New workers' compensation reforms make significant changes to the reimbursement methodology in the CA Workers' Compensation Program. Under the SB 228 amendments, the maximum reasonable fees for medical services commencing January 1, 2004, other than physician services, are 120 percent of the aggregate fees prescribed in the relevant Medicare payment systems or 100 percent of the fees prescribed in the relevant Medi-Cal payment system. Newly enacted (4/04) SB 899, has stirred even more controversy by radically changing the way medical treatment is delivered in the workers' compensation system, among other things, allowing employers and insurers to create network pools of doctors. Thus, eliminating genuine choice in selecting a physician...

Almost all payers conduct computer-generated fee reviews to determine whether charges are "usual and customary." They purchase or obtain a license to use usual-and-customary bill-repricing software and then run claims through the database. Your claims are compared with data in the computer for your alleged "geographic region" (usually the first three digits of your zip code). The database often contains Medicare, CHAMPUS, worker's compensation, and managed care contract payment data. The data are skewed to be artificially low, as evidenced by the fact that virtually all providers in all geographic regions have had their bills reduced. Also, the database review is specialty blind, meaning it does not take into account the physician's training, expertise, experience, or success rate. Under California law, "Reimbursement of a Claim" means...

To help healthcare providers understand and benefit from protections under California's new fair payment practices regulations (AB1455), Glendale Adventist Medical Center has invited Ed Norwood and the CA STOP THE ABUSE CAMPAIGN to their campus on Wednesday, June 23, 2004 from 8:00am- 4:30pm. This dynamic program offers take home materials, such as sample appeal/demand letters, affidavits of compliance, policies and procedures and case studies to get you off to the right start! TO REGISTER, CONTACT DANIELLE WIRTH OR HARLEM QUIJANO @ (714) 995-6900.

STA is a two (2) day boot camp that teaches healthcare professionals on statutory laws that prohibit Knox-Keene licensed-health plans (HMOs, Blue Cross PPO, and Blue Shield PPO) from engaging in unfair payment patterns and authorizes the California Department of Managed Health Care (DMHC) to fine and penalize plans that engage in such practices (Also covers Regulatory laws for indemnity, workers' compensation and ERISA plans). If you would be interested in participating as a host facility, contact our office by July 1, 2004. (Out of State Providers encouraged to apply as well.) Only six (6) slots are left remaining for host locations.

REVAssurance 3.0 RELOADED is an intuitive, single browser based program that simplifies prompt payment law research and application at your fingertips. With over 250 appeal, demand, and script templates, this Denial Management and Training Program will improve cash flow and reduce bad debt write-offs by assisting providers appeal improper denials, establish policies and procedures for managed care recovery, track the disposition of unpaid and denied claims and provide denial prevention reporting and analysis. Using REVAssurance 3.0, your staff will be able to search the knowledge base for policies, procedures, scripted responses and answers, allowing them to reduce the time to answer review and denial tactics by insurers. With a complete library to our information base, your support staff will also be able to work as a more efficient and cohesive team to protect patient and provider rights and improve your bottom line. CALL TODAY FOR A FREE DEMO VERSION.

ERN Enterprises welcomes Elizabeth Estorge to its team of Consultants. With more than sixteen years in the healthcare industry, her experience focuses on patient financial services, business office and admissions. As a Senior Consultant and Revenue Cycle Specialist, Elizabeth is available for onsite High Dollar Auditing Projects or Interim Management. In addition to possessing HIPAA regulation knowledge and certification, she has completed her ERN Training and Orientation on Healthcare Administrative Laws and her last project yielded results of reducing outstanding claims from 2003 by more than two thirds. Fire your temporary agency. Get ERN's "Claiminator" onsite today. During the tenure of any project consultant onsite, clients are granted FREE Management access to our Online Consulting Services for ANY internal compliance issues.