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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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Issues of Causation / Contested Liability  Issues / Procedural Issues / Pleadings / General Law and Information
All States Work Comp News, Issues, Articles Daily
Medical Legal Providers and Procedures /
Medical Legal Services
Hospitals. Burn Centers, Trauma Centers  Long
Term, Outpatient / PPO
MPNs (Medical Provider Networks)
Interpreter Services and Issues / Procedures
Denied Cases / Contested Liability Issues
Outpatient Surgery Centers
Sanction Issues at WCAB
Psychiatric  Treatment / Medical Legal / Pain
Management
Medication / Compound / Physician Dispensed /
Pharmacy
Copy Services / Medical Legal
Toxicology / Urine Drug Screening
DME (Durable Medical Equipments)
Medical Testing Services
MD, PTP, Treatment - Chiropractic / Physical
Therapy / Acupuncture
General Billing Issues / Medical Necessity  Issues
January 15, 2015: Pleading: Sample: "Petition
for Non-IBR- Medical Legal" for Interpreters
January 15, 2015: Medical Legal: Case When
are service medical legal and when are they
treatment even when requested by a PTP,  when
does not do or bill for a medical legal
January 15, 2015: Pleading: Sample: "Petition for
Non-IBR- Medical Legal" for Interpreters
January 15, 2015 Medical Legal:  Lien : did not
show that its diagnostic services were "capable of  
proving or disproving a disputed medical fact."
January 15, 2015: Sanctions: Outline 65 pages

January 15, 2015: Research Paper:
WCAB: Avoiding Sanctions at The WCAB,
Simple Acts Changes Everything
Surgeries Professional Component
January 16, 2015: Research Paper:
WC Billing, E&M, RFA, Medical Legal ,
Record Review, Providers Missing the Point!
January 16, 2015: Research Paper:
WC Billing, E&M, RFA, Medical Legal ,
Record Review, Providers Missing the Point!
Lien Issues
Medical Necessity Issues
Home Health Care
Sample Pleadings / Petitions / Response Etc.,
anuary 15, 2015: Liens: 45 Page outline
regarding lien issues
October 13, 2014: Panel Decision: Home Health
Care:
The first condition  requires that home health
care services be prescribed by a physician, and
an employer may become liable for home health
care services provided 14 days prior to receipt of
a prescription. The second condition requires
that an employer's liability for home health care
services is 2 subject to either section 5307.1 or
section 5307.8."
September 22, 2014: See why providers are
trying to put physical therapists out of the
work comp business The worst offenders of
Sloppy RFAs (so bad that they have to be
purposeful)  that have 10's of thousands of IMRs
upholding UR denials are requests for physical
therapy, acupuncture and chiropractor visits, and
it is not that the treatment is not needed,
January 20, 2015, WCAB States can enforce
settlement agreements outside of lien however the
agreements in this case were not drafted properly:
January 20, 2015, WCAB States can enforce
settlement agreements outside of lien however the
agreements in this case were not drafted properly:
January 21, 2015: Panel_Denied_ Post
Termination -Employer Should have Known of
Injury before Termination
January 22, 2015: Panel:  found that defendant
had failed to  prove the existence of a valid
Medical Provider Network (MPN). ---. also failed
to provide the proper access standards of
chiropractic primary treating physicians as required
January 30, 2015: WCAB Awards an Additional
$98,383.57 Above Fee Schedule.
January 30, 2015: Panel Decision: WCJ with
WCAB Upholding an award of $98,388.57 above
the fee schedule.
Todays Posted Information
January 30, 2015: WCAB Awards an Additional
$98,383.57 Above Fee Schedule.
January 30, 2015: Panel Decision: WCJ with
WCAB Upholding an award of $98,388.57 above
the fee schedule.
Feb -2015 Collections
Newsletter
Jan -2015 Collections
Newsletter
Oct 2015 Collections
Newsletter
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 :Georgia Workers’ Compensation
Medical Fee Schedule Pharmaceuticals
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 04, 2015: Mississippi ◾2015 DRG Relative
Weights
February   02, 2015 Alabama News: Out-of-State Medical
Providers
February 02, 2015: Arizona: What is subject to fee schedule
and what is subject to usual and customary fees
February 02, 2015: Arkansas Case Law: Issue:
barred unless filed within one year from the date of the last
payment of compensation or two years from the date of the
injury, whichever is greater
February  02, 2015: Colorado:
Industrial Claim Appeals Office
Table of Cases
February  02, 2015 Case Law: CONNECTICUT "... must
stand unless they are without evidence, contrary to law or
based on unreasonable or impermissible factual inferences.”
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
February 24, 2015: UR/Authroization UR
Denial Overturned: 1 Evaluation with Pain
Psychologist
February 24, 2015: Educational chart  
Authorization / Payments / Facility /
Physician Carpal tunnel release
February 24, 2015: Educational chart  
Authorization / Payments / Facility /
Physician Carpal tunnel release
WC No Lien, No IBR Fee, Getting Paid and Getting
Treatment Authorized -- Video Below as Method Below
March  04, 2015 WC: PPO Contracts- Some Providers Using
Them to Their Benefit.
8 WEEK 24 LESSON COURSE  IN WORK COMP TREATMENT AND
COLLECTIONS for $325.00 (INDIVIDUAL OR ENTIRE STAFF)
March  5, 2015: Medical Necessity
ANTERIOR L5 -S1 LUMBAR FUSION W/
INSTRUMENTATION, USE AUTOGRAFT
AND/OR ALLOGRAFT:
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
March 10, 2015: Authorization Issues: URINE DRUG
SCREEN :Overturned
March 10, 2015: Authorization Issues: 1 DEBRIDEMENT
OF THE RIGHT SHOULDER AND BICEP TENODESIS
March 10, 2015: Authorization Issues: 14 ADDITIONAL
DAYS AT THE SKILLED NURSING FACILITY
March 17, 2015: How to Get ACUPUNCTURE  
Authorized
March 17, 2015: How to Get BIOFEEDBACK
Authorized
March 17, 2015: How to Get: AQUA THERAPY
Authorized  
March 17, 2015: How to Get BLOOD PRESSURE
CUFF Authorized
March 17, 2015: How to Get BONE
STIMULATOR   Authorized
March 17, 2015: How to Get CARDIAC
CLEARANCE  
   Authorized
March 17, 2015: How to Get CARDIOLOGY
CONSULT     
   Authorized
March 17, 2015: How to Get CHIROPRACTIC    
Services   Authorized
March 17, 2015: How to Get COGNITIVE
BEHAVIOR THERAPY   Authorized
March 17, 2015: How to Get
  • EKG    
  • ELECTROENCEPHALOGRAPHY (EEG)
  • ELECTROMYOGRAM  EMG
  • (ELECTROMYOGRAPHY) EMG/NCS   
March 17, 2015: How to Get FUNCTIONAL
RESTORATION PROGRAM: INITIAL EVALUATION
Authorized
March 17, 2015: How to Get  Extracorporeal Shock
Wave Treatment  / Shock Wave Therapy   Authorized
March 17, 2015: How to Get  Medications / compounds /
Etc.   Authorized
March 17, 2015: How to Get  Urine drug Screen.   
Authorized
March 17, 2015: How to Get . PSYCHOTHERAPY  
Authorized
March 17, 2015: How to Get .  PSYCHE TREATMENT
Authorized
March 17, 2015: How to Get PHYSICAL THERAPY.   
Authorized
March 17, 2015: How to Get .PAIN MANAGEMENT    
Authorized
March 17, 2015: How to Get .OCCUPATIONAL
THERAPY   Authorized
March 17, 2015: How to Get  OCCUPATIONAL
THERAPY   Authorized
Getting Treatment Authorized: Guidelines / Common errors element What Must Be shown  In Medical Reports -As Required BY The IMRs to
Get Services Treatment Authorized
ACUPUNCTURE = Guidelines = Elements Required in Documentation =Common Errors= Authorized
AQUA THERAPY = Guidelines = Elements Required in Documentation =Common Errors= Authorized
AQUATIC THERAPY     = Guidelines = Elements Required in Documentation =Common Errors= Authorized
BIOFEEDBACK   = Guidelines = Elements Required in Documentation =Common Errors= Authorized
BLOOD PRESSURE CUFF = Guidelines = Elements Required in Documentation =Common Errors= Authorized
BONE STIMULATOR    = 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
CHIROPRACTIC SESSIONS= Guidelines = Elements Required in Documentation =Common Errors=
Authorized
COGNITIVE BEHAVIOR THERAPY    = 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
DME        ONE (1) MONTH OF RENTAL OF AN H-WAVE UNIT= Guidelines = Elements Required in
Documentation =Common Errors= Authorized
DME TENS        THE REQUEST FOR TENS UNIT PURCHASE: = 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   = Guidelines = Elements Required in Documentation =Common Errors= Authorized
EMG/NCS   = Guidelines = Elements Required in Documentation =Common Errors= Authorized
EVALUATION FOR FUNCTIONAL RESTORATION     = Guidelines = Elements Required in Documentation
=Common Errors= Authorized
FUNCTIONAL RESTORATION PROGRAM = Guidelines = Elements Required in Documentation =Common
Errors= Authorized
EXTRACORPOREAL SHOCK WAVE TREATMENT = 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
MRI        MAGNETIC RESONANCE IMAGING (MRI)= Guidelines = Elements Required in Documentation
=Common Errors= Authorized
NCS (NERVE CONDUCTION STUDY) = 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
PHYSICAL THERAPY   = 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
CARPAL TUNNEL RELEASE = Guidelines = Elements Required in Documentation =Common Errors= Authorized
LUMBAR SPINE POSTERIOR INTERBODY FUSION = Guidelines = Elements Required in Documentation =Common Errors= Authorized
DEBRIDEMENT OF THE RIGHT SHOULDER = Guidelines = Elements Required in Documentation =Common Errors= Authorized
KNEE ARTHROSCOPY C = 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
EPIDURAL STEROID INJECTION = 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
URINE DRUG SCREEN    = Guidelines = Elements Required in Documentation =Common Errors= Authorized
WORK HARDENING VISITS = Guidelines = Elements Required in Documentation =Common Errors= Authorized
AMBIEN
ANAPROX
ATIVAN
CAPSAICIN 0.025%, FLURBIPROFEN 20%, TRAMADOL 10%,
MENTHOL 2%, CAMPHOR 2%
CARAFATE #
CARISOPRODOL
CELEBREX
CLONAZEPAM
COLACE
COMPOUND CREAM
COMPOUND GABAPENTIN POWDER
CYCLOBENZAPRINE
CYMBALTA
DENDRACIN
DIAZEPAM (VALIUM)
DICLOFENAC
SODIUM GEL
DICOPANOL (DIPHENHYDRAMINE)
DICYCLOMINE HCL 2
DILAUDID
DUEXIS
EFFEXOR
FENTANYL
FEXMID
FLECTOR
FLEXIRIL
FLURBIPROFEN CREAM,
FLURIFLEX (FLURBIPROFEN/CYCLOBENZAPRINE 15/10 %) CREAM 1
GABAPENTIN
HYDROCODONE
IBUPR
KETOPROFEN
KLONOPIN
LIDOCAINE PAD
LIDODERM PATCH
LINZESS
LORTAB ELIXIR
LYRICA
MELOXICAM (MOBIC)
MENTHODERM
METHADONE
METHODERM OINTMENT
MORPHINE SULFATE
MS CONTIN
NABUMETONE
NAPROXEN
NOCTURNAL OBSTRUCTIVE AIRWAY ORAL APPLIANCE / DECAY OR FRACTURED TEETH
NORCO
NUCYNTA
OMEPRAZOLE
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: The denial of CPT 25929 26, 63048 59, 63048 59 and 20936.
It was noted additional codes were listed on the IBR application, however the codes
22612, 22630, 22214, 63047, 22842, 22851, 22614 x 2, 64722,and 22216
x 2 were not listed on the SBR-1 form, therefore not eligible for IBR.
ISSUE IN DISPUTE: Provider is dissatisfied with reimbursement of DRG 454, Inpatient
Services.
March 23, 2015: Paper: WC Denial of Treatment:
Interpretation of IMR Data Wrong, and Wrong.
March 23, 2015: WC: Are Injured Workers Being
Denied Necessary Medications?WC: Are Injured
Workers Being Denied Necessary Medications?
March 23, 2015; Paper: WC Authorization,
Providers Forgetting Who the Experts Are: They
Are!
March 23, 2015: Paper: “Petition Non-IBR
Medical Legal Dispute” Confusing to Be Effective?
March 23, 2015: WC: Attacking Providers Quality
of Care, ---- Insane Statements
March 23, 2015: Paper: WC Denial of Treatment:
Interpretation of IMR Data Wrong, and Wrong.
March 23, 2015: WC: Are Injured Workers Being
Denied Necessary Medications?WC: Are Injured
Workers Being Denied Necessary Medications?
March 23, 2015; Paper: WC Authorization,
Providers Forgetting Who the Experts Are: They
Are!
March 23, 2015: Paper: “Petition Non-IBR
Medical Legal Dispute” Confusing to Be Effective?
March 23, 2015: WC: Attacking Providers Quality
of Care, ---- Insane Statements
March 23, 2015: Paper: WC Denial of Treatment:
Interpretation of IMR Data Wrong, and Wrong.
March 23, 2015: WC: Are Injured Workers Being
Denied Necessary Medications?WC: Are Injured
Workers Being Denied Necessary Medications?
March 23, 2015; Paper: WC Authorization,
Providers Forgetting Who the Experts Are: They
Are!
March 23, 2015: Paper: “Petition Non-IBR
Medical Legal Dispute” Confusing to Be Effective?
March 23, 2015: WC: Attacking Providers Quality
of Care, ---- Insane Statements
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
Please register for Lesson 2 Authorization Medical Necessity - Getting Treatment Authorized
on Tuesday, March 31, 2015 2:30 PM - 3:30 PM PDT at:

https://attendee.gototraining.com/r/6127621548051913730

Because of the complications of SB 863 this will be a 6 month course so those that already a
part to know and those that still wish to sign up

After registering you will receive a confirmation email containing information about joining the
training.

Brought to you by GoToTraining®
Online Training Made Easy™
Citrix Online | 7414 Hollister Avenue | Goleta, CA 93117
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
H-WAVE STIMULATION. = Guidelines = Elements Required in Documentation =Common Errors= Authorized