California Work Comp News, Issues,
Articles Daily
September  20, 2014: Defective or Untimely UR: Using
Requesting Physician Medical Reports to show Medical
Necessity


September 19, 2014: IMR Appeal at WCAB:
applicant's attorney filed an appeal of the IMR
determination regarding the Duragesic patches, writing
that the "reviewer failed to review documents submitted
by applicant and  applicant's representative before
making the determination," contrary to applicant's right
to due process.

September 19, 2014: Case Law:
Defendant contends that a proper RFA was not
submitted. However, defendant entered into evidence two
UR determinations regarding the applicant's referral to a
pulmonologist, nephrologist and hematologist

September 19, 2014: WCAB: Sanctions Against
Defense Attorney in Lien Case Rains Down. (See Full
Decision:

September 18, 2014: Panel Decision:
Judge Orders Treatment outside MPN based on access
based on where injured worker presently employed not
where injury occurred.

September 17, 2014: Part 2 of 10 Part Series on
Authorization, Utilization review and IMRs (Shameful
Requests for Authorization)

September 17, 2014: Panel Decision Full:
Interpreter Gets Sanctions / Costs Against Defense (Still
Active Case)

September 17  2014: Case / News:
Interpreter Flexing Muscles: WCJ Orders Defendant to
Pay Sanctions

September 17, 2014: DWC:
DWC Posts Updated Physician Fee Schedule FAQs
Regarding Physician-Dispensed Durable Medical
Equipment

September 17, 2014: DWC News:
DWC Issues Revision to Copy Service Fee Schedule
Regulations with Additional 15-Day Public Comment
Period
CALIFORNIA WORKERS COMPENSATION COLLECTIONS PUBLICATIONS AND
INFORMATION FOR MEDICAL PROVIDERS AND LIEN CLAIMANTS
All States Work Comp News, Issues, Articles
Daily
September 16, 2014: Idaho Case Law:
A motion for reconsideration must “present to the
Commission new reasons factually and legally to support
[reconsideration] rather than rehashing evidence
previously presented.” Curtis v. M.H. King Co., 142
Idaho 383, 128 P.3d 920 (2005). The Commission is not
inclined to reweigh evidence and arguments simply
because the case was not resolved in the party’s favor.

September 16, 2014: Colorado News:
Colorado Division of Workers’ Compensation
2014 Legislative Advisory

September 16, 2014: Arkansas Case Law:
One of the purposes of the attorney's fee statute is to put
the economic burden of
litigation on the party who makes litigation necessary.
Brass v. Weller, 23 Ark. App. 193, 745 S.W.2d 647
(1998).

September 16, 2014: Arizona News:
2014-2015 Physicians' and Pharmaceutical Fee Schedule
(Eff Oct 1, 2014) -

September 04, 2014: Texas News:
Informal Working Draft of Rules Relating to Independent
Review Organizations

September 04, 2014: Ohio News:
Investigators crack Nelsonville chiropractor's $300,000
fraud scheme

September 04, 2014: Michigan News:
Change to Rule 408.45, Effective 08/19/14
8/19/14With respect to an appeal of a director’s
vocational rehabilitation order, R 408.45 has been
updated to bring it in alignment with 2011 statutory
changes to MCL 418.319(2). Note revisions in section (3)
(d), effective 08/19/14.

September 04, 2014: Idaho Information:
17-0209-1301 Medical Fees

September 04, 2014: Hawaii News:
STATE CIVIL RIGHTS COMMISSION ISSUES
DECISION IN RELIGIOUS HARASSMENT CASE
Employer Held Liable for Religious and Sexual Harassment
IBR Decision:
Decided services not Medical Legal no denial letter
submitted.

July 10, 2014: 3 Additional IBR Decisions Posted
Bringing total to 11 and 22 overall stating 82486 to be
paid under G0431 at $119.94. ****

June 24, 2014: IBR Decision:
PPO Discount does not apply to medical legal services


May 28, 2014: IBR Decision PPO Issue:
Explanation of review (EOR), the Claims Administrator
made a payment of $2,850.00, and applied a PPO
discount of $3,527.81. MAXIMUS requested a copy of
the PPO contract. The PPO contract was not received.
It does not appear the PPO discount was applied to the
correct OMFS Inpatient Hospital Allowance for the
DRG 491. . The additional reimbursement of $9,597.51
is warranted per the Official Medical Fee Schedule
Inpatient Hospital Fee Schedule DRG code 491


May 26, 2014: IBR Decision:
The dispute regards the payment for surgical facility
services on date of service 3/13/2013. The facility
services were billed on a UB-04/CMS1450 using revenue
codes for services and supplies related to CPT 29881,
CPT 29876, CPT 29870 Modifier 51, CPT 29884
Modifier 51, CPT 20680, CPT 27570 Modifier 51and
CPT 20610. The Provider was reimbursed $4,865.09
and is requesting additional reimbursement of $1,049.35.
The Claims Administrator reimbursed $4,865.09 for the
following billed procedure codes: 29881, 29876, 29870,
20680, 27570, S0020, E0114 and 81025. The Claims
Administrator denied the billed procedure code 20680
with the explanation “Post –op pain management is
included in the global surgical package." The Claims
Administrator denied the billed procedure code 29884
Modifier 51 with the explanation “This separate
independent procedure is considered an integral part of
the total services performed and does not warrant a
separate charge.”
The Provider is disputing the denial of CPT codes
20610 and 29884 Modifier 51.


May 26, 2014: IBR Decision:
Outpatient Surgery: This decision was based on OMFS
Outpatient Hospital Fee Schedule, National Correct
Coding Initiative/Outpatient Code Editor and
comparison with explanation of
May 19, 2014: IMR Decision:
Frovatriptan 2.5mg determined medically necessary

May 01, 2014: IMR Decisions Pain Management
Medically Necessary

April 21, 2014: IMR Decision:
Psych Consult Not Medically Necessary

April 14, 2014: Recorded Lecture on process

March 31, 2014: En Banc
Defective UR to WCAB Failure to review all medicals

March 10, 2014: IMR Decision:
Spinal Fusion not Medically  Necessary

February 16, 2014: IMR Decision:
Urgent PET scan of the brain is not medically necessary
and appropriate.

January 27, 2014: IMR Decision:
Determine Psychiatric Evaluation and Treatment
necessary for spinal injury

January 26, 2014: DWC Presentation on
Authorization, UR and IMR

January 20, 2014: IMR Decision:
24 post operative physical therapy  not medically
necessary

January 16, 2014: IMR Decisions:
Found Spinal Fusion not
January 19, 2013: Article:
The Real Fraud Against Medical Providers the WCAB will Not
Address

January 15, 2013: Article:
Parties Choosing Weapons Under SB 863

January 13, 2013: Article:
Medical Providers' Inactions waiting fro a Lawsuit to Stop SB 863 has
Already Resulted in Millions of Dollars of Lost  Collectible Files.

January 11, 2013: Article:
Litigation at The WCAB the True Reform in 2013

January 10, 2013: Article: Those Who Will Survive SB 863
Knowing the Law in 2013 is Not an Option for Medical Providers
Even under  Requirement Issues of the IBR and IMR Process  
(disputes will still be Argued regardless of the "Check List"
perceptions of these procedures)

January 06, 2013: Article False Sence of Security as to the IBR and
IMR Process
Are Legal Arguments Required for the IBR and IMR Process

January 03, 2013: Article:
Why Collections will Increase for Medical Providers under SB 863.

January 02, 2013: Article:
2013 and SB 863 is Still Here; What Medical Providers Need to
Know About SB 863

December 30, 2012: Article:
Are Lien Claimants Required to pay a $100.00Lien Activation Fee if
a Lien Conference was Completed Prior to 2013 and set  for Lien
Trial After 2013?
January 31, 2013: Article:
What to do When an Insurance Company will Not Settle Unless a
Lien Activation Fee or Lien Filing Fee is Paid.

January 28, 2012; Article:
Medical Providers, Lien Claimants, and Lien Collection Companies
who Do not Understand the Message Sent by the California Law
Makers, the DWC and WCAB and Learn SB 863;  Organize and
Change the way they Present Cases at the WCAB Will not be Long
in this industry.
January 11, 2013: Article
The Message from the California Law Makers, The DWC and
WCAB to Lien Claimants
February 21, 2013: Article:
Every reform in workers comp, insurance companies come up with
some nonsensical   reason not to resolve medical bill disputes with
medical providers regardless of the merits of the claim and SB 863,
has proven to be no different.
February 28, 2013: Article:
Article: DWC Sends Warning  to Unethical Insurance
Companies Stating
Payors must negotiate in good faith with
potential lien claimants - filing a lien is not a prerequisite”
March 14, 2013: Article:
Review of the Third Month into SB 863
March 22, 2013: Article:
Understanding an Order Disallowing for Failure to Appear and or
Failure to Pay a Lien Activation Fee

March 21, 2013: Article:
Defense Attorneys' Dirty Little Tricks now Flooding Lien
Claimants with Petitions for Sanctions.
April 01, 2013: Article:
How Many Times Must SB 863 Be Re-Regulated, Amended, and or
Changed before it is Scrapped as a Failed Reform?

March 30, 2013: Article:
How Many Times Must SB 863 Be Re-Regulated, Amended, and or
Changed before it is Scrapped as a Failed Reform?
April 04, 2013: Article:
The New Norm for Lien Claimants at the WCAB is Pleadings
(There are 23 Different Pleadings Concerning Lien Claimants)
April 17, 2013:  Article:
Article:  Opponents Claiming the “Sky is Falling” or Will Fall if
Petition for Costs Proposed Regulations for Copy Services and
Interpreters is Adopted.

April 11, 2013: Article:
Why SCIF is Prohibited by Law from Apply PPO Discounts of Blue
Cross
Richard J Boggan JD
Publisher of Work Comp Collections Newsletter

April  11, 2013: Article:
TRAUMA CENTERS ARE EXEMPT FROM THE OFFICIAL
MEDICAL FEE SCHEDULE FOR THE TREATMENT OF
INJURED WORKERS AND ARE TO PAID AT THEIR USUAL
AND CUSTOMARY FEES.
April 21, 2013: Article:
Weighing in on “The Great Debate of Petition for Costs”
(Interpreters, Copy Services and Non-Medical Services)

April 19, 2013: Article:
5th Month into SB 863, What Changes are still to Come and What
Will Not Change

April 17, 2013:  Article:*
Article:  Opponents Claiming the “Sky is Falling” or Will Fall if
Petition for Costs Proposed Regulations for Copy Services and
Interpreters is Adopted.
April 28, 2013: Article:
On July 1, 2013 Additional Changes in SB 863 and Supporting
Regulations Will Automatically Take Effect That Providers Need
to be Aware of and Summary of WCAB Proposed Rules

April 26, 2013: Article:
Is The WCAB realizing that the Trial Judges decisions in the
understanding of law, and in the application of the laws, as reflected
by their decisions, inconsistent with each other Trial Judge causing
the WCAB to issue En Banc Decisions and are more En Banc
Decisions needed.

April 26, 2013. Article News from WCAB:
Article: Notice of recent En banc decision and a Significant panel
decision posted by WCAB on April 26, 2013: Lien Activation fee
1. Lien activation fees do not have to paid at Lien Trial if a Lien
Conference was held prior to 2013 and the Lien Trial After 2013
2.        Lien activation fee must be paid prior to Lien Conference  
or the filing of the DOR or Prior to end of 2013

April 25, 2013: Article:
The Question is Whether a Provider is bound by the Reasons put
forth in the Request for Second Review or Can the provider Bring
up Additional Issues for Payments not Included in the Request for
Second Review.
May 06, 2013: Article:
ARE THERE MORE WAIVES OF DISMISSALS IN THE  
PROVISIONS OF SB 863 THAT MAKE COLLECTIBLE FILES
NON-COLLECTIBLE?

April 30, 2013: Article:
Ways a Collection File can be deemed Noncollectable under SB 863
if Procedures are not followed: (Working Noncollectable Files)

April 29, 2013: Article:
Article: MPNs / Authorization Granted However Revoked if
Provider not Part of MPN Valid or Invalid?

April 28, 2013: Article:
On July 1, 2013 Additional Changes in SB 863 and Supporting
Regulations Will Automatically Take Effect
May 12, 2013: Article:
Are Lien Collections Companies Doomed under SB 863 when
Pre-2013 Collections Files are Gone.

May 10, 2013: Article:
A Plan of Action: How to Develop Phone Collections under 2013
Collection Laws (SB 863)

May 09, 2013: Article:
SB 863 / MPNS: Why Pre-SB 863 Collections Methods Have
Disappeared and Where do Providers go from Here

May 08, 2013: Article:
Duplicate Bills, Bill Revisions, Second Review and the IBR Process
May 12, 2013: Article:
Are Lien Collections Companies Doomed under SB 863 when
Pre-2013 Collections Files are Gone.
May 20, 2013: Article: Misstatement about liens

May 17, 2013: Article:
The New Adverse Party to the Litigation Process for Lien
collections “Rules” , “Laws” and “Burden of Proof” (Everybody
Still Gets Paid Except Providers and Some Collection Companies).

May 16, 2013: Article / Education:
How to Understand the Authorization, Utilization Review and
IMR Process (Independent Medical Reviewer) Under SB 863

May 16, 2013: Article: No Conspiracy Against Lien
Claimants
Lien Claimants failing to understand their Burden of Proof at the  
WCAB,  and Dismissals and Sanctions Keep Raining Down
udicated or admitted by the employer.
May 26, 2013: Article:
Avoiding Sanctions at the WCAB by Lien Claimants

May 24, 2013: Article:
Article – Causation, Medical Necessity; and Reasonable
Reimbursement at the WCAB and Under SB 863

May 21, 2013 ; Article / Education:
Understanding Pleadings at the WCAB for Lien Claimants  
June 05, 2013: Article:
Additional Collections for Providers

June 04, 2013: Alert -Article:
The Letter “s” in Labor Code § 4903.5. (a) Saves Providers
Millions in time to File Liens.

June 04, 2013: Article:
Appeals Board Correctly finds that time to file a lien starts from
last date of service of continuous treatment

June 03, 2013: Article:
Training Collectors:  Contested Liability, Denied Injury, Admitted
Injury, IMR, IBR , Burden of Proof and WCAB

May 31, 2013: Article:
What the IMR (Independent Medical Reviewer ) Posted Decisions
are Showing Providers

May 29, 2013: Article:
Do any Default Laws Exist for Insurance Companies under SB 863
and Supporting Regulations when they do not comply?

May 27, 2013: Article
Article: Petitions for Reconsiderations by Lien Claimants
June 16, 2013: Article:
Review Of First 6 Months Of SB 863, Petition of Costs, Lien
Activation Fees / Notice of Intent to Disallow, Burden of Proof,
Sanctions, IMR and IBR

June 13, 2013: Article:
WHAT THE RECENT POST BY THE DWC MEANS
“UPDATES STATUS OF SB 863 EMERGENCY REGULATIONS”

June 07, 2013: Article:
What Makes Collections in 2013 Appear Complicated?
June 19, 2013: Article:
Importance of Collectors in 2013 and What Laws Must they
Know in Handling Disputed Collection Files
June 27, 2013: Article:
SCIF is Still Defrauding Providers out of Millions of Dollars Every
Year, Even Though Labor Codes Exist to Prevent the Fraud.

June 24, 2013: Article /Education:
There are Two Types of Management Approaches in dealing with
2013 Collections (SB863), Reactive and Proactive.

June 21, 2013: Article:
The Formalization of Arguments at the WCAB in 2013 / SB 863
and Bad Law
July 02, 2013: Article:
Knowing What a Contested Liability Issue is and the Several Ways
it Can Be Resolved to Start
the Second Review or IBR Time Requirements, Including Being
Resolved by Operation of Law

July 01, 2013: Article:
Repeating the Behavior that has Resulted in Millions of Dollars of
Lost Collection Files, Sanctions and Dismissals against Providers
and Lien Claimants.

June 28, 2013: Article:
Revisiting the Request for Second Review and IBR Request –What
Happens When Issue of Second Review Arise?
1.        Do I have write off files as un-collectible if I failed to
seek a second review within 90 days?
2.        What happens when the Adjuster states that the
time to file a second review expired when the request for
second review was timely?
July 15, 2013: Article:
SB 863 Has Just Achieved Fairness for all Parties in the Collection
Dispute Process The Importance of the Proposed / Modified
WCAB Policy and Procedures posted For Public Comment until
July 25, 2013.

July 12, 2013: Article:
How the Independent Bill Review (IBR) and Independent Medical
Review ( IMR )Process Changed and or Has Been Clarified Under
The Modified Proposed Rules by the WCAB Posted for Public
Comment.

July 11, 2013: Article:
Recent Developments That Should If Applied Right Increase
Phone Collections for Providers and
Collection Companies in Disputed Medical Bills

July 07, 2013: Article:
Article: WCAB Fears Ruling Against Largest Workers
Compensation Insurance Carrier and Largest Health Care Carrier,
Ignoring Laws Specifically Enacted 13 Years Ago to Prevent the
Profiteering From These Companies. SCIF / Blue Cross
July 16, 2013: Article:
Only The Most Knowledgeable  Will Survive SB 863 as we get
Closer and Closer to 2014

July 15, 2013: Article:*
SB 863 Has Just Achieved Fairness for all Parties in the Collection
Dispute Process The Importance of the Proposed / Modified
WCAB Policy and Procedures posted For Public Comment until
July 25, 2013.
July 18, 2013: Article:
Will the WCAB Proposed Rules Open the Door to Litigation and
Pressure Settlements?

July 17, 2013: Article:
Factual Misrepresentations of the Law under SB 863 That are
being Passed Around Even by Lien Attorney that Can Cost
Providers Millions
July 21, 2013: Article:
The Real Targets of SB 863: Lien Collection Companies.
Why We Have Yet to See the Insurmountable Number  of
Dismissals and Sanctions Against Lien
Claimant That are Sure to Come  in 2014.
August 01, 2013: Article:*
The Simplicity of Negotiating Liens and Achieving Fairness at
the WCAB , Providers Missing The Greatest Tool The DWC
and WCAB has Given Them To Resolve Collection Disputes.

July 31, 2013: Article:
On Federal Lawsuit to Stop Enforcement of Lien Activation Fee

July 30, 2013: Article:
The Apocalypse of Lien Dismissals and Accountability Coming
January 01, 2014.

July 29, 2013: Article:
Tricks, Short Cuts, Plans of Attack, and Secrets Revealed by
Collection Companies and Insurance Companies in the
Application of  2013 Collections and Defenses Under SB 863
and 2012 /2013 Laws

July 26, 2013: Article:
A Few Lessor Known Laws in 2013 that results In Money
Losses for Providers

July 25, 2013: Article:
When Will Medical Providers and Lien Claimants Determine
they Had Enough and Become Experts in the 2012 and 2013
Collection Laws.

July 24, 2013: Article:
Overworked, Underpaid, Neglect, Surprise, Excusable Neglect,
Calendared Wrong, the WCAB is not Buying Any.
August 06, 2013: Article / Education:
Workers’ Comp Collection Settlement Demand Letters in
2013, are they Worth Anything for Pre-2013 Collection
Dispute Files?

August 05, 2013: Article:
Substantial Changes in the Independent Bill Review Process
(IBR)  and Independent Medical Reviewer (IMR)Based on
“Contested Liability” and “WCAB Rules”,

August 04, 2013: Article:
Article and Sample Letter on How to Resolve Fee Disputes for
Dates of Services Prior to 2013to Avoid Dismissals on January
01, 2014

August 02, 2013: Article:
Republished: Understanding an Order and a NOI Disallowing for
Failure to Appear and or to Pay a Lien Activation Fee
August 16, 2013: Article:
Modified and updated Medical Legal and Treatment
Disputes Under Proposed WCAB Rule

August 15, 2013: Article:
Medical Legal and Treatment Disputes Under Proposed
WCAB Rules

August 13, 2013: Article:
Are Claims That Fall Outside the Time to File Liens Still
Recoverable, (A Mental Exercise in Law)?

August 13, 2013: Article:
Clarity in 2013 with the Combination of Laws and
Regulations, Revealing

August 11, 2013: Article:
Making Sense of Collection Disputes in 2013 for Both
Pre-2013 and Post -2013 Disputes

August 10, 2013: Article:
Just Because a Claim is Out of The Time to File a Lien
Does not Mean that it is un-collectible under the Present
Rules and Regulations from the DWC and WCAB and
Should be written off, it is still collectable

August 09, 2013: Article:
Some Questions from Providers and Lien Claimants in
the 8th Month of SB 863, Regarding Lien Collections,
2013 Disputes on How to Stop The
August 22, 2013: Article:Missing the Mark on SB 863 by Some
August 22, 2013: IMR Flowchart Modified:

August 21, 2013: Article: Why Some Collections are ensuring that
they Will Not get paid under Disputed Files that Fall under SB 863,
by their System of Collections.

August 21, 2013: Recorded Lecture:Overview of 2013
Collections and Pre-2013 Collection Files

August 19, 2013: Article:Are We Missing An Exception to the
Time to File Liens
August 28, 2013: Article:
Mistakes in Understanding 2013 (SB863) Collection Laws)

August 26, 2013: Article:
Article: MPNs, Interpreter Required to Part of MPNs and
Chiropractor Cannot Stay a Treating Physician after 24, What’s
Wrong with these Provisions?

August 25, 2013: Article:
Medical Provider Networks (MPNs) Without Purpose and
Function Other Than to Exclude Providers, Including Interpreters,
Copy Services and DME Suppliers from Providing Service to
an Injured Worker.

August 25, 2013: Article:
How the Independent Bill Review (IBR) and the Independent
Medical Review (IBR) Has Changed Based On Adopted and
Proposed Rules of DWC and WCAB
September 04, 2013: Article:
Is there a weak link in the  2013 collections laws, is there a
provision, a law, an overlooked unregulated loophole that would
defeat or bring liberation to those who do not follow all the laws or
miss time requirements?

September 03, 2013: Article:
Understanding the IBR Process and Contested Liability Issues

September 01, 2013: Flowchart / Diagram:
Medical Legal Flowchart / Diagram Proposed Rules by the WCAB

August 31, 2013 Article:
Article: Understanding 2013 Collection Laws (SB 863) in Relation
to Pre-2013 Collection Disputes and Post-2013 Collection
Disputes

August 30, 2013: Article:
9th Month into SB 863

August 28, 2013: Article:
Mistakes in Understanding 2013 (SB863) Collection Laws)
September  06, 2013: Article:
How Defaults Against Insurance Company Applies to IBR and
IMR Process

September, 05, 2013: Article:
Whether a Collection Dispute File Is WCAB Qualified to
Warrant Paying a Lien Activation Fee.
September 15, 2013; Article:
Going to the WCAB vs Settlements, Medical Providers, Facilities,
Interpreters, Copy Services DME, etc., all have To Make
Choices.

September 12, 2013: Article:
20 Steps In Determining if a Pre-2013 Collection Dispute Files
are  Collectable and or WCAB Qualified.
September 25, 2013: Article Diagram
What Happens when Adjuster Does not Comply with Time
Requirements.

September 23, 2013: Diagram:
How to Settle Collection Disputes

September 19, 2013: Article:
Providers Provide Services to the Injured Worker, There Exists a
Fee Schedule to Get Paid, So Why are Providers Not Getting Paid
and Writing off Mass Receivables and Receiving Dismissals?

September 18, 2013: Article:
The message has been clear now for over a year; a provider
cannot keep knocking at the WCAB door with the same
collection dispute files that went through the WCAB in years
past, lacking in preparedness and evidentiary documentation to
go forward.
October 03, 2013; Article:
The WCAB Adopted Rules with an Effective Date of October 23,
2013, What it Means for All Parties.

September 30, 2013: Article:
Day of Reckoning Fast Approaching:  Persistence No Longer
Key to Resolving Collection Disputes, Knowledge, Detail and
More Knowledge is Required.
October 14, 2013: Article:
Providers and Lien Collection Companies, Still Putting Their
Hand in the Lions (WCAB) Mouth

October 11, 2013: Education:
Time Sheets IBR

October 10, 2013: Article:
Medical Legal Disputes, If and Or But, Maybe, Which Way do
Medical Legal Disputes Go or Can Go?
October 29, 2013: Article:
Some Making SB 863 More Confusing in 2013 Collections Than it
Is!

October 26, 2013: Article:
Article: An Evaluation of § 10774.5  “Notices of Representation,
Change of Representation, and Non-Representation for Lien
Claimants”

October 25, 2013: Article:
Are Persuasive Arguments a Fading Talent in California Work
Comp Collections?

October 24, 2013: Education:
Members 2014 Guidebook

October 23, 2013: Article:
Chaos at The WCAB Today

October 21, 2013: Article / Research Paper
Denied Body Part, Admitted Injury, Complications for That What
Appears Simple
November 08, 2013: Article:
Lien Activation Fees: Preliminary Injunction  Was Issued to be
Finalized on Tuesday November 12, 2013;

November 07, 2013: Article:
Falling Into the Ways of the Old WCAB

November 05, 2013: Article:
No Victory Yet for Providers: Granted Preliminary Injunction
with Conditions  Still to be decided for Lien Activation Fee
Lawsuit.

November 03, 2013: Article:
Should Providers Be Outraged When They See Their Receivables
Disappear?

November 01, 2013: Article:
WCAB Dismissing Liens with Prejudice Even if Lien Fee paid if
No Proof at Hearing of Payment even if EAMS Shows Paid
November 14, 2013: Article:
Zero Dollars to $3,654.00 in 60 Minutes or Less a WCAB
Collection Dispute File.

November 13, 2013: Article:
The Difference between Authorization and Utilization Review
Certification California Work Comp

November 10, 2013: Article:
Lien Claimants Fearing the WCAB: 10 Cents on the Dollar or 20
Cents on the Dollar if you have a good Argument.

November 08, 2013: Article:
Lien Activation Fees: Preliminary Injunction  Was Issued to be
Finalized on Tuesday November 12, 2013;
December 02, 2013: Article:
Medical Legal Process 2013

November 24, 2013: Article:
Work Comp Collectors, How to Make a Better Collector

November 24, 2013: Article:
How to Increase Collections and Give Dispute Files Their
True Value

November 19, 2013: Article:
MPNs Collection Dispute Issues  in 2013

November 18, 2013: Article:
The Defense of “Post Termination” How it applies and how it
does not apply
December 11, 2013: Article:
Authorization, Express, by Operation of Law, by Default and
Utilization Review

December 10, 2013: Article:
Correct Information on Appeal of Liens for Failure to pay Lien
Activation Fee Orders, (Injunction)Correct Information on
Appeal of Liens for Failure to pay Lien Activation Fee Orders,
(Injunction)

December 06, 2013: Article:
The Ruse of Shifting Body Parts and MPNs by Insurance
Companies

December 04, 2013: Article:
Lien Claimants and Medical Providers Need to Get Angry and Get
Paid
December 18, 2013: Article:
Article: SB863 and the Adoption of OMFS to the RBRVS SB
863 mandate a 4-Year transition

December 17, 2013: DWC News
The Office of Administrative Law (OAL) Has Approved DWC’
s Final Version of Electronic Document Filing and Lien Filing
Fee Rules

December 16, 2013: Educational Book
2019 Page Book on  Case and Statutory Laws Citations
January 03, 2013: Article:
Mistakes in Organizing for Collection disputes That Fall under
SB 863    
December 31, 2013: Article:
What We Saw in 2013 and What to Expect in 2014, Work
Comp Provider Collections Disputes

December 30, 2013:  Article:
Another Rain of Sanctions and Dismissals are Coming for Lien
Claimants: The Laws Passed in 2012 and SB 863 was to Shorten
the Live Span of A Collection Dispute File Either Voluntarily of
by Operation of Law.

December 25, 2013: Article:
The Secret of Success in Work Comp Collections Why we Plan
for Failure Instead of Success.

December 23, 2013: Article:
The Ability to Change: Billing, Collections and Appearances at
The WCAB , 2012 and 2013 Laws /SB863
January 17, 2014: Education:
25 Procedures for Collection Dispute Files from Birth to Death

January 15, 2014: Article:
SB 863 Laws Lying in Wait, One Thing Not Tolerated in 2014
is the Wait and See Approach

January 13, 2014: Education:
Summary of New Fee Schedule

January 10, 2014: Article:
Providers Creating Garbage Piles of Receivables and No one is
Stopping Them

January 09, 2014: Education:
Corrected Diagram under SB 863 Denied Liability

January 08, 2014:Article:
Preparing for Lien Trials at the WCAB What Lien Claimants
are Missing.
January 31, 2014: Article:
Productive Organization and Training for Collectors in Work
Comp 2014

January 30, 2014: Article:
The Simplicity /Complexities of Collection Disputes in 2013
and 2014 All the Way to The WCAB

January 26, 2014: Article:
Three Fee Schedules Created for Providers: Two Quasi Fee
Schedules Created: One Created by Insurance Companies and
The Other Created by Defense Attorneys at the WCAB  in
Work Comp Claims Disputes.

January 24, 2014: Article:
Toxicology / Drug Screening Reimbursement in Workers
Compensation G0431 and G0434 Are IBR Posted Decisions
Wrong?

January 22, 2014: Article:
SB 863 and “Torres” Case: Friend to Providers, Enemy to Run-
of-the-mill Collections
February 13, 2014: Article:
Part 4 Practicing Law at WCAB for Lien Claimants
(Respecting the WCAB and Providers)

February 12, 2014: Article Part 3 of series "Practicing
Law at WCAB"

February 11, 2014: Article Part 2 of Series "Practicing
Law at WCAB"

February 09, 2014: Article:
WCAB: How to Practice Law for Lien Claimants and
Collectors from Collections to WCAB

February 07, 2014: Article/Information:
The New 2014 Physician Fee Schedule: Some Important
Provisions from Regulations         

February 05, 2014; Article:
Running for the Hills 2014 Official Medical Fee Schedule:

February 04, 2014: Article:
SB 863: The Law They Missed,  Selling out  Providers at The
WCAB
February 20, 2014: Article:
Part 7 Practicing Law at WCAB for Lien Claimants (Spotting
Issues)

February 18, 2014: Article:
Part 6 Practicing Law at WCAB for Lien Claimants (Pleadings
/ Sanctions)Part 6 Practicing Law at WCAB for Lien
Claimants (Pleadings / Sanctions)

February 14, 2014: Article:
Part 5 Practicing Law at WCAB for Lien Claimants
(The Law)

February 13, 2014: Article:
Part 4 Practicing Law at WCAB for Lien Claimants
(Respecting the WCAB and Providers)
February 26, 2014: Article:
Part 9 Practicing Law at WCAB for Lien Claimants (Applying
the Law to the Facts)

February 25, 2014: Article:
Part 8 Practicing Law at WCAB for Lien Claimants (Applying
the Law to the Facts)
March 11, 2014: Article:
Part 13 Practicing Law at WCAB for Lien Claimants (Making
Sense of it All)

March 10, 2014: Article:
Part 12 Practicing Law at WCAB for Lien Claimants (The
Training Process for Lien Claimants in
Substantive and Procedural Laws)

March 10, 2014: Article:
Part 11 Practicing Law at WCAB for Lien Claimants (The
WCAB’s Secret Files on Lien
Claimants)

March 04, 2014: Article:
Part 10 Practicing Law at WCAB for Lien Claimants (Rite of
Passage  to the WCAB)
2014; Article:
Knowledge, Coupled With the Ability to Spot Patterns to
Adjust and Succeed under SB 863 Collections Disputes

2014: Article:
2014 Collection Disputes and WCAB (Getting It)
2014: Article:
Usual and Customary Fees for California Hospitals
(Facilities): Above Fee Schedule, Exempt from Fee Schedule,
Day Outlier for Extended in Patient Stays, Distinct Rehab
Units, Rehabilitation Hospitals, PPO Contracts (Stop Loss
Provisions) where they are in 2014.

April 08, 2014: Article:
Article: Second Bill Review Process Gateway to Dispute
Resolution do it Right or do not get paid
Education 10 Cases and Arguments That Allowed
Payment for Treatment Outside a Valid MPN

September 06, 2014: Article / Research Paper
From Collector; to 2001 One Book 297 Pages; to 2014 --
19 Different Books Each Over 300 Pages, Work Comp
Collections Disputes

September 06, 2014: Article / Research Paper
Take Aspirin before Reading: Example of Complexities
of the Laws by Way of Illustration of the Medical Legal
Process.

September 06, 2014: Article / Research Paper
The Shame And History of PPO Discounts In California
Work Comp, Why Providers Are Losing The Issue

Alert: New WCAB Proposed Rules and Policy:
When appearance required (Medical Legal, Interpreters
and  over $25,000.00 and more changes:  with any
proposed regulations  always read the Statement of
reasons.


6 Page Research Report and Development Paper on
Toxicology Billing and Payments

Research Paper
Whether to Assert A Defective UR or A Defective Second Review or
Waive Defects Depends on Services That are Either IMR Friendly,
IBR Friendly or
WCAB Friendly

2014: Article:
Insanity: Two Years Later and Still Some Not Getting, The Second
Review Process. --Imagine Treating an Injured Worker for a year
and All Treatment Authorized then Receiving No Payments  and
Have No Recourse. --- Or Treat for a denied Injury and Then the
Injury is  Admitted through C&R and  getting No payments
because you did not do a Second Review Request and No Recourse.

2014: Article:
How to Fail Under SB 863 – We Can No Longer Blame Providers

2014: Article:
Sales Pitch  to Providers on SB 863

, 2014: Article:
Usual and Customary Fees for California Hospitals (Facilities): Per
Diem Outlier (Exceeds Average Length of Stay) Awarded an
additional Amount of $58,971.22 above Fee schedule
Panel Decision:
The fact that the record does not contain an express designation
of Dr. Mays as the primary treating physician should not defeat a
legitimate claim for medical treatment services.

Panel Decision in line with En Banc Simmons: Proper
mechanism for objecting to medical determinations by a primary
treating physician where liability to at least one body part has been
accepted.

Panel Decision:
Letter correctly addressed and properly mailed is
23 presumed to have been received in the ordinary course of mail
(Evid. Code, § 641).
Panel Decision:
We find that sanctions are warranted in this case in that the
language used by applicant's counsel in the Petition for
Reconsideration is insulting, offensive, insolent, intemperate and
disrespectful towards the WCJ.
Panel Decision:
WCAB / Indicated That a Trial Judge May Have Jumped the Gun
in Pre-Judging an MPN Issue and Sanctions Against Lien Claimant

Panel Decision:
We are not persuaded by the response and accompanying
declarations that a sanction should not be imposed in this case.
The argument that the false statement in the petition was an
inadvertent mistake caused by neglect and not by intentional
misconduct is not persuasive given the large number of petitions
filed by LMM around the same time with that same false averment.
Recent En Banc Decision on QME Process

Panel Decision:
"...when the Order Dismissing had been served on lien claimant. It
was therefore not clear whether the
Petition was timely filed." (Report, pp. 1-2.)

Panel Decision:
Kunz and Tapia cases really focus on evidence of what the lien
claimant usually accepts

Panel Decision:
"Here, we conclude that the defendant's UR process suffers from
material procedural defects that undermine the integrity of the UR
decision because the UR physicians were not provided with
adequate medical records."
Panel Decision:
sanctions: litigating a lien to the point of setting it for
trial without submitting any evidence in support thereof
Recent En Banc Decision on QME Process

Panel Decision:
"...when the Order Dismissing had been served on lien claimant.
It was therefore not clear whether the
Petition was timely filed." (Report, pp. 1-2.)

Panel Decision:
Kunz and Tapia cases really focus on evidence of what the lien
claimant usually accepts

Panel Decision:
"Here, we conclude that the defendant's UR process suffers from
material procedural defects that undermine the integrity of the
UR decision because the UR physicians were not provided with
adequate medical records."

Panel Decision:
sanctions: litigating a lien to the point of setting it for
trial without submitting any evidence in support thereof
Panel Decision:
"Compensable consequences" doctrine. Under this doctrine,
where a subsequent injury is the consequence of an original
industrial  injury, the subsequent injury is considered to relate
back to the original injury

F Panel Decision:
Appeals Board States When SCIF can use Blue Cross PPO discount
WCAB Published Significant Panel Decision: An expedited
hearing may be requested and conducted under Labor Code section
5502(b)(2) and Administrative Director Rule 9767.6(c) to
determine whether the employee must treat in the employer’s
medical provider network during the 90-day delay

Panel Decision:
Here, applicant's attorney barely manages to squeeze the petition
for reconsideration into 25 pages, but he does so only by
violating the 12-point font size requirement (§§ 10845(a),
10205.12(a)(5) [formerly, § 10232(a)(5)1) and possibly by
violating the line- spacing requirement as well (§§ 10845(a),
10205.12(a)(11) [formerly, § 10232(a)(1 1)]).
Panel Decision:
Lien claimant did not file the Petition for Reconsideration within
25 days of the decision (20 days per Labor Code section 5903,
plus 5 days for mailing per Code of Civil Procedure section 1013).
Panel Decision:
The WCJ's determination "must be based on admitted evidence in
the record."

Labor Code section 5313 requires the WCJ to "make and file
findings upon all facts involved in the controversy

Panel Decision:
“It appears that lien claimant does not fully  understand its
evidentiary burden. Under Labor Code section 5705, "The burden
of proof rests upon the party or lien claimant holding the
affirmative of the issue."
Panel Decision:
"...we strongly admonish applicant's counsel for citing medical
reports that are not in evidence, thereby failing to "fairly state
all of the material evidence relative to the point or points at issue
[,]"
January 15, 2013: Panel Decision
Order of Dismissal Lien Served by Defense and not Board Held
Invalid Order for Dismissal.

January 31, 2013: Panel Decision:
Sanctions for Lien Claimant withdrawing DOR

January 31, 2013: Panel Decision:
"Finally, we note that Labor code section 4907 will be expanded
on January 01, 2013. Beginning on that date, a Lien
Representative may lose the privilege of practicing before the
WCAB..."
January 12, 2013: Panel Decision:
Lien claimants offered no evidence of the OMFS for the
services provided to treat applicant's industrial injury.
February 15, 2013: Daily News Broadcast: New En Banc
Decision and DEVELOPMENT of a collection file.

February  15, 2013: Newly Published En Banc Decision:
Good cause having been established, we order that
_______________be suspended from appearing before the
Workers' Compensation Appeals Board as a hearing
representative on behalf of any party or lien claimant for a
period of 90 days.

February 15, 2013: WCAB Definition of "Good Cause"
February 20, 2013: Panel Decision: Evidence:
However, while a party's failure to lay a foundation, to
authenticate, and to corroborate documentary evidence with oral
testimony may affect the weight and substantiality of the
evidence, these possible deficiencies do not necessarily render that
evidence inadmissible.

February 19, 2013: Panel Decision:
Additionally, even if lien claimant's assertion about lack of notice
were correct, lien claimant's skeletal petition for reconsideration
would still be "unsupported by specific references to the record and
to the principles of law involved" and thus subject to dismissal.
(Cal. Code Regs., tit. 8, § 10846.)

February 19, 2013: Panel Decision:
"... the petition fails to identify what "good cause" petitioners
contend supports rescission of the WCJ's Order. The petitions are
also unverified."
March 01, 2013: Panel Decision:
Moreover, although the presumption of proper mail service may be
rebutted by evidence that the Findings and Order was not in fact
mailed as declared by the proof of service  a bare declaration of
non-receipt is insufficient to overcome proof of service.g

February 26, 2013: Panel Decision:
Sanctions-- Lien claimant for failure to respond to NOI
March 06, 2013: Panel Decision:
Labor Code section 5502(b) establishes issues which require
expedited hearing. As of 2012,these issues did not include MPN
issues or issues regarding attorney's fees. However, because the case
is now off calendar, defendant's Petition for Removal is moot, and
we deny it.

March 06, 2013: Panel Decision:
"With regard to the defendant's contention that the lien claimant's
attorney did not state under penalty of perjury that the attorney
was appearing on no other matters on that date and that the entire
time was spent at the Pomona Board exclusively waiting for the
defendant to appear in this matter,
the defendant cites no legal authority that in order for the court to
award costs that said Petition must include such a declaration."

March 04, 2013: Panel Decision:
“…affirmative burden of proving all of the elements  necessary to
establishment of its lien and all relevant issues, including that the
lien was for properly  provided services and that the claim is
industrially related.”  “…also require that lien claimant prove that
the treatment rendered was reasonable and necessary to cure or
relieve the effects of the injury.”

March 04, 2013: Panel Decision:
“…defendant unreasonably delayed applicant's referral to his
treating spinal surgeon for a surgical consultation and unreasonably
delayed provision of spinal surgery.”
March 18, 2013: Panel Decision:
However, we note that, although lien claimant filed a Request to be
Available by Phone for the November 21, 2012 lien conference,
there is no indication in the record that the WCJ granted that
request. Notifying an opposing party, or even the WCAB, of
unavailability does not in itself excuse  failure to appear.

March 15, 2013: Panel Decision:
The verified petition for reconsideration is impermissibly skeletal,
contrary to California Code of Regulations, title 8, section 10846.
It is unsupported by specific references to the record and to the
principles of law involved.
March 19, 2013: Panel Decision:
"In order to have been "prior timely payments," the payments
would have had to be made prior to 8:30 a.m. on the date of the
lien conference"
March 28, 2013: Panel Decision:
Lien claimant's excuse for failing to obtain permission and for
filing duplicate documents is that it assumed that the documents  
would be discarded, and it contends that it was not aware of a
provision that would impose sanctions for that behavior.

March 28, 2013: Panel Decision:
However, we determine that lien claimant may have
misunderstood the language and effect of the Order quoted above.
As such, lien claimant may have been objecting to the Notice and
seeking reconsideration if the Order of Dismissal was in effect
.

March 28, 2013: Panel Decision:
Pre-trial orders regarding evidence, discovery, trial setting, venue,
or similar issues - such as the orders here - are non-final
interlocutory orders that do not determine any substantive right of
the parties. Accordingly, the Petition, to the extent it seeks
reconsideration, must be dismissed
March 29, 2013: New En Banc Decision:
Mercy is an “air carrier that may provide air transportation”
within the meaning of the preemption provision of the ADA.?

March 28, 2013: Panel Decision:
Lien claimant's excuse for failing to obtain permission and for
filing duplicate documents

March 28, 2013: Panel Decision:
However, we determine that lien claimant may have
misunderstood the language and effect of the Order

March 28, 2013: Panel Decision:
Pre-trial orders regarding evidence, discovery, trial setting, venue,
or similar issues -
April 16,2013: Panel Decision:
Appeals agrees with Lien Claimant there was no intention to cause
unreasonable or unnecessary delay, and not motivated by bad faith
reduce sanctions from$2,500.0 to $500.00 still unnecessary
hearing.

April 14, 2013: Panel Decision:
The Court does not believe relief should be granted per CCP 473.If
the WCAB does determine that relief should be granted, as CCP
473 includes mandatory costs and sanctions, the matter should be
returned to the trial level for the award of same.
April 23, 2013: Panel Decision:
Treatment outside MPN allowed whenLack of Notice that results
in a neglect or refusal to provide reasonable medical treatment
renders the employer or insurer liable for reasonable medical
treatment self-procured by the employee." (71 Cal.Comp.Cases
at1435.)

April 19, 2013 Panel Decision:
Notice of Intent not a final Order and not subject to Petition for
Reconsideration unless order served by Court

April 18, 2013: Panel Decision:
There are no citations to any evidence or actual testimony, as
required by WCABRule 10842.

April 18, 2013: Panel Decision:
The supplemental response shall only address evidence and issues
raised in lien claimant's Answer, and shall not address any other
evidence or raise any other issues, and must befiled within fifteen
(15) days, plus an additional five (5) days for mailing
April 23, 2013: Panel Decision:
Treatment outside MPN allowed when Lack of Notice that results
in a neglect or refusal to provide reasonable
May 08, 2013: Recent Published En Banc Decision:
Where a medical-legal lien claim for copy costs was filed before
January 1, 2013, and after January 1, 2013 it was withdrawn and
re-filed as a petition for costs under Labor Code section 5811, the
Appeals Board held:
May 15, 2013: Panel Decision:
A failure to fairly state all of the material evidence may be a basis
for denying the petition." (Cal. Code Regs., tit. 8, § 10842.

May 15, 2013: Panel Decision
Lien Claimant ordered to pay $10,030.25 in cost and sanctions

May 14, 2013: Panel Decision: NOI:
A letter that is properly addressed and mailed is presumed to be
received, and a bare statement of non-receipt is insufficient to
overcome proof of service. . Additionally, even if lien claimant's
assertion about lack of notice were correct, lien claimant's skeletal
petition for reconsideration would still be "unsupported by specific
references to the record and to the principles of law involved" and
thus subject to dismissal. (Cal. Code Regs., tit. 8, § 10846.)

May 14, 2013: Panel Decision MPN Issue:
The record reflects a neglect or refusal to provide reasonable
medical treatment because defendant did not carry its burden of
proving that such treatment was properly available to applicant
through its MPN. For that reason, defendant is liable for the cost
of the reasonable medical treatment self-procured by applicant.
May 16, 2013: Panel Decision:
As discussed above, section 4600(a) imposes a mandatory duty to
timely provide reasonably required medical treatment. The Labor
Code does not permit a defendant to bury its head in the sand in
order to dodge its obligations.

May 16, 2013: Panel Decision:
A medical provider lien claimant can no longer present a prima
facie case merely by demonstrating that the treatment giving rise
to the lien claim was for an alleged
industrial injury. To the contrary, the present rule of law is that
Lien Claimants have the burden of proof on their lien claims,
including the burden to demonstrate every
element necessary for recovery unless that element was previously
adjudicated or admitted by the employer.
May 21, 2013: Panel Decision:
It is also recommended that petitioner be admonished not to file
Petitions for Reconsideration and mislabel them as
Objection-other and to comply with Reg. 10842.
May 30, 2013: Panel Decision:
The language of the statute is mandatory concerning the payment
of an activation fee by the lien claimant at the lien conference,
and the sanction of dismissal of the lien with prejudice should the
lien claimant fail to pay the fee or show proof of such payment at
the lien conference.

May 28, 2013: Panel Decision:
“____________ have violated a number of important WCAB
Rules in the underlying proceedings and in the Petition for
Reconsideration, making the imposition of Labor Code section
5813 sanctions appropriate in this case.”
June 14, 2013: Panel Decision:
as CCP 473 includes mandatory costs and sanctions, the matter
should be returned to the trial level for the award of same.

June 11, 2013: Panel Decision:
Defendants allege that the Qualified Medical Examiner should not
have his charges adjudicated in the absence of a lien.

June 11, 2013: Panel Decision:
but none of the evidence submitted is evidence that applicant
received notice or that lien
claimants received notice.
June 18, 2013: WCAB Post En Banc Decision:
Bengals are exempted by section 3600.5(b) from the provisions of
California’s workers’ compensation law,

June 18, 2013: Panel Decision:
Lien Claimant contends it was error to dismiss its lien solely for
failure to pay the lien activation fee which it described as a
technicality. This contention is frivolous in light of the express
language of Labor Code section 5903.06 (a) (1), (a) 2 and (a) (4).

June 17, 2013: Panel Decision:
Additionally, it is unclear why lien claimants have raised Code of
Civil Procedure section 473.Claims of mistake, inadvertence,
surprise, or excusable neglect under Code of Civil Procedure
section 473 cannot be used as a basis for avoiding dismissal.

June 17, 2013: Panel Decision:
Labor Code section 4620 defines "medical-legal expenses" as any
costs and expenses incurred by or on behalf of any party for X-
rays, laboratory fees, other diagnostic tests, medical reports,
medical records, medical testimony, and needed, interpreter's fees,
for the purpose of proving or disproving a contested claim. (Lab.
Code § 4620.)
June 25, 2013: Panel Decision:
“…lien claimant is not required to pay a lien activation fee prior to
a 2013 lien trial where: (1) the declaration of readiness (DOR) is
filed prior to January 1, 2013; (2) the lien conference takes place
prior to January 1, 2013; and (3) the lien trial takes place in 2013,
without any intervening 2013 lien conference."

June  25, 2013: Panel Decision:
Petitioner has not provided any specific examples of alleged error
by the WCJ and has failed to
cite to the record in any way whatsoever.
July 01, 2013: Panel Decision:
The [WCAB] shall not designate a party or lien claimant, or their
attorney or agent of record, to serve any final order, decision, or
award relating to a submitted disputed
issue."

July 01, 2013: Panel Decision:
(1) a claim for medical-legal expenses may not be filed as a petition
for costs under section 5811.

July 01, 2013: Panel Decision:
In her Report, the WCJ stated that lien claimant consistently argued
that the settlement agreement did not address the entire lien
July 17, 2013: Panel Decision:
The undersigned is perplexed as to why a member of the bar would
rely on a letter to which there was no response by the Workers
Compensation Appeals Board to assume or presume that no
appearance was required when Notice of Hearing was sent and
received.


July 16, 2013: Panel Decision:
Have to Love Judge Thompsons’ Humor in this decision: “So what
shall we do when faced with a “bogus” Declaration of Readiness”
(DOR)?

July 16, 2013: Penal Decision:
In order to obtain an order pursuant to section 4903.6LC must file a
petition specifying the  medical information to be provided and the
relevance of that information to the proof of the reasonableness
and necessity of the services that are the subject of LC's lien.

July 16, 2013: Panel Decision:
More important, his allegation of "technical difficulties" in paying
the lien activation fee, without reference to any specifics or
evidence to support the allegation, is the same thing as outright
misrepresentation.
July 18, 2013: Panel Decision:
The mailing of an item to a correct address creates a presumption
that that document was received. (Evid. Code see. 641.) However,
the presumption is rebuttable, and in my view was properly rebutted
by the timely objection to the second transmittal of the document,
supported by a sworn declaration of the mail clerk for Frontline's
representative, Controlled Health

July 17, 2013: Panel Decision:
The undersigned is perplexed as to why a member of the bar would
rely on a letter to which there was no response by the Workers
Compensation Appeals Board to assume or presume that no
appearance was required when Notice of Hearing was sent and
received.
July 23, 2013: Panel Decision:
Here, Lopez withdrew its lien prior to the date of the Martinez
decision, and there is no evidence that the lien has otherwise been
dismissed. Although Lopez's petition for costs must be dismissed, it
can  reinstate its lien and pay the lien activation fee prior to the
conference scheduled..."


July 22, 2013: Panel Decision:
Meanwhile, on January 1, 2013, section 4903.6(d) became
operative. That section provides: "With the exception of a lien for
services provided by a physician as defined in Section 3209.3, no
lien claimant shall be entitled to any medical information, as
defined in subdivision

July 22, 2013: Panel Decision:
In Figueroa, the Board stated that '(1) the lien activation fee must  
be paid prior to the commencement of a lien conference, which is
the time that the conference is scheduled to begin, not the time
when the case is actually called
July 30, 2013: Panel Decision:
Every petition for reconsideration "shall fairly state all of the
material evidence."

July 25, 2013: Panel Decision:
Defense Not Sanctioned for not verifying Petition for Recon and
for stating he did not understand the lien issues at Trial.
August 08, 2013: Panel Decision:
While I appreciate the special concerns arising from the huge
volume of lien litigation we are experiencing, I have also considered
that it seems quite unlikely that an applicant would have their case
dismissed or a defendant suffer a default judgment in a high-money
claim under similar circumstances.

August 05, 2013: Panel Decision:
But defendant's failure to conduct utilization review does not relieve
applicant of the evidentiary burden of showing, by a preponderance
of the evidence, that the requested medical treatment is reasonably
required to cure or relieve the effects of his injury.

August 02, 2013: Panel Decision:
The problem here is that there is no evidence that LCs received
notice of the lien conference on April 9, 2013. As the WCJ has
pointed out, LCs do not appear on the Official Address Record.
Panel Decision: In addition, we reject the petitioning lien
claimant's contention that because defendant failed to furnish
documents to lien claimant and failed to negotiate its lien,
petitioner is somehow excused from paying the lien activation fee
("LAF"). The contention fails because the LAF is prerequisite to
invoking the jurisdiction of the WCAB to raise allegations that
defendant failed to negotiate, etc.

Panel Decision:"lien conference was due to inadvertence
/miscalendaring, relief should be granted pursuant to L. C. Section
§5506 and/or CCP § 473. However, these code sections only apply
to default judgments being entered against a party for its failure to:
appear. In this case, a default judgment (Order of Dismissal)"

Panel Decision: However, our NIT was issued because lien
claimants filed a skeletal Petition for Reconsideration failing to
provide a statement of facts, to raise issues of contention, to make
arguments of law upon which reconsideration was sought, or to
identify the individual filing the Petition for Reconsideration.

Panel Decision:We note, however, that the order does not specify
that Greenway's lien was dismissed with prejudice. Because this case
concerns a filing fee and not an activation fee, upon return to the
trial level Greenway may re-file its lien, provided  that it does so
within three years from the date that services were provided and
contemporaneously pays the required lien filing fee. (Lab. Code, §
4903.5(a).)
Panel Decision:
Essentially, lien claimant contends that its failure to appear at the
April 15, 2013 lien conference was due to inadvertence because it
had miscalendared this matter.

Panel Decision: In addition, we reject the petitioning lien
claimant's contention that because defendant failed to furnish
documents to lien claimant and failed to negotiate its lien.*
Panel Decision: -17
However, procedural rules, such as the service of orders under Rule
10500, serve the convenience of the WCAB and they do not  
deprive it of the power to disregard violations where there is no
substantial prejudice to the parties."

Panel Decision:
In addition, we reject the petitioning lien claimant's contention that
because defendant failed to furnish documents to lien claimant and
failed to negotiate its lien, petitioner is somehow excused from
paying the lien activation fee ("LAF").

Panel Decision:
provides no evidence that it actually attempted to pay the fee, It
provides no evidence as to the exact problems encountered when it
allegedly tried to pay the lien activation fee. Further, lien claimant
has had ample opportunity to pay the fee since January 1, 2013.

August 29, 2013: Injunction for Dismissals 01/2014 that do not
show a lien fee dismissed by operation of law Scheduled Oct 24 2013;
What it means if rant and what it means if denied.
Panel Decision:
"due to human error" and that its lien representative was at the
Marina Del Ray District Office on the day of trial but failed to sign
in "for reason unknown." However, we find that the claim of
"human error ... for reason unknown" does not  rise to the level of
good cause." 21

Panel Decision:
Due process simply requires notice and an opportunity to be heard.
If a party does not take advantage of that opportunity, then it
waives its right to be heard.
Panel Decision:
From Recent Panel Decision: Because lien claimant did not have a
lien in ADJ7541189, the order dismissing a (nonexistent) lien has
no effect and lien claimant is not aggrieved by the WCJ's Order

Panel Decision:
Petition falls within Appeals Board Rule 10561, subdivisions (b)(2),
(b)(5), and (b)(6) because it was filed without justification, appears
to contain multiple material misrepresentations, and takes positions
that are indisputably without merit. -25
Panel Decision:
It is clear under [section 4903.8(e),  that if the lien is filed after
January 1, 2013 and violates this section it is invalid.
Panel Decision:
Finally, we admonish petitioner that his failure to adhere to the
form requirements of petitions for reconsideration is conduct that is
unacceptable. With respect to the form of the Petition,
Panel Decision:
If Dismissed by Operation of Law cannot be with prejudice:

Panel Decision:
No Letter of Rep -Petition  for Recon Dismissed as filed by a
NON-Party

Case Law, The Case That Changed Everything for Providers at
the WCAB, must be read and Known
Panel Decision:
Communications with AMEs are governed by Labor Code section
4062.3 and WCAB Rule 35. "If an agreed medical evaluator is
selected.., the parties shall agree on what information is to be
provided to the agreed medical evaluator." "All communications
with an agreed medical evaluator... shall be in writing and shall be
served on the opposing party 20 days in advance of the evaluation.

Panel Decision:
lien claimant never mentions the issue of whether lien claimant
met its burden to show that its medical services were medically
reasonable and necessary

Panel Decision:
The WCJ further found that applicant did not receive notice of
defendant's Medical
Provider Network [MPN] prior to her injury and that a letter sent
to applicant on May 4, 2010 did not comply with MPN notice
requirements.

Panel Decision:
Petition for Costs Medical Legal
Panel Decision:
sanctionable conduct includes "using any language in any pleading or
other document [.. .] where the language or gesture impugns the
integrity of the Workers' Compensation Appeals Board or its
Commissioners,
judges, or staff.

Panel Decision:
Petitioner argues that due to an EAMS scheduled maintenance
Petitioner was unable,to pay the activation fee. Although Petitioner
states their inability to pay the activation fee due to regularly
scheduled maintenance, Petitioner offers no offer of proof of this
in the Petition.
Panel Decision:
Finally, it is noted that the record contains no requests for
authorization regarding the treatment at issue. In order to meet its
burden of proof, Lien Claimant must show that authorization for
the treatment was properly requested.

Panel Decision:
Reconsideration may be had only of a final order, decision, or
award. (Lab. Code, § 5900.)
NELAYNE VALDEZSUPREME COURT OF CALIFORNIA  -
MON Admissible of Reports outside MPN

: Panel Decision:
Between the Petition and the July 30, 2012 lien conference, we
have three purported lien representatives for a single lien claimant.
The record in this matter lacks the appropriate notice appointing
Panel Decision:
Failure of PTP to incorporate does not mean the secondary /
consultant does not get paid
: Panel Decision
Dr. Massey had not yet adopted Dr. Newman's findings does not
mean the latter physician's reports were not reasonable and
necessary at the time the expenses for the reports were incurred
Panel Decision:
As all of the requirements have been met, it is appropriate for Dr.
Newman to bill for his evaluation and reports as a medical-legal
expense, rather than services payable pursuant to the OMFS. Here,
Dr. Newman was designated by the primary treating physician -
Educational Materials
April 28, 2014: Lecture Outline:
2014 Collections Disputes Outline

April 27, 2014: Lecture:
2014 Collections Dispute Update

April 07, 2014: Education:
Highlighted Sections of WCAB Policy and Procedures \

April 02, 2014: Education / Information:
2014 Physical Therapy Ground Rules:

April 01, 2014: Article / Education:
Clarifying Second Bill Review (SBR) and Independent Bill Review (IBR)

March 23, 2014: Education 28 Minute Recorded Lecture on 2014
Collections

March 18, 2014; Education:
Diagram  Events that change the status of a collection dispute file.

March 17, 2014: Education:
Flowchart -Collections to WCAB

March 13, 2014: Education 2014 Flowchart Collection Procedures

March 06, 2014: Education:
Diagram e Permitted  to file a lien for WCAB hearing and when not
January 17, 2014: Education:
25 Procedures for Collection Dispute Files from Birth to Death

January 13, 2014: Education:
Summary of New Fee Schedule

January 09, 2014: Education:
Corrected Diagram under SB 863 Denied Liability
January 07, 2014: Education:
Flowchart When Receiving 0 payment under SB 863:

December 27, 2013 Recorded Lecture RB-RVS Fee Schedule for
Physician Services
Part One

December 16, 2013: Educational Book
2019 Page Book on  Case and Statutory Laws Citations

October 11, 2013: Education:
Time Sheets IBR

October 02, 2013: Education:
New Diagram with Recently Adopted Rules IBR and IMR Process

October 01, 2013: Education:
9 pages on Authorization, UR and IMR with New and Proposed Rules /
Regulations

September 30, 2013: Diagram:
Medical Legal Under Newly Adopted Rules / Regulations
Mid May 2014
Collections
Newsletter
June 2014
Collections
Newsletter
July 2014
Collections
Newsletter
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Important Posted IMR
Decisions
Past Articles:
Case Law Regarding Lien Issue
Important Posted IBR
Decisions
Mid July 2014
Collections
Newsletter
August  2014
Collections
Newsletter
July 25, 2014: Significant Panel Decision Posted; July 24, 2014:

Where the defendant had unilaterally terminated nurse case manager services to
the injured worker, the Appeals Board affirmed the WCJ’s award reinstating
those services, holding as follows:
1.The provision of a nurse case manager is a form of medical treatment ..."

2.An employer may not unilaterally cease to provide approved nurse case
manager services when there is no evidence ..."
3.Use of an expedited hearing ..."

4.It is not necessary for an injured worker to obtain a Request For
Authorization ..."

July 11, 2014: Panel Decision:

WCAB / Indicated That a Trial Judge May Have Jumped the Gun in Pre-
Judging an MPN Issue and Sanctions Against Lien Claimant


June 24, 2014: Panel Decision:
Appeals Board Held Judge uses wrong burden of proof not AOE/COE but
Medical Legal --- Pursuant to Labor Code section 4620, the definition of a
"medical-legal expense" expressly includes "medical records" ..."


June 13, 2014: New En Banc Decision

Recent June 2012 En Banc Decision Posted:
With regard to the SB 863 additions and amendments to the Labor Code
regarding home health care services, which became effective January 1, 2013,
the Appeals Board held

June 07, 2014: Panel Decision on Liens:
Panel decision; from 2011; the law changed twice the issue and or questions
what effect this case has on cases resolved prior to 2012 and those when the
law changed again prior to October 2013.
"We disagree. The fact that the lien was not "filed" with the WCAB does not  
mean the lien was extinguished or that the WCAB lost jurisdiction over it by
virtue of section 4903.5(a). AMG's lien was already in existence and WCAB
jurisdiction was preserved by virtue of the notices it gave to defendant
between  October 2001 and April 2003.



May 29, 2014: Panel Decision:
Huntington's contention that BCC did not follow the terms of their contract in
accordance with section 4906 does not change the fact that the WCAB is
without jurisdiction because there is an express agreement fixing the amounts
to be paid. A different forum must be used by Huntington to adjudicate its
breach of contract claims.

May 23, 2014: New WCAB En Banc:
New En Banc: WCAB Posts New En Banc Decision on prior en banc
decision regarding defective UR for failure to review all medical reports  Since
SCIF was newly aggrieved party by the prior en banc it has a right to request
a reconsideration, letting the appeals board look at it again


May 14, 2014: Case Law Watch:
WCAB Overrules Sanctions Orders for Lien Claimants:




May 09, 2014: Panel Decision:
Thus, because injury AOE/COE is a threshold issue upon which
compensability depends (Lab. Code, § 3600(a)(2)) and because Southland did
not establish it by a preponderance of evidence, we need not proceed to the
issue  of whether applicant's claim was barred as a post-termination claim
under subsequent subsection  3600(a)(10).

May 06, 2014: Panel Decision:
Invalid UR, did not review MRI finding.
West Virginia Workers'
Individual States Work Comp Collections
Guidebooks
DME Providers
Medical Testing
Primary Treators
Chiropractic
Physical Therapists
IBR Decisions By billing Code: Why Some are Being Paid High for the Same
Services and Others being Paid Nothing. - All About The Ground Rules.

Some providers were paid nothing because of lack of documentation and
ground rule reasons. Others were paid high for the same services - majority
of decisions had little to do with numbers -- see book at end of list


88305        Pathology Services

00300 QZ 6        Anesthesia services

99214        Evaluation and Management

ASC Facility Fees        Surgical Facility


00300 QZ (6 units)        Anesthesia Services
0060 QZ (9)        Anesthesia Services / Requested PPO non-supplied
0060 QZ (9)        Anesthesia Services / Requested PPO non-supplied
00630        Anesthesia Services
00630 modifier QZ (9 units)        Anesthesia services
00630 QZ        Anesthesia Services
00750; 94760        Anesthesia Services
11100        Surgical Facility Services
11100 / 11101        Surgical Facility Services
11100 59        Surgical Procedure
11101 59 / 17002        Surgical / PPO contract is Incomplete so applied fee
schedule
12001        Surgical Procedure
12001        Surgical Procedure
15740 / 17311 / 17106 / 11100 / 11101        Surgical Center
17002        Cryosurgery Procedure
17002        Surgical Procedure
17002        Surgical Procedure
17002 (11)        Surgical Procedure
17002 (16)        Cryosurgery
17002 (25)        Surgery Destruction of Lesion
17034 / 17107        Surgical Procedure
17034 / 17999        Surgical Procedures
17106 (17999) / 11100 / 11101        Surgical Facility Services
17304 / 1799 /        Surgical Procedures
17304 / 17999        Surgical Procedures
17304 / 17999        Surgical Procedures
17304 / 17999 59        Surgical Procedure
17304 / 17999 59 / 11100 59 / 11101 59 /        Surgical Procedures
17304 and 17999 Modifier 59        Surgical Procedures
17304; 17304 modifier 59; 17999 modifier 59; 17999 modifier 59        
Surgical Procedures
17304; 17999        Surgical procedures
17304; 17999        Surgical procedures
17304; 17999 59        Surgical Procedures
17311; 17999 modifier 59        Surgical Procedures
17999        Surgical Procedure
17999        Unlisted Procedure Code / Not enough documentation
17999 (1)        Surgical Procedures Unlisted
17999 (59) / 17000 (59) / 17001 (59) / 17002 (59) / 111000 959) / 11101
(59)        Surgical Procedures
17999 / 17999 / 17999/ 17999/ 17999        Unlisted Procedure Codes
17999 / 99080 / 99085 / 99086        Chart Reproduction / Photos / Report /
Surgical Procedure
17999 59        Surgical Procedure
17999; 99080; and 99085        Photo services; surgical procedures
17999; 99080; J3301        Surgical procedures
17999; J3301; 11901; 99080        Surgical Procedures
18860072210        Pharmaceutical Supplies
20550 Modifier 51        Surgical Procedure
20550 modifier 51        Surgical Procedure
20680 / 20680 / 20680 / 29125        Surgical Facility Services / Bundles no
FS
22110 /22110 59 / 22116 / 22116 59 / 76001 / 64830         Multiple
Surgical Procedures / Services were denied by claims stating report did not
indicate services performed – IBR awarded FS
22554; 22851; 22851 59 – ASC Services        Surgical Facility Services
22830; 22855; 63090; 63091; 63047        Spinal surgery: two stages and co-
surgeon involved
24102; 25290; 24341         Surgical Facility Services
24314        Surgical Facility Services
24314; 25290        Surgical Facility
24341 / 64718        Surgical Facility Services
25000 Modifier 51        Multiple Surgical Procedures
26145 x 9 units  no payments        Surgical Center / no payments on initial
review IBR ordered Fee schedule of $5,940.68
26145; 26055        Surgical Facility Services
26370; 26373; 26373; 20103        Surgical Facility Services
274 Revenue Code        Upper limb orthosis (L3999)
27422; 29870; 29881; 29875        Surgical Facility Services
27570 / 29870        Surgical Procedures
27570 / 29870 / 20610        Surgical Procedures
27625; 29898; 20605        Surgical Facility Services
27685        Surgical Procedure
27685 Modifier 51        Multiple Surgical Procedures
29805;29821;29807;29826;29827;29819;29999        Surgical Facility
Services
29819 / 29820        Device  for surgical procedure
29823        Surgical Procedure / Paid Prior to IBR Determination
29823        Surgical Procedure
29823 Modifier RT          Surgical Procedure
29823; 29826; 29827; 23120; 20690; 29805;        Surgical Facility Services
29824        Surgical Facility Services
29825 (51)        Surgical device for outpatient surgery
29846 / 64721        Outpatient Hospital Services
29876 / 29870 / 27570         Surgical Facility Services
29880 / 29877 / 29874 / 29875 / 20610        Surgical procedures
29880;29870;29871;29875        Surgical Facility Services
29881 / 29875        Surgical Facility
29881 / 29875        Surgical facility Services
29881 / 29875 (59)         Surgical Procedures
29881 / 29876        Surgical Facility Services
29888        Surgical Facility Services
37720 / 76942 / 93971        Laser Procedure and unlisted
37785 / 76942 / 93971        Laser procedures
37799 (37720; 76949 26 and 93971 26)        Surgical Procedures
37799 (37785, 76942 26 and 93971        Surgical Procedures
37799 and  99080        37799 laser procedure  / 99080 by report
38779056104        Pharmaceutical Supplies
38779056104 / 38779175603        Pharmaceutical Supplies
38779056104 /38779175603        Pharmaceutical Supplies
45861000405 NDC        Medrox Patches
49452003202 / 38779052409  / 62991142202        Compound Drug
Product
49452003202 / 38779052409 /  / 62991142202        Compound Drug
Product
49452003202 / 38779052409 /  / 62991142202        Compound Drug
Product
58468009001        Pharmaceutical
58468-0090-01        Pharmaceutical Supplies
58468-0090-01        Pharmaceutical supplies
58468009003 (NDC) 12 units        Pharmaceutical Supplies
62991140305        Pharmaceutical Supplies
62991140307        Pharmaceutical Supplies
62991140307        Pharmaceutical Supplies
62991140706 / 38779056104        Pharmaceutical Supplies
62991140706 / 38799056104        Pharmaceutical Supplies
62991140706 /38779196806        Pharmaceutical Supplies
6299114305        Compound Medication
63047 / 63048 / 63048 59        Surgical Facility
63091 62        Surgical Procedural two/co-surgeon
63660 / 63660 59        Removal of spinal Cord Stimulator Test Leads
63685 / 76496 TC        Surgical facility / Corrected Billing Code
63685 and 76496        Surgical Facility         / PPO discount applied
64483 / 72100 / 76000 / 94760        Surgical Facility services
64483 LT 1 unit and 64484 LT 1 unit         Surgical Facility Services
(injections)
64484 / 64483        Surgical Facility
64484 rt / 64484 lt        Outpatient Surgical Facility
64555 59        Surgical Facility
64719 51        Surgical Facility
64722 (59)        Surgical Facility
64830 20 / 72100 / 72148 26        Surgical Procedural
64999 (63047)        Unlisted Procedure Nervous System
80102 and 82486        Laboratory Services
82055 / 80299 59 / 80299 59 / 83925 59 / 83986 / 83992 / 81002 / and
80152        Laboratory Services
82055; 82145; 82205; 80299 (2); 82520; 83840; 83925 (3); 83986;
83986; 83992; 81002 and 80152        Laboratory  Services
82145 / 82205 / 80154 / 82520 / 83992 / 83925 / 82145 / 82055 /
82570        Laboratory Services
82145(2); 82205; 80154; 82520; 83840; 83840; 83992; 83925 (2)        
Laboratory Results
82145/ 82205/ 82520 / 83840 / 83992 / 83925 / 82145 / 82055 /
82570        Toxicology
82145; 82205; 80154; 82520; 83840; 83840; 83992; 83925; 83925 mod
59; 8214559; 82055 and 82570        Laboratory Services
82145; 82205; 80154; 83480; 83992; 83925 modifier 59; 82542 and
82145 modifier 59        Laboratory testing
82415; 82205; 80154; 82520; 83840; 83992; 83925; 82145        
Laboratory Results
82415; 82205; 80154; 82520; 83840; 83992; 83925; 82145        
Laboratory Results
82415; 82205; 80154; 82520; 83840; 83992; 83925; 82145        
Laboratory Results
82486        Laboratory Services
82486        Laboratory services  
82486        Laboratory
82486        Laboratory services
82486        Laboratory services
82486        Laboratory services
82486        Laboratory services
82486        Laboratory services
82486        Laboratory services
82486        Laboratory services
82486        Lab – Interesting case the insurance paid $476.48 and IBR
stating should have been paid $119.94 -
82486        Laboratory Results
82486        Laboratory Results
82486        Lab – Interesting case the insurance paid $1,264.88 and IBR
stating should have been paid $119.94 -
82486         Laboratory Results
82486         Laboratory Results
82486        Laboratory services
82486        Laboratory services
82486 (40 units)        Laboratory Results
88305        Pathology services
88305        Pathology services
90862 / 99081        Medication Management Services
93320 / 93325        Echocardiography services
93320 / 93325        Echocardiography services
93320 / 93325        Echocardiography Services
93320 / 93325        Echocardiography Services
93320 / 93325         Echocardiography Services
93320 and 93325          Echocarpidraphy services
93320; 93325        Echocardiogarphy Services
93320; 93325        Echocardiogarphy Services
95904        Nerve conduction Studies
95904 (52)        Nerve Conduction Study
96100        Psychological Testing / ML
96360 and 99284        Emergency Department Services billed by an
Outpatient Hospital Facility
96530 modifier 59        Refilling and maintenance of implantable pump
services
97799        Unlisted Physical Medicine Service
97799        Unlisted Physical Medicine Service
97799 Modifier 86        Unlisted Physical  Medicine (functional restoration  
program)
97799 modifier 86        Unlisted physical medicine  -- functional
restoration program psychological
97799 modifier 86        Unlisted procedure code – the IBR should have been
appealed in this case clear error in amount to reimburse
97799 Modifier 86        Unlisted Physical  Medicine (functional restoration  
program)
97799 Modifier 86        Unlisted Physical  Medicine (functional restoration  
program)
97799 modifier 86        Unlisted physical medicine  -- functional
restoration program psychological
97799 Modifier 86        Unlisted Physical  Medicine (functional restoration  
program)
97799 Modifier 86        Unlisted Physical  Medicine (functional restoration  
program)
97799 Modifier 86        Unlisted Physical  Medicine (functional restoration  
program)
97799 Modifier 86        Unlisted Physical  Medicine (functional restoration  
program)
97799 Modifier 86        Unlisted Physical  Medicine (functional restoration  
program)
97799 Modifier 86        Unlisted Physical  Medicine (functional restoration  
program)
97799 modifier 86 (exceeds FS)        Unlisted physical medicine –
functional restoration program 10 days
97799 modifier 86 (exceeds FS)        Unlisted physical medicine –
functional restoration  program
97799 modifier 86 (exceeds FS)        Unlisted physical medicine –
functional restoration  program
97799 modifier 86 (exceeds FS)        Unlisted physical medicine –
functional restoration  program
97799 modifier 86 (exceeds FS)        Unlisted physical medicine –
functional restoration  program
97799 modifier 86 (exceeds FS)        Unlisted physical medicine –
functional restoration  program
99080        Consultation Report
99080        Review of Records: Initial Comprehensive Dermatologic
Evaluation Report
99080        Special Reports
99080        Initial Comprehensive Preoperative  Consultation Report
99080 86 / 99358        Prolonged Services
99081        PTP Progress Report
99081        PR-2
99085 / 99080 / 99358        Prolonged Services
99086 / 99085 / 99080 / 17999        Prolonged Services
99203 / 99080        Office Consultation
99203 / 99354 / 99358 / 99080         Prolonged Evolution and Management
99203 / 99354 / 99358 / 99080        Evaluation & Management
99205 / 99354 / 99358        Evaluation and Management
99213        Office Visit
99213        Evaluation and Management
99213 / 99081        Evaluation and Management
99213 / 99081        Evaluation and Management
99214         Visit Falls within Surgery follow-up
99214        Office Visit
99214        Office Visit
99214        Office or Outpatient Visit
99214        Office Visit
99214        Office Visit
99214        Evaluation and Management
99214        Evaluation and Management
99214        Evaluation & Management
99215        Evaluation & Management
99215        Visit Falls within Surgery follow-up
99215        Office or Outpatient Visit
99215 / 99215  (25)        Office or Outpatient Visit
9924 / 99080 / 95832 / 95832        Evaluation and Management
99244        Office consultation
99244 / 99080 / 99358        Office consultation / Prolonged services and
Report
99244 / 99080 / 99358        Office Consultation
99245 / 99080        Consultation / Report Psychiatric
99245; 99080; 99358; 99354        Office consultation / reports and etc.
99245; 99358; 72114; 72220        Physician services
99354        Prolonged Office Visit
99354        Prolonged Services  / Medical Report Does not Support Services
99354 (1) / 99358 (12) / 99080 (2)        Prolonged Services Evaluation and
Management
99354 / 99358        Evaluation & Management
99358        Prolonged Evaluation
99358        Prolonged Evaluation & Management
99358        Evaluation and management
99358 (1 unit)        Evaluation and Management
99358 / 99080        Prolonged Management
99358; 99080        Evaluation and Management / Special Report
99373        Evaluation & Management  (phone call)
99373 / 99081        Phone Call and Required Report
ASC Facility Services        Outpatient Surgery
ASC Facility Services (25115)        Outpatient Surgery
ASC Service        Surgical Center
ASC Service        Surgical Center
ASC Service        Surgical Center
ASC Services        Surgical Facility Services
ASC Surgical Services / and 81025        Surgical Facility Services
Compound Medication / Prialt 18860072010        Compound Medication
Compound Medication / Prialt 18860072010        Compound Medication
Consolidation DME        DME E0214 Sample of Consolidation
DRG 454        Seeking additional for cost of implants
DRG 455        No additional Allowance for Implants
DRG 455        Seeking additional for cost of implants
DRG 455        Inpatient Hospital services / requesting addition for supplies
DRG 459        Seeking additional payments for implants not separately
reimbursable
DRG 460        Seeking additional for cost of implants
DRG 460        Provider requesting cost of implants
Provider Requesting = $246,248.16
DRG 460        Provider requesting cost of implants

DRG 460        Seeking implants as separately reimbursable / no
DRG 460 – spinal implants        Impatient Services requesting additional
funds for spinal implants
DRG 460 Revenue Code 274 (L0464 / L2830)        Device with inpatient
services
DRG 473        Seeking Implants as separately reimbursed / denied
DRG 473         In Patient Hospital Seeking implants – not separately  
reimbursement
DRG 473        Seeking additional for cost of implants
DRG 473        Provider requesting cost of implants

DRG 491        Reduced by PPO contact PPO contract not received when
request by IBR amount of discount ordered.
DRG 494        Inpatient Hospital Services
E1399        Durable Medical Equipment
E1399  LL (3 units)         Durable Medical Equipment
E1399 (LL) (6)        Durable Medical Equipment
E1399 LL (7 units)        Durable Medical Equipment
E1399 modifier LL        Durable Medical Equipment
E1399 modifier LL (3 units)        Durable medical equipment
E1399 Modifier LL 1 unit        Durable Medical Equipment
G0260 Modifier 50        Surgical Facility Procedure
G0431        Laboratory Services
G0431        Laboratory Services / claims adjuster denied a duplicative billing
/ decision for provider
G0431        Laboratory
G0431        Toxicology
G0431 / 82055 / 82570        Laboratory Services
G0431 / 82570 / 82055        Toxicology
L0635        Orthotic Device part of DGR 455
L1990 / and Outlier for Outpatient         Outpatient Hospital Surgical
Services
L4360 / and Outlier for Outpatient         Outpatient Hospital Surgical
Services
L86999 / C9399         Surgical Facility
ML 104 (46) / 96100        Medical Legal Services
ML 104 (90801 and 99358 8 units        Medical Legal services
ML 104 93 units        Medical Legal Services
ML 104 94        Medical Legal Services
ML 104 Modifier 94 (62 units)        ML Extraordinary  (Psychiatric  Eval)
ML 104 modifier 94 and 95        ML PPO / MPN discount mot allowed
ML 104 Modifier 95 (23) units        For Provider Medical legal services
ML 106 Mod 94 / ML 100 Mod 94        Medical Legal services Reports no
complete to warrant
ML=103 reduced to ML 101        Medical Legal Services
ML=104 95 (20)        Medical Legal  Services
ML0104 94 / 99070        Medical Legal and Supplies
ML104 Modifies 95        Reviewed as a ML 103 Modifier 95 (1 unit)
Outpatient Hospital Emergency Room Services        Payment based on PPO
Outpatient Surgical Services        Outpatient Services Facility
Revenue Code 278 HCPCS C1713        Surgical Facility
Over 300 indexed IBR (Independent Bill Reviewer) Decisions by
billing code and services provided Complete Decisions, can submit
with IBR request or with second bill review request, lets you know
if you will win before submitting for an IBR request, can even
submit as evidence at WCAB. The best way to win is know ahead
of time how they will decide.
Response to NOI Dismissal
Response to NOI sanctions
Points and authorities for trial
Petitions for Reconsideration
Response to Petition for
Reconsideration
Petition to Enforce IBR
Petition for IBR Ineligibility
Requirement
Petition to Appeal IBR Decision

Petition for Medical Information
by a Non-Physician Lien Claimant

Petition for a Non-IBR Medical
Legal Dispute
Lien Filing Issues
Denied Cases and
Contested Liability Issues /
Also Post Termination
2nd Review  Process
2015 8 Week Treatment and Collection Disputes Course
from RFA to Petitions for Reconsideration. Addressing all 3 Forums (IMR, IBR,
WCAB)
The Course consists of eight (8) weeks -- twenty four  (24) lessons --  
Total Course $325.00 INDIVIDUAL  OR ENTIRE OFFICE
Every lesson with lectures and books will be sent on a USB Flash Drive in order to
offer the course at this price  
See How The Course Works: