Experiencing a delay in workers' compensation utilization review decisions? File a complaint The California Division of Workers’ Compensation (DWC) has finalized regulations to ensure that utilization reviews (UR) are conducted in compliance and within specified timeframes (see chart below). The regulations authorize DWC to conduct periodic reviews of all utilization review organizations (URO), including a review of any credible complaints against the organization received by the DWC Administrative Director. The California Medical Association (CMA) encourages physicians experiencing delays in the receipt of workers’ compensation UR decisions to be diligent in submitting complaints to DWC to highlight organizations that fail to meet the ... September 25, 2017 General Division of Workers' Compensation, Utilization Review, Workers' Compensation 0 0 Comment Read More »
CMA-sponsored bills head to Governor Brown for his signature The California State Legislature has passed two California Medical Association (CMA)-sponsored bills: AB 2121, a life-saving measure requiring alcohol servers and managers to complete a training course on responsible beverage service; and SB 1177, to establish a Physician Health and Wellness Program for California physicians. Another CMA-sponsored bill, SB 563, was incorporated into SB 1160 to increase transparency and accountability in the workers’ compensation utilization review process. These bills are now on the Governor's desk awaiting his signature. AB 2121 would make Department of Alcoholic Beverage Control responsible beverage training ... September 13, 2016 General California Legislature, Physician Wellness, State Legislative Advocacy, Workers' Compensation, Alcohol 0 0 Comment Read More »
Chronic pain and opioid treatment guidelines for injured workers now in effect The California State Division of Workers’ Compensation’s (DWC) new guidelines on the treatment of chronic pain and opioid prescribing for injured workers are now in effect. The guidelines include best practices and universal precautions for safe and effective prescribing of opioids for pain due to a work-related injury. According to DWC, the new guidelines encourage safer prescribing of opioid pain relievers with the primary goal of significantly reducing the rate of opioid-related adverse events and substance misuse and abuse. Since 2014, the California Medical Association (CMA) has provided input to the ... August 25, 2016 General Drug Prescribing, Opioids, Pain Medicine, Workers' Compensation, Division of Workers' Compensation 0 0 Comment Read More »
Anthem asking physicians to affirm participation in workers' comp MPNs by Dec. 31 Anthem Blue Cross recently sent a request to physicians who participate in various workers’ compensation medical provider networks (MPN) through their Prudent Buyer agreements, asking them to affirm their continued participation in each of these networks. This request is required as part of the reforms instituted under SB 863, which mandates that MPNs obtain written acknowledgement from each participating physician that the provider elects to be a member of the network. Under the resulting regulations, physicians who have entered into contracts with workers’ compensation payors prior to August 27, 2014, and ... December 7, 2015 Managed Care Medical Provider Networks, MPN, Workers' Compensation, Anthem Blue Cross 0 0 Comment Read More »
DWC reinstates requirement to pay lien activation fees for Workers' Compensation claims The Division of Workers’ Compensation (DWC) recently announced that beginning November 9, 2015, the lien activation fees mandated under the Senate Bill 863 workers' compensation reforms will be reinstituted. This announcement comes in the wake of the Ninth Circuit United States Court of Appeals decision to uphold the constitutionality of the lien activation fees and subsequent dismissal of the preliminary injunction imposed as part of the Angelotti Chiropractic, Inc., et al. v. Baker, et al. case. Under this order, any affected lien claimant who files a Declaration of Readiness or appears ... December 7, 2015 General Workers' Compensation 0 0 Comment Read More »
CMA takes on public health, Medi-Cal with 2015 sponsored legislation California Medical Association (CMA) sponsored bills for 2015 include a $2 per pack tax on cigarettes, increasing provider rates for Medi-Cal and establishing a Graduate Medical Education Trust Fund in light of inadequate funding levels from the federal government. SB 591 (Pan) – Cigarette and tobacco products taxes: California Tobacco Tax Act of 2015 This bill is the CMA-led Save Lives Coalition’s legislative strategy to increase the state’s tobacco tax by $2 per pack. The bill would allocate funds raised by the tax to tobacco prevention and education, programs provided by ... March 24, 2015 General Medi-Cal, POLST, State Legislative Advocacy, Tobacco Tax, Workers' Compensation, Graduate Medical Education 0 0 Comment Read More »
New fee reduction for Workers' Compensation Independent Medical Review and Independent Bill Review submissions The California Department of Industrial Relations (DIR) announced that fees for submission of an Independent Medical Review (IMR) or Independent Bill Review (IBR) for workers’ compensation were reduced effective January 1, 2015. The following table summarizes the reduction in fees. Fee prior to December 31, 2014 ... March 17, 2015 General Insurance/Reimbursement, Department of Industrial Relations, Workers' Compensation 0 0 Comment Read More »
DWC implements annual changes to workers' compensation physician fee schedule The California Division of Workers’ Compensation (DWC) has implemented its annual adjustments to the California workers’ compensation resource-based relative value scale (RBRVS) fee schedule effective for dates of service on or after March 1, 2015. Under the RBRVS Physician Fee Schedule regulations, located under “Physician services” on DWC’s Official Medical Fee Schedule (OMFS) webpage, the calculations to determine maximum allowable amounts for each code incorporate a number of factors, including the assigned relative value units for each code along with the yearly adjusted conversion factor determined by DWC. DWC ... March 17, 2015 General RBRVS, Resource Based Relative Value System, Workers' Compensation 0 0 Comment Read More »
CMA survey finds workers' comp reform has brought new challenges for physicians California’s workers’ compensation system is arguably undergoing its biggest period of transformation since its enactment in 1914. Senate Bill 863, signed into law on September 19, 2012, initiated changes to the utilization review process, implementation of an independent medical review and independent bill review process, and a migration to a resource-based relative value scale payment system, among other changes. In late 2014, after hearing complaints from physicians that these changes have resulted in patient care roadblocks, the California Medical Association (CMA) initiated a survey to solicit physician feedback on ... February 5, 2015 General Insurance/Reimbursement, Workers' Compensation 0 0 Comment Read More »
Save on your workers' compensation program See What You Could be Saving! “When I found out how much money I could save ($1,650) on the sponsored workers’ compensation program, I joined CMA. The savings paid for my membership and then some. Now I have access to everything CMA offers” – Nicholas Thanos, M.D. CMA Member Did you know that CMA/Society members can save 5% on their workers’ compensation insurance? And, they may save up to 15%, depending upon where they place their group medical insurance. It’s true. CMA/SBCMS members receive a discount on workers’ compensation insurance policies provided through ... May 17, 2013 General Marsh, Workers' Compensation 0 0 Comment Read More »
