Medical Billing questions (California)

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Medical Billing questions (California)

Postby on Fri Aug 21, 2009 1:13 pm

I hope you can help me answer a few basic general Work Comp billing questions.

1. What is the regulation/law for the time frame that insurance providers have to reply or reimburse an invoice?

2. Can an invoice to an insurance provider offer a discount if paid within a specific time frame (i.e. 30 days)?

3. Can an insurance provider be charged a penalty, late fee or interest on unpaid invoices?
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Re: Medical Billing questions (California)

Postby jonbrissman on Fri Aug 21, 2009 2:32 pm

Regarding invoices for medical treatment, see LC Section 4603.2 and 8 CCR Section 9792.5

Regarding invoices for medical-legal services, see LC Sect. 4622 and 8 CCR Sect. 9793 - 9795.

Parties are free to contract for payment at rates either below or above (good luck on that) the fee schedules. If a provider wants to offer a discount below the fee schedule for prompt payment, nothing prevents the offer.

Insurance companies, TPAs, and self-insured employers are supposed to self-impose the penalty, increase, and interest provisions of Sections 4603.2 and 4622. Payment of the underlying charges without self-imposition of additional statutory obligations are grounds for a complaint to the Audit Unit.

The medical provider should join CSIMS; he or she can learn much of the above from the association.

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Re: Medical Billing questions (California)

Postby on Tue Aug 25, 2009 7:06 am


What does CSIMS stand for?
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Re: Medical Billing questions (California)

Postby rider001 on Tue Aug 25, 2009 8:30 am

California Society of Industrial Medicine and Surgery
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