California Work Comp News, Issues,
Articles Daily
December 18,  2014:  MPNS-Running a amuck? "...it I
the policy of the City and County of San Francisco
Division of Workers ' Compensation that all prescribed
medications must be pre-authorized by a claims staff and
must be dispensed by a licensed pharmacy in which the
prescribing physician has no financial interest


December 17, 2014; IBR: $3,000.00 for ML other
than QME / AME requested by PTP

December 17, 2014: IBR Holds Reimbursement can
be Higher Than Billed charges (Surgical Facility)

December 16, 2014: Providers Learning PPO
contract Trick with IBRs

December 16, 2014: WC: Some Insurance
Companies Getting Stupid - Running with The
Bank!

December 13, 2014: IBR (2014 DOS) = 29824  
additional $1,453.13 and 29826 additional
$1,453.13  awarded to provider

December 13, 2014: IBR: (2014 DOS) = 99358 /
99359 = NO = 2014=OMFS=(B) = 2014 FS

December 13, 2014: IBR 2014DOS- 99354 - awarded
$114.35

December 12, 2014: Article: 82486 / G0431 2-States
2-Different Interpretations of Medicare $

December 10, 2014: Article: WC MPNs: The Simplest
Defense to Overcome / the Most Costly Providers.===

December 09, 2014: 2015 Guidebook download for
members

December 09, 2014: IBR Decision Lack of
Documents fo 22845-22 / 22851-22 /64550-22-59

December 09, 2014: IBR Decision: 72100 22x7
incorrect  modifier

December 09, 2014: IBR ML 106-94- No Initial ML
FS=0

December 03, 2014: WC Clarity, 2nd Review, URs,
IMRs, RFA, The Law States What it States!
CALIFORNIA WORKERS COMPENSATION COLLECTIONS PUBLICATIONS AND
INFORMATION FOR MEDICAL PROVIDERS AND LIEN CLAIMANTS
All States Work Comp News,
Issues, Articles Daily
December 09, 2014: US Labor
Department helps more than 5,300
Pennsylvania and West Virginia
oil and gas workers recover $4.5M in
back wages for unpaid overtime

December 09, 2014: Florida News:
•2014 WCI Conference - DWC
The Florida Division of Workers'
Compensation, recently participated in
the 69th Annual Workers'
Compensation Educational Conference
with the Workers' Compensation
Institute, in Orlando, Florida. The
Division breakout session included the
following topics: Legislative Updates,
Big Data, Reemployment Services for
Injured Workers, Audits and Carrier
Compliance, and EDI Updates.

December 09, 2014: District of
Columbia: Clinical Laboratory Fee
Schedule (CLFS)
Preliminary Determinations

December 09, 2014: Connecticut Case
Law:It is black letter law that we
cannot consider issues on appeal that
the parties did not properly preserve
for appeal at the trial level. As we
cannot identify a ruling by the trial
commissioner that prejudiced the
respondent in their defense of the
claim, and the respondent presented a
thorough defense to the claim; we
cannot now determine that the
respondent was prejudiced by the
inaccurate date in the claimant’s Form
30C

December 09, 2014: Arkansas News:
Proposed Changes to Rule 099.30

December 09,2014:  Arizona:
Commission to Consider Adoption of
Treatment Guideline Process
July 2014 Collections
Newsletter
Become a Subscriber / Member for
Full Access $250.00 per year
Mid July 2014
Collections
Newsletter
August  2014
Collections
Newsletter
Medical Testing
Primary Treators
Chiropractic
Physical Therapists
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
September 2014
Collections
Newsletter
Issues of Causation / Contested Liability  Issues / Procedural Issues / Pleadings / General Law and Information
WC: California FS=Drug Screening Fee
Schedule Based On IBR Decisions; this is IBR
fee schedule interpretation of Medicare
Reimbursement.

Billed: 82055 / 80299 59 / 80299 59 / 83925 59 /
83986 / 83992 / 81002 / and 80152 Laboratory
Services

  • FS=G0431=$107.95 / 82055=$16.04 /
    $4.43 / 81002=$3.17

Billed: 82055 / 82145 / 80154 / 80299-59 /82520 /
80299-59 / 83840 / 83925-59 9x2 0 / 83986 / 83992
/ 81002 /80152 / Drug Testing Toxicology

  • FS=G0431=$107.95 / 3.17 / 4.43 / 16.04

Billed: 82055; 82145; 82205; 80299 (2); 82520;
83840; 83925 (3); 83986; 83986; 83992; 81002 and
80152 Laboratory Services

  • FS=G0431=$107.95 /81002; $3.80
    /83986=$5.31 /

Billed: 82145 / 82205 / 80154 / 82520 / 83992 /
83925 / 82145 / 82055 / 82570 Laboratory Services

  • FS=G0431=$119.94 / 82055=$17.85 /
    82570=$8.53 /

Billed: 82145(2); 82205; 80154; 82520; 83840;
83840; 83992; 83925 (2) Laboratory Results

  • FS=Bundled under G0431=$107.94 /

Billed: 82145/ 82205/ 82520 / 83840 / 83992 /
83925 / 82145 / 82055 / 82570 Toxicology

  • FS=G0431=$113.94 82570=$8.10 /
    82055=$16.93 /

Billed: 82145; 82205; 80154; 82520; 83840;
83840; 83992; 83925; 83925 mod 59; 8214559;
82055 and 82570 Laboratory Services

  • FS=G0431=$119.94 / 82055 = $17.85 /
    82570= $8.53

Billed: 82145; 82205; 80154; 83480; 83992;
83925 modifier 59; 82542 and 82145 modifier 59
Laboratory testing

  • FS=Bundled under G043= $107.95 /

Billed: 82205 several 8000 codes Drug Screen

  • FS=127.73

Billed: 82415; 82205; 80154; 82520; 83840;
83992; 83925; 82145 Laboratory Results

  • FS=G0431=$113.94 / 82055=$16.93 /
    82570=$8.10

Billed: 82415; 82205; 80154; 82520; 83840; 83992;
83925; 82145 Laboratory Results

FS=Bundled under G0431=$113.94 /

Billed: 82415; 82205; 80154; 82520; 83840; 83992;
83925; 82145 Laboratory Results

FS=Bundled under G0431=$113.94 /

Billed: 82486 Laboratory services

FS=Bundled under G0431=$119.94

Billed: 82486 Laboratory services

FS=Bundled under G0431=$119.94

Billed: 82486 Laboratory Results

FS=Bundled under G0431=$119.94 /

Billed: 82486 Laboratory Results

 FS=Bundled under G0431=$119.94

Billed: 82486 Lab – Interesting case the insurance
$119.94 -

FS=G0431 bundled $119.94

Billed: 82486 Laboratory Results

FS=bundled under G0431=$119.94 /

Billed: 82486 Laboratory Results

FS=bundled under G0431=$119.94 /

Billed: 82486 Lab – Interesting case the insurance
paid $476.48 and IBR stating should have been
paid $119.94 -

FS=G0431 bundled $119.94

82486 Laboratory Services

FS=$119.94 /

82486 Laboratory services

FS=$119.94 /

82486 Laboratory services

FS=Bundled under G0431=$119.94

82486 Laboratory services

FS=Bundled under G0431=$119.94 /

82486 Laboratory services

FS=Bundled under G0431=$119.94

82486 Laboratory services

FS=Bundled under G0431=$119.94 /

82486 Laboratory services

FS=Bundled under G0431=$119.94

82486 Laboratory services

FS=Bundled under G0431=$119.94

82486 Laboratory services

FS=Bundled under G0431=$119.94

82486 (40 units) Laboratory Results

FS=Bundled under G0431=$119.94 /

82486 / to G0431 Drug Screening

FS=119.95

G0431 Drug Screen

FS=$119.94 /

G0431 Urine Drug Screen

FS=$119.94

G0431 Urine Drug Screen

FS=$119.94

G0431 Drug Screen

FS=$101.96

G0431 Drug Screening

FS=$101.96

G0431 Drug Screening

FS=$119.94

G0431 Drug Screening

FS=$119.94

G0431 Drug Screening

FS=$119.94

G0431 Drug Screening

FS=$101.95

G0431 Drug Screening

FS=$119.94

G0431 Drug Screening

FS=$101.95

G0431 Drug Screening

FS=$101.95

G0431 Drug Screening

FS=$119.94

G0431 Drug Screening

FS=$113..94

G0431 Drug Screening

FS=$119.94

G0431 Drug Screening

FS=$107.95

G0431 Laboratory

FS=$119.92 /

G0431 Toxicology

FS=61.79 /

G0431 Drug Screening

FS=$113.95

G0431 Drug screening

FS=$119.94

G0431 Laboratory Services / claims adjuster denied
a duplicative billing / decision for provider

FS=$119.94 .

G0431 Drug Screening

FS=102.95 / Additional $85.16 to

G0431 Drug Screening

FS=119.95 / Additional $97.15 Provider

G0431 Laboratory Services

FS=$107.95 /

G0431 Drug Screening / Additional to provider
$95.00

FS=119.94

G0431 Drug Screening

FS=$119 – additional $50.94 Provider

G0431 Urine Drug Screening

FS=$107.95 / Additional $86.36 Provider

G0431 Urine Drug Screening

FS=$107.95 / Additional $86.36 Provider

G0431 Urine Drug Screening

 FS=$119.34 Insurance

G0431 Drug Screening

FS=$119.94 / Additional $108.68 Provider

G0431 Drug Screening

FS=$113.94 additional $97.15 Provider

G0431 Drug Screening

FS/ =$107.96 / additional awarded / $98.95
Provider

G0431 Drug Screening

FS/ PPO= $119.94 / additional awarded / $95.50
Provider

G0431 Drug Screening

FS/ PPO= $61.79 / additional awarded / $49.76
Provider

G0431 Drug Screening

FS=107.14 / additional $85.71 awarded

G0431 / 82055 / 82570 Laboratory Services

G0431=101.95 / 82055=$15.15 / 82570=7.25 /
for

G0431 / 82055 / 82570 Drug Screening

FS=$119.94 / $17.82 /$8.35

G0431 / 82055 / 82570 Drug Screening

FS=119.00

G0431 / 82055 / 82570 // Billed as: 82145 / 82205 /
80154 / 82520 / 83840 / 83992 / 83925-59 / 82145-
59 / 82055 / 82570 Drug Screening

FS=$113.94 / $16.93 / $8.10

G0431 / 82570 / 82055 Toxicology

 FS=$113.95 / 82570=$7.68 / 82055=$16.04 /

G0431 / Billed = 82055 / 82145 / 80154 / 80299-59
/82520 / 80299-59 / 83840 / 83925-59 9x2 0 /
83986 / 83992 / 81002 /80152 / Drug Testing
Toxicology

FS=G0431=$113.95

G0431 / Billed = 82055 / 82145 / 80154 / 80299-59
/82520 / 80299-59 / 83840 / 83925-59 9x2 0 /
83986 / 83992 / 81002 /80152 / Drug Testing
Toxicology

FS=G0431=$119.94

G0431 / Billed = 82055 / 82145 / 80154 / 80299-59
/82520 / 80299-59 / 83840 / 83925-59 9x2 0 /
83986 / 83992 / 81002 /80152 / Drug Testing
Toxicology

FS=G0431=$107.95

G0431 / Billed = 82055 / 82145 / 80154 / 80299-59
/82520 / 80299-59 / 83840 / 83925-59 9x2 0 /
83986 / 83992 / 81002 /80152 / Drug Testing
Toxicology

FS=G0431=$119.94

G0431 / Billed = 82055 / 82145 / 80154 / 80299-59
/82520 / 80299-59 / 83840 / 83925-59 9x2 0 /
83986 / 83992 / 81002 /80152 / Drug Testing
Toxicology

FS=G0431=$119.94

G0431 / Billed 8000 codes Drug Screen

FS=119.94 / for

G0431 / Billed 81002 / 82055 / 83986 Drug
Screening

FS=$113.94

G0431 / Billed 82486 Drug Screening

FS=$119.94 Insurance

G0431 / Billed at 8000 codes Drug screening

FS=$107.95

G0431 / Billed at 8000 codes Drug screening

FS=$107.95

G0431 / Billed several 8000 codes Drug Screening

FS=107.95

G0431 / billed varies 8000 codes Drug screening

FS=107.95



by www.workcompliens.com
Fee Schedule Medical Legal  Based on IBR
Decisions:



Billed: ML 102

FS=$625.00

Billed: ML 102     

FS=0

Billed: ML 102 / ML 104        

FS=0

Billed: ML 102 Billed 103        

FS=$625.00

Billed: ML 102 Billed 103

FS=$625.00

Billed: ML 102-86 / billed at 103-86-94    

FS=$781.25

Billed: ML 103        

FS=$937.50

Billed: ML 103

FS=$937.50

Billed: ML 103 / Billed 104        

FS-$937.50

Billed: ML 103 / Billed 104-95

FS=$937.50

Billed: ML 103 / Billed 104-95

FS=$937.50

Billed: ML 103 /93/95

FS=$1,031.25 /

Billed: ML 104 (46) / 96100       

FS=ML104=$2,875.00 / 96100=$299.73 /

Billed: ML 104 (90801 and 99358 8 units        

FS=$483.94 /

Billed: ML 104 93 units

FS=$5,812.50 /

Billed: ML 104 94        

FS=$5,875.00 / for insurance

Billed: ML 104 Modifier 94 (62 units)        

FS=$4,843.75 for Insurance

Billed: ML 104 modifier 94 and 95        

FS=$2,343.75 == $920.31 amount of PPO
discount not allowed / for provider

Billed: ML 104 Modifier 95 (23) units        

FS=$1,437.50 / for provider

Billed: ML 104-93        
FS=$825.39

Billed: ML 106 -93        

FS=0 / no documentation as time spent

Billed: ML 106 Mod 94 / ML 100 Mod 94        
ML106 (unis 7) $100.00 /

ML 100 FS=0 / for insurance company

Billed: ML=103 reduced to ML 101       

FS=$625.00 / for insurance

Billed: ML=104 95 (20)        

FS=$1,250.00 / for provider

Billed: ML0104 94 / 99070        

FS=Reduced to ML 103 upheld at $1,484.4

99070=$1.80 / for insurance

Billed: ML-102        

FS=0 / for insurance

Billed: ML102-95        

FS=$625.00

Billed: Billed: ML103-93        

FS=$625.00

Billed: Billed: ML104 Modifies 95     

FS=$937.50 / for provider
In-Patient Fee Schedule Based on IBR
Decisions

Billed: DRG 042        

FS /PPO=$48,252.40 / 30% of billed charges

Billed: DRG 460 Revenue Code 274 (L0464 /
L2830)        

FS= L0464 / L2830=$1,219.94 / for provider

Billed: DRG 473        

FS=$ no show no fee for implants
Billed: DRG 454        

FS=$102,547.33

Billed: DRG 491        

FS=$12,477.51 / for provider

Billed: DRG 473        
: FS=$25,985.58

Billed: DRG 473

FS=$25,985.58  no implants / for insurance
Billed: DRG 473        

FS=$25,985.58 / for insurance  - implants included
Billed: DRG 473

FS=$26,532.64 / for insurance implants not
separately reimbursable

Billed: DRG 494

FS=$30,951.77  -- additional $15,391.98
Billed: DRG 472

FS=$34,843.04 / requesting implants
Billed: DRG 473        

FS=$40,543.47 / for insurance

Billed: DRG 460

FS=$45,128.10

Billed: DRG 460

FS=$45,128.10 / for insurance implants not
separately reimbursable

Billed: DRG 460 – spinal implants

FS=$45,128.11 paid by insurance no additional
allowance for implants

Billed: DRG-472        

FS=$48,165.00 / For Insurance

Billed: DRG 460        

FS=$48,165.00 / For Insurance

Billed: DRG 460

FS=$48,170.45

Billed: DRG 460

FS=$48,170.45

Billed: DRG 473

FS=$48,170.45

Billed: DRG 460

FS=$48,170.45 / for insurance implants not
separately reimbursable

Billed: DRG 460        
FS=$48,289.28 / For Insurance

Billed: DRG 460        

FS=$49,184.57

Billed: DRG 460       

FS=$50,504.80  no implants / for insurance

Billed: DRG 460        

FS=$50,705.74

Billed: DRG 460

FS=$50,705.74 / for insurance

DRG 460        

FS=$52,244.73 / for insurance implants no paid
separately

Billed: DRG 455 / Provider Billed 454

FS=$64,062.03 / for insurance

Billed: DRG 459        

FS=$75,938.73 / for insurance

DRG 458

FS=$76,681.06 / additional $22,449.05

Billed: DRG 455

FS=$79,169.47  no implants / for insurance
Billed: DRG 454        

FS=$93,838.22  no additional allowance
Billed: DRG 454

FS=$94,843.63  no implants / for insurance

Billed: DRG 473

FS=25,985.58

Billed: DRG 494      

FS=30,951.71 additional $15,391.98 / for provider

Billed: DRG 455

FS=79,164.44 / for insurance
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
[,]"
Panel Decision
Order of Dismissal Lien Served by Defense and not Board Held
Invalid Order for Dismissal.
Panel Decision:
Sanctions for Lien Claimant withdrawing DOR
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..."
: Panel Decision:
Lien claimants offered no evidence of the OMFS for the
services provided to treat applicant's industrial injury.
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.

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.)
Panel Decision:
"... the petition fails to identify what "good cause" petitioners
contend supports rescission of the WCJ's Order. The petitions
are also unverified."
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
Panel Decision:
Sanctions-- Lien claimant for failure to respond to NOI
: 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.

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."

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.”

Panel Decision:
“…defendant unreasonably delayed applicant's referral to his
treating spinal surgeon for a surgical consultation and unreasonably
delayed provision of spinal surgery.”
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.

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.
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"
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.

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
.

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
New En Banc Decision:
Mercy is an “air carrier that may provide air transportation”
within the meaning of the preemption provision of the ADA.?

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

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

Panel Decision:
Pre-trial orders regarding evidence, discovery, trial setting,
venue, or similar issues -
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.

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.
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.)

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

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

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
Panel Decision:
Treatment outside MPN allowed when Lack of Notice that
results in a neglect or refusal to provide reasonable
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:
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.

Panel Decision
Lien Claimant ordered to pay $10,030.25 in cost and sanctions

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.)

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.
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.

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.
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.
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.

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.”
Panel Decision:
as CCP 473 includes mandatory costs and sanctions, the matter
should be returned to the trial level for the award of same.

Panel Decision:
Defendants allege that the Qualified Medical Examiner should
not have his charges adjudicated in the absence of a lien.
Panel Decision:
but none of the evidence submitted is evidence that applicant
received notice or that lien
claimants received notice.
WCAB Post En Banc Decision:
Bengals are exempted by section 3600.5(b) from the provisions
of California’s workers’ compensation law,

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).
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.

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.)
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."

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.
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."

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

Panel Decision:
In her Report, the WCJ stated that lien claimant consistently
argued that the settlement agreement did not address the entire
lien
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.


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)?

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.\

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.
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

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.
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..."

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

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
Panel Decision:
Every petition for reconsideration "shall fairly state all of the
material evidence."

Panel Decision:
Defense Not Sanctioned for not verifying Petition for Recon
and for stating he did not understand the lien issues at Trial.
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.

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.

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: - AME-Medical Leag
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 -
Case Law Regarding Lien Issue Updated Weekly
Alert New IBR Decisions  Posted

September 29, 2014: New IBR Decisions Posted: All Three Additional Monies Owed to Provider

-63047  /63048



-22/830 /22855 / 63090 / 63091



-82145 /82205 / 80154 / 82520 / 83480 / 83992 / 83925 / 83925 59 / 82145 59 / 82055 / 82057
New IMR Decisions  Posted OCT 2014
Errors on Documentation and Requests
Updated October 04, 2014
MRI
Medication
Physical Therapy
Epidural
Back Surgery
Surgical Procedures and Out-Patient  Surgical
Facility Fee schedule Based on IBR Decisions

Billed: 11100        FS=0 / for insurance no
documentation

Billed 11100 / 11101        FS=11100=$76.60 /
11101=$196.92

Billed 11100 59        FS=0 / services not authorized

Billed 11101 59 / 17002        FS=11101 59
=$133.59 / 17002=$72.70

Billed 12001        FS=$61.20 /

Billed 15740 / 17311 / 17106 / 11100 / 11101    
FS=15740=$1,066.24 / 17311=$161.43  /
17106=$87.84 / 11100=$47.72 / 11101=$27.92 /

Billed 17002        FS=$47.31 /

Billed 17002        FS=$74.26 /

Billed 17002        FS=60

Billed 17002        FS=$232.64 /

Billed 17002 (11)        FS=0 / lack of
documentation / for insurance

Billed 17002 (25)        FS=$363.50 /

Billed 17002 / 69100 / 17001         FS=42.62 /
203.65 / 40.00

Billed 17034 / 17107        FS=2nd=17304=$416.16
/ 17107=$188.58 /

Billed 17034 / 17107        FS=2nd=17304=$416.16
/ 17107=$188.58 /

Billed 17034 / 17999        FS=17034=$416.16 /
17999=$52.05 /

Billed 17034 / 17999        FS=17034=$416.16 /
17999=$52.05 /

Billed 17106 (17999) / 11100 / 11101        
FS=17106 (17999)=$87.85 / 11100=0 / 11101=0 /

Billed 17106 (17999) / 11100 / 11101        
FS=17106 (17999)=$87.85 / 11100=0 / 11101=0 /

Billed 17106 / Billed as 17999        FS=$104.09

Billed 17106 -59        FS=$104.04

Billed 17108        FS=$425.00 /

Billed 17108 / Billed as 17999        FS=$350.00

Billed 17108 Billed as 17999        FS=$500.00

Billed 17262 /11100 / 17000 / 17001 / 17002        
FS=17262=52.02 /11100 =26.01/ 17000=9.76 /
17001=49.42 / 17002=333.69

Billed 17304        FS=$691.92

Billed 17304        FS=$416.16

Billed 17304        FS=$416.16

Billed 17304 / 1799 /        FS=17304=$416.16 /
17999=$52.02

Billed 17304 / 17999        FS=17304=$416.16 /
17999=$52.02 /

Billed 17304 / 17999        FS=17304=$416.16 /
17999=$104.04 / for provider

Billed 17304 / 17999 59        FS=17304=$416.00
17999 56=$52.02 /

Billed 17304 / 17999 59 / 11100 59 / 11101 59
/        FS=17304=$416.16 / 17999 59=$104.04 /
11100 59=$13.01 / 11101 59=$9.27

Billed 17304 / 17999-59 / 111000-59        
FS=$416.16

Billed 17304 / Billed as 17999        FS=$416.16

Billed 17304 and 17999 Modifier 59       
FS=17304=$416.16 / FS=17999=$52.02 / for
provider 25% PPO discount

Billed 17304; 17304 modifier 59; 17999 modifier
59; 17999 modifier 59        FS=17304=$416.16;
17304 modifier 59=$416.16; 17999 modifier
59=$52.02; 17999 modifier 59=$52.02  /

Billed 17304; 17999        FS=17304=$416.16 /
17999=$52.02 /

Billed 17304; 17999        FS=17304=$416.16 /
17999=$52.02 /

Billed 17304; 17999 59        FS=17304=$489.60 /
17999 59=$52.02 /

Billed 17311; 17999 modifier 59        
FS=17311=$416.16 / FS=17999.59 = $59.02 /

Billed 17999        FS=$25.37 /

Billed 17999        FS=$94.29

Billed 17999        FS=$17999

Billed 17999        FS-$2,463.00

Billed 17999        FS=$619.34 /

Billed 17999        FS=$208.08 / for insurance lack
of documentation

Billed 17999        FS=$209.08

Billed 17999        FS=$104.04

Billed 17999        FS=$489.60

Billed 17999         FS=$377.15

Billed 17999         FS=$104.04

Billed 17999 (1)        FS=17999 = $377.15 /

Billed 17999 (59) / 17000 (59) / 17001 (59) / 17002
(59) / 111000 959) / 11101 (59)        17999 (59)
=$104.04 / 17000 (59)=$9.76 / 17001 (59)=$49.42
/ 17002 (59)=$284.26 / 111000 959) $13.01/ 11101
(59=$185.34  /

Billed 17999 / 17999 / 17999/ 17999/ 17999        
FS=17999=$297.50 / 17999==$297.50/
17999=$297.50/ 17999=$297.50/ 17999=$297.50 /

Billed 17999 / 99080 / 99085 / 99086        
FS=17999=$130.82 / 99080=0 / 99085=0 /
99086=0 /

Billed 17999 59        FS=$220.32 /

Billed 17999; 99080; and 99085        
FS=17999=$1,020.36; 99080=0; 99085=0 /

Billed 17999; 99080; J3301        
FS=17999=$377.15 / 99080=$17.14 / J3301=0 /

Billed 17999; J3301; 11901; 99080        
FS=17999=$377.15 / 00003-0494-20=$15.26 /
99080=0 /

Billed 17999-59        FS=$104.40 /  additional
$52.02

Billed 18860072210        FS=$1,559.64 /

Billed 20550 Modifier 51        FS=$22.95 /

Billed Billed 20680 / 20680 / 20680 / 29125        
FS=0 bundled in procedures

Billed 22110 /22110 59 / 22116 / 22116 59 / 76001
/ 64830         FS=22100=0 /22100 59=0 / 22116=0
/ 22116 59=0 / 76001=$228.00 / 64830=$1,024.72

Billed 22554; 22851; 22851 59 – ASC Services        
FS=22554; 22851; 22851 59 – ASC
Services=$4,825.12 /

Billed 22830 / 22855 / 63090 / 63091 / 63047        
22830 =$897.09/ 22855=$446.95 / 63090=999.29 /
63091=$669.98 / 63047=1,998.56

Billed 22830; 22855; 63090; 63091; 63047        
FS=63047=$1999.00 / FS=22830=$448.54
/FS=22830=$448.54 /FS=22855=$2,234.76
/FS=63090=$1,999.00 / FS=$670.00 /

Billed 22842 /20936/64722        FS=0 / Included in
other services

Billed 24102; 25290; 24341         
FS=24102=$2,568.91 / 25290=0 /24341=0

Billed 24314        FS=Claims adjuster reimbursed
$5,587.81 for 64708; 25290; 24102; 26442
therefore no additional payments for $24341 /

Billed 24314; 25290        FS=24341=$13,398.83 /
FS=25290=$2,568.92

Billed 24341 / 64718        FS=$10,910.47 / awarded
an additional of $7,669.41

Billed 24341 / 64718        FS=$9,878.20 /

Billed 25000 Modifier 51        FS=$232.00 /

Billed 25020 / 64721        FS=0 / No indication
separate procedure

Billed 25020 / 64721-51        FS=$2,301.68 / FS=0

Billed 25020 / 64727        FS=0 / Documentation
did not support procedures billed

Billed 25118 / 25118-5        FS=$2,137.35 /
$1,068.68

Billed 25320-59 / 64772        FS=603.21 / FS=221.
85 /

Billed 26145        FS=$5,366.43

Billed 26145        FS=$5,643.72  / Additional
$3,762.51 awarded

Billed 26145 x 9 units  no payments        
FS=$5,940.68 / for provider full amount of fee
schedule

Billed 26145; 26055        FS=26145=0 /
FS=26055=$1,096.60 / for insurance

Billed 26370; 26373; 26373; 20103        FS=ASC
Facility Services = $3,822.59 /

Billed 274 Revenue Code        FS=$314.00 /
payment of $314.00 to provider /

Billed 27422; 29870; 29881; 29875        FS=27442
(29877)=$1,953.38 / 29881=$976.69  29875=0 /
29870=0 /

Billed 27570 / 29870        FS=0 included in surgery
/ for insurance

Billed 27570 / 29870 / 20610        FS=0 included in
surgery / for insurance

Billed 27625; 29898; 20605        
FS=27625=$2,133.55 / 29898=$976.69 / 20605=0
/
Billed 27685        FS=$141.72 /

Billed 27685 Modifier 51        FS=$289.98 /

Billed 29805;29821;29807;29826;29827;29819;
29999        FS=29805=0;29821=$1,794.71;
29807=0;29826=$976.68;29827=$13,589.43;
29819=0;29999=0 /

Billed 29807 / 29823 / 29826 / A6531         
FS=$5,916.72

Billed 29819 / 29820        FS=0 / no documentation
/ for insurance

Billed 29819-59 / 29820-59        FS=0 /
documentation  did not support

Billed 29823        FS=$490.56 /

Billed 29823        FS=$1,408.44 = paid prior to
IBR determination insurance to pay IBR fee

Billed 29823        FS=$1,482.51

Billed 29823        FS=$1482.57 / Awarded
$1482.57

Billed 29823 / 29821        FS=$3,595.15 / 0

Billed 29823; 29826; 29827; 23120; 20690;
29805;        FS=29823-$3,595.25; 29826=$978.27;
29827=$1,797.63; 23120=0; 20690=0; 29805=0;

Billed 29824        FS=$1,081.73 /

Billed 29825 (51)        FS=0 /

Billed 29826        FS=0

Billed 29827 / 29826 / 29822 / L8699        
FS=$4,321.17 / $1,175.80 / 0 / 0

Billed 29846 / 64721        FS=$3,525.10 /

Billed 29870 / 27570 / 20610         FS=0 / reports
and documentation did not justify billing

Billed 29876 / 29870 / 27570         
FS=29876=$861.92 / 29870=0 / 27570=0 / for
provider

Billed 29880 / 29877 / 29874 / 29875 / 20610        
FS=29880=$1,569.78  / 29877 =$113.37/ 29874
=0/ 29875=$107.56 / 20610=0

Billed 29880;29870;29871;29875        
FS=29880=0; 29870=$1,953.38; 29871=0;
29875=$976.69 /

Billed 29881 / 29875        FS=29875=$2,673.75 /
29875=0 /

Billed 29881 / 29875 (59)        
FS=29881=$2,673.75 / 29875 (59) =0 /

Billed 29881 / 29876        FS=29881=$2,673.75 /
FS=29876=$1,336.88 /

Billed 29888        FS=$2,296.353 /

Billed 29914        FS=2,456.58

Billed 37720 / 76942 / 93971        FS=$566.87
/$62.51 / $57.32

Billed 37720 / 76942 / 93971        
FS=37720=$566.387 / 76942=$62.51 /
93971=$57.37 /

Billed 37785 / 76942 / 93971        
FS=37785=$333.59 / 76942=$53.13 /
93971=$48.72

Billed 37785 / billed at 37799        FS=$71.23

Billed 37799        FS=$614.68

Billed 37799 (37720; 76949 26 and 93971 26)        
FS=37799=$583.76 / 99080=0 / 99086=0 /

Billed 37799 (37785 / 76942-26)        FS=$466.39

Billed 37799 (37785 / 76942-26)        FS=$481.84

Billed  37799 (37785 / 76942-26)        FS=$481.84

Billed  37799 (37785 / 76942-26)        FS=$481.84

Billed 37799 (37785, 76942 26 and 93971        
FS=$435.50 /

Billed 63047 / 63048 / 63048 59        
FS=63047=$1,650.31 /63048=$1,650.31 / 63048
59= $1,650.31 / for provider

Billed 63091 62        FS=63091=$1,607.96 /

Billed 63368         FS=$43.61

Billed 63650 / 63650 / 63685 / 63685 / 63661         
FS=$4,034.80 / $4,034.80 / $13,716.43 /
$13,716.43

Billed 63650 -59        FS=$1,104.66 /

Billed 63660 / 63660 59        FS=63600=$766.60 /
63600 59=$383.30 /

Billed 63685        FS=$13,693.32
Billed 63685 / 76496 TC       
FS=63685=$13,679.51 / 76496=$95.29

Billed 64483        FS=$1,824.45  / additional
$717.06 awarded

Billed 64483 / 72100 / 76000 / 94760        
FS=64483=$945.27 / FS=72100=$27.90 / 76000=0
/ 94760=

Billed 64483 LT 1 unit and 64484 LT 1 unit         
Fs=64483=$525.50 / 64484=$135.50 //

Billed 64484        FS=$129.26

Billed 64484 / 64483        FS=64484=$203.23 / for
provider

Billed 64484 / 99214 / 64483-59 / 64484 /01936  
(DOS 2014)        Varies

Billed 64484 rt / 64484 lt        FS=64484
RT=$57.59 / 64484=$115.18 /

Billed 64555 59        FS=8,217.02 /

Billed 64636        FS=0 /

Billed 64719 51        FS=$256.40 / for provider
applied PPO discount

Billed 64721        FS=$0

Billed 64721        FS=0 / No indication separate
procedure

Billed 64721 / 26145        FS= $1,497.53 / FS=
$5,940.68

Billed 64721 / 26145  (DOS 2014)        Varies
Billed Billed 64722 (59)        FS=0 – service
including in other services no fee schedule
determined

Billed 64830 20 / 72100 / 72148 26        FS=64830
20 / 72148=0/ 72148 26=0 /

Billed 64999 (63047)        FS=$2,558.16 /

Billed 76942 / Billed 99135        FS=0

Billed 76942 / Billed 99135        FS=0

Billed 88305        FS=$446.25

Billed 88305        FS=$267.75

Billed 88305        FS=$535.50  - additional $433.55
awarded

Billed 88305        FS=$315.00 / for provider

Billed 88305        FS=$315.00 / for provider

Billed 88305        FS=1050.00 / Additional  -
945.00 provider

Billed 90862 / 99081        FS=99081=0 /
90862=$47.91 / 99081=0 / 90862=$47.91 /
99081=0 / 99081=0 /

Billed 90862 / billed 90841        FS=$47.91

Billed 92215        FS=$129.41 /

Billed 93320        FS=$157.16 /

Billed 93320        FS=$157.16

Billed 93320 / 5        FS=0 /

Billed 93320 / 5        FS=0 /

Billed 93320 / 93325        FS=$157.16 / $110.08

Billed 93320 / 93325         FS=933320=$157.16 /
93325=$110.08

Billed 93320 / 93325        FS=93320=$157.16 /
FS=93325=$110.08 /

Billed 93320 / 93325        FS=93320=$157.16 /
93325=$110.08 /

Billed 93320 / 93325        FS=157.16 / 110.08 /

Billed 93320 / 93325        FS=93320=$157.16 /
FS=93325=$110.08 /

Billed 93320 / 93325        FS=93320=$157.16 /
FS=93325=$110.08 /

Billed 93320 / 93325 / billed = 93307        
FS=$157.16 / $110.08

Billed 93320 and 93325          FS=93307 = $247.72
/93320=$157.16 /93325= $110.09 /

Billed 93320; 93325        FS=93320=$157.16 /
93325=$110.08 for provider

Billed 93320; 93325        FS=93320=$157.16 /
93325=$110.

Billed 93880        FS=0

Billed 95831        FS=$34.40

Billed 95831        FS=0

Billed 95851        FS=0

Billed 95904        FS=$967.56

Billed 95904        FS=$806.30 / additional $322.52

Billed 95904        FS=$806.30 /

Billed 95904  /  95904        FS=$806.03 /
FS=$322.52

Billed 95904 (52)        FS=$806.30 /

Billed 95904 /95904 / 99080 / 99358     
Additional awarded for studies =$1,168.72

Billed 96100        FS=$299.73 ML

Billed 96360 and 99284        FS=96360=$309.37 /
FS=99284=$93.42 / for provider

Billed 96530        FS=$47.05

Billed 96530 / Billed 99214 / 96530        FS=$47.0

Billed 96530 modifier 59        FS=$47.05 for
insurance

Billed ASC  Services         FS=$9,563.89

Billed ASC Facility Fees        FS-$4,586.94 /
additional amount awarded $978.22

Billed ASC Facility Services        FS=$6,399.00 /
Billed ASC Facility Services (25115)       
FS=$1,437.22 /

Billed ASC Service        FS=$2,146.45 /

Billed ASC Service        FS=$2,455.50 /

Billed ASC Service        FS=$4,865.09 /

Billed ASC Services        FS=$5,347.57 /

Billed ASC Surgical Services / and 81025        FS=5,
861.46 /
WC: Fee Schedule for DME Based on IBR
Decisions
Billed:E1399-LL

FS=$792.00 / award for Provider

Billed:E1399-LL

FS=$3,300.00 / additional $3,200.05 awarded
provider no payments made

Billed:E1399-ll

FS=3,300.00 / award for provider

Billed:E1399-LL

FS=$330.00 / Additional $230.15 for provider

Billed:E1399-LL

FS=$2,970.00 / Additional $2,,970.00 for
provider / 0 paid

Billed:E1399-LL

FS=$2,970.00 / Additional $2,,970.00 for
provider / 0 paid

Billed:E1399-LL

FS=$3,300.00 / Additional $2,,026.89 for provider

Billed:E1399-LL

FS=$1,986.00 / Additional $1,566.for provider

Billed:E1399-LL

FS=0 no proof of authorization

Billed:E1399-LL

FS=$999.00 / Additional $615.00 provider

Billed:E1399-LL

FS=$2,227.75 / Additional $969.39.for provider

Billed:E1399-LL

FS=$247.50 / Additional $157.63.for provider

Billed:E1399 Modifier LL 1 unit

FS=$330.00 for provider additional $330.00, 0
paid

Billed:E1399 modifier LL (3 units)

FS=$990.00 – additional award $693.42 to
provider / for provider

Billed:E1399 modifier LL

FS=990.00 / for provider additional awarded
$990.00 / 0 paid

Billed:E1399 LL (7 units)

FS=2,310.00 no objection or documents by
insurance / for provider $2,310.00

Billed:E1399 LL

FS=0 / Authorized but no documentation as to
cost

Billed:E1399 LL

FS=$792.00 / award for provider

Billed:E1399 LL

FS=$247.50 / Additional $141.75

Billed:E1399 LL

FS=$2,970.00 / Additional awarded provider
$2,071.36

Billed:E1399 LL

FS=$330.00/ Additional $330.00 for provider / 0
paid

Billed:E1399 LL

FS=$1,980.00/ Additional $1,710.39 awarded
provider

Billed:E1399 LL

FS=$661.32 Additional $661.32 to provider / 0
paid

Billed:E1399 LL

FS=$ 1,880.15 Additional $1,800.15 awarded to
provider / 0 paid

Billed:E1399 LL

FS=$3,300.00 – additional $1,014.00 to provider

Billed:E1399 (LL) (6)

FS=$1,980.00 for provider an additional
$1,446.17

Billed:E1399 LL (3 units)

FS=$990 billed charges == / for provider $990.00

Billed:E1399

FS=$3,300.00 / for provider additional awarded
$3,300.00 / 0 paid

Billed:E1399

FS=$330 / Provider awarded $330.00 / 0 paid

Billed:E0215

FS=$62.00 / for provider
$125 With Two Years Free
Updates
1000 IBR Decisions  
Download Free Now:(553 Pages) 2015
Treatment and Collections Dispute
Guidebook   Available for download to
subscribers 553 page Guidebook  
Medicare  and  States Using Medicare or Codes G0431 /
82486 and Related Billing Codes
Toxicology Billing and Payments: Medicare, Each
States Fee Schedule
What are Valid Arguments and What are Invalid
Arguments
2015 Book Billing and Payments for Drug
Screen, Lab Tests, Toxicology   
Clinical Laboratory Fee Schedule G0431,
G0434, 82486, etc.
Toxicology Billing and Payments
All States Work Comp News,
Issues, Articles Daily
IMR Decisions
IMR-Topical Transdermal Cream
Not Medically Necessary
MRI        Meet Guidelines         
UR Reversed / Certified
Medication        No
documentation         UR Upheld
Medication        No indication
how long patient will take
medication        UR Upheld
Aquatic Therapy         No
indication of duration or number
of visits         UR upheld
8 Additional Chiropractic
Sessions        Failed to show
objective Functional
Improvement         UR Upheld
Left knee under anesthesia        
Medically necessary        UR
reversal / certified
Psychotherapy         Requested
36 visits guidelines 16
recommended more after
showing objective functional
improvement         UR Upheld
Additional Physical
Therapy         Failed to show
objective Functional
Improvement from prior
treatment        UR Upheld
Epidural Steroid        Insufficient
Evidence submitted        UR
Upheld
36 Cardiac Rehabilitation
Treatment        Reasonable and
necessary stated in
guidelines         UR reversal /
certified
Cervical Laminectomy C4-6 /
fusion/ one day in-patient         
Clinical notes fail to evidence
findings…”        UR Upheld
Medication        No
Documentation of functional
deficits…”        
Massive Billing and Documentation Error that Resulted in Millions (lost)
Three (3)  out of Several "Findings and Decisions" Posted Here  Based on Medicare Reimbursement
for Labs Performing Urine Drug 82486 and G0431 Shows Massive Billing and Documentation Error
that Resulted in Millions (lost)  being Paid Incorrectly and or Settled for 2 years?
Download Free to Subscribers:
2015 (243 PAGES) LEGAL
CITATIONS BOOK FOR
TREATMENT AND COLLECTIONS
DISPUTES / OVER 500 LEGAL
CITATIONS CASE  LAW AND
STATUTORY LAW – IN ORDER  
WWW.WORKCOMPLIENS.COM
Millions Flushed away 7 exceptions to Time to File
Liens -- Hospital,s Burn Centers, Trauma Centers
have window for DOI regardless of Date of
Services  Prior to 2012 for exceptions