Documentation =Common Errors= Authorized
MS CONTIN= Guidelines = Elements Required in Documentation =Common Errors= Authorized
NABUMETONE= Guidelines = Elements Required in Documentation =Common Errors= Authorized
NAPROXEN= Guidelines = Elements Required in Documentation =Common Errors= Authorized
NOCTURNAL OBSTRUCTIVE AIRWAY ORAL APPLIANCE / DECAY OR FRACTURED TEETH=
Guidelines = Elements Required in Documentation =Common Errors= Authorized
NORCO= Guidelines = Elements Required in Documentation =Common Errors= Authorized
NUCYNTA= Guidelines = Elements Required in Documentation =Common Errors= Authorized
OMEPRAZOLE= Guidelines = Elements Required in Documentation =Common Errors= Authorized
ONDANSETRON ODT = Guidelines = Elements Required in Documentation =Common Errors= Authorized
Program now available for purchase $500.00 set up, monthly updates $100.00 per
month with new laws and updated features and information.