As a result of the passage and enactment of Senate Bill 1160 (SB1160), California Labor Code Section 4903.05 has been amended to impose additional lien filing requirements. Labor Code Section 4603.2(b) was also amended under Senate Bill 1175 (SB1175); this amendment shortens the deadline for submission of treatment bills to the employer even when no lien is filed.
NEW LIEN DECLARATION
In addition to the various declarations and certifications already filed with a medical treatment lien, Labor Code Section 4903.05 has been amended to require a new declaration, signed under penalty of perjury and filed and served when the lien is initially filed.
Effective January 1, 2017, all liens of providers who are subject to the lien filing fee must be accompanied by a declaration stating, under penalty of perjury, that the dispute is not subject to an independent bill review (IBR) and independent medical review (IMR), and that the lien claimant qualifies under one of the following conditions:
(A) Is the employee’s treating physician providing care through a medical provider network.
(B) Is the agreed medical evaluator or qualified medical evaluator.
(C) Has provided treatment authorized by the employer or claims administrator under Section 4610.
(D) Has made a diligent search and determined that the employer does not have a medical provider network in place.
(E) Has documentation that medical treatment has been neglected or unreasonably refused to the employee as provided by Section 4600.
(F) Can show that the expense was incurred for an emergency medical condition, as defined by subdivision (b) of Section 1317.1 of the Health and Safety Code.
(G) Is a certified interpreter rendering services during a medical-legal examination, a copy service providing medical-legal services, or has an expense allowed as a lien under rules adopted by the administrative director.
Pursuant to Labor Code Section 4903.05(3), the failure to file this new declaration will be grounds for dismissal of the lien “with prejudice by operation of law.”
Because of this stringent new requirement and the severity of the consequences a lien claimant faces for failure to comply, Boehm & Associates would like to emphasize to its clients the need for all documentation to support the lien claim at the earliest possible opportunity.
Documentation needed to evaluate any potential lien claim includes the following:
- Complete medical billing and itemization;
- Complete medical records;
- Complete collection notes (documenting attempts to collect reimbursement prior to referral to Boehm);
- Complete documentation with regard to Requests for Authorization (RFA’s), pre-certification, authorization, denials of authorization, UR documentation, IMR documentation (if any), and any and all encounters or discussions with the employer and/or the workers’ compensation carrier or administrator; and
- Any and all other documentation which the medical provider believes substantiates the validity and compensability of the treatment lien.
For those liens filed before January 1, 2017, for which a filing fee was paid, medical providers will have until July 1, 2017 to file a declaration in compliance with Labor Code Section 4903.05. Boehm & Associates is in the process of identifying those liens and bringing them into compliance for its clients before the deadline. For this reason, Boehm & Associates’ clients are urged to comply with any documentation requests regarding these liens as soon as possible.
NEW, SHORTENED TIMEFRAME FOR SUBMISSION OF MEDICAL TREATMENT BILLING
SB1175 amended Labor Code Section 4603.2(b) to include the following provision:
(1)(B) Effective for services provided on or after January 1, 2017, the request for payment with an itemization of services provided and the charge for each service shall be submitted to the employer within 12 months of the date of service or within 12 months of the date of discharge for inpatient facility services. The administrative director shall adopt rules to implement the 12-month limitation period. The rules shall define circumstances that constitute good cause for an exception to the 12-month period, including provisions to address the circumstances of a nonoccupational injury or illness later found to be a compensable injury or illness. The request for payment is barred unless timely submitted.
As a result, all medical provider billing should be submitted as early as possible after services are rendered, but no later than 12 months from the date(s) of service, even if there is no intention to file a lien with the WCAB. As the statute plainly states, the failure to tender the bills for payment in a timely manner will bar any later request for payment.
It should be noted, however, that the administrative director has been directed to adopt rules that will outline the circumstances that provide “good cause” for a late submission of billing for payment (such as situations where the provider was not informed of the patient’s workers’ compensation claim).
In any event, Boehm & Associates again encourages its clients to move swiftly to submit their fully documented and compliant bills to the employer or workers’ compensation carrier or administrator for payment under any circumstances.
Boehm & Associates’ client services and legal staff are available to evaluate any issues that may arise and to answer client questions in this, or any, regard. Additionally, Boehm & Associates is ready, willing, and able to assist any prospective clients in bringing their liens into compliance with the July 1, 2017 deadline for their pre-January 1, 2017 liens as well as ensuring proper and compliant filing for their new liens this year.
Boehm & Associates wishes its clients the very best in the New Year, and our staff stands ready to address the questions and challenges arising in the New Year as we continue to bring your claims to successful resolution.