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We are excited to announce the launch of our new “Penalty and Interest” calculator, designed specifically for medical-legal claims not paid within 60 days. According to the California Code of Regulations Section 9794(b) and Labor Code (LAB) Section 4622(a)(1), medical-legal bills not paid within 60 calendar days are subject to penalties and interest. This regulation… Continue reading Simplexam’s “Penalty and Interest” Calculator for Medical-Legal Claims

Below are some best practices to ensure you have the right supporting documentation to get your med-legal bills paid. To schedule an evaluation through Simplexam: Scenarios to charge for a Missed Appointment (ML200): Supporting Documentation needed for a Missed Appointment: In the scenarios where a patient does not show, is late, leaves early, or the… Continue reading Medical-Legal Fee Schedule (MLFS) Best Practices: ML200

It’s important to stay on top of regulatory changes and Simplexam has got you covered. Below is the latest announcement from the DWC: DWC Posts Adjustments to Official Medical Fee Schedule (Physician Services / Non-Physician Practitioner Services) The Division of Workers’ Compensation (DWC) has posted an order adjusting the Official Medical Fee Schedule (OMFS) to… Continue reading New updates to the DWC Official Medical Fee Schedule (OMFS) effective July 1st, 2024

Steps to Take if a Bill is Ignored If your medical-legal claim is ignored or denied by the claims administrator, this is your playbook for objections. This playbook assumes that you have all your proper documentation, including the request for the QME, letter from party/parties, proper reporting, and most importantly proof of service (or proof… Continue reading Playbook for Non-IBR Medical-Legal Disputes

In 2019, the California state audit report found that the DWC had failed to address its QME shortage. From 2013-2018, as requests for QME services increased, the number of QMEs decreased, leading to unnecessary delays for injured workers hoping to resolve their disputes and get benefits. It also resulted in increased costs for employers. Fast… Continue reading Is Your QME Volume Going Down?

It’s important to stay on top of regulatory changes and Simplexam has got you covered. One of the changes made this year regarding Place of Service affects reimbursement rates for psychological testing conducted via telehealth if the patient is seen anywhere other than his/her home or the Examiner’s office. If the patient is seen in… Continue reading Important changes to Telehealth reimbursement rates

Often, collectors will call the bill reviewer or adjustor and be told “Your claim is denied.” Inexperienced collectors will hear this and give up, mistakenly believing nothing else can be done and that the denial is final. But – there is a difference between the applicant’s claim – aka case-in-chief (CIC) – and the bill… Continue reading QME Billers & Collectors: Don’t be deterred when “Your claim is denied!”

Pursuant to Title 8CCR §9793(l&n), when submitting a bill, providers should always include:  In the rare instance where there is no advocacy letter, providers can supply the “Request for the QME.” Sometimes that might just be an email or fax.  When billing for no-shows, billers should include the request to cancel the appointment. Even if… Continue reading Boost QME Medical-Legal Bill Approval with these Helpful Tips from our Simplexam Billing Expert