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Official Medical Fee Schedule Review (Bill Review)

The Official Medical Fee Schedule (OMFS) is promulgated by the DWC administrative director under Labor Code section 5307.1 and can be found in sections 9789.10 et seq. of Title 8, California Code of Regulations. It is used for payment of medical services required to treat work related injuries and illnesses.

Often insurance payers do not follow the guidelines provided by the DWC to review and pay medical provider’s claims for injured worker’s treatment. Insurance companies down code /partially pay / or offer zero payment erroneously, citing vague reasons even after multiple attempts of second bill review and independent bill review. In most cases, insurance companies do not reimburse providers the right amount that they are entitled to, which results in providers litigating the matter at the Workers’ Compensation Appeals Board.  In court defense attorneys representing insurance companies state that they “paid per fee schedule” at that point of time it becomes very important for a lien claimant to produce a certified bill review. Having a certified bill review guarantees a greater outcome when faced against defense’s argument of ‘being paid appropriately’. A bill review provides an extra shield of protection for providers while they guard their rights to be reimbursed according Official Medical Fee Schedule.

 

How we can help?

We provide Official Medical Fee Schedule Review (Bill Review) as a service to Workers’ Compensation treating providers and are focused on helping Lien Claimants settle their liens and be prepared for Trial with the proper evidentiary Certified Bill Review.  We are able to provide a flat fee per bill review at a reduced rate when working on a bulk amount of bills.  We can do all of your hearing calendar set for Lien Conferences and/or Lien Trials in an expedited manner and at fraction of cost from our competitors.

Our team is located in California and India, we have a trained team in India able to quickly and efficiently create multiple bill reviews that are then reviewed, approved, and certified by our Certified Bill Review Experts.  At a Lien Trial, our Bill Review Expert(s) can be present to testify to the accuracy of its bill review.

Why is obtaining the OMFS from a software insufficient?  Simple, software and/or non-certified bill reviewer cannot testify to the authenticity and validity of the value of their Bill Review.  A few important reasons to hire us:

      Importance of bill review: a Certified Bill Review needs to be part of the Exhibits at the Lien Conference so that the Judge accepts it at the Lien Trial without objection.  Many times a Judge will disallow a bill review at a Lien Trial if it was not part of the original Exhibits or served within 20 days of Trial.

      Bill Review is essential to settle cases at the Lien Conference as the defense shows up with a bill review and many times a bill review expert.  There is a much higher success rate of settlements at Lien Conference with a Certified Bill Review which ultimately avoids Lien Trials in the future and the costs associated with it.  We have consistently seen a higher settlement amount when a Certified Bill Review is prepared.  Simply having a software printout or an Excel from an internal team with a Bill Review is insufficient as they are not admissible evidence at Trial