A Clear Message to Lien Claimants
Monday, April 8, 2013 | 0
Medical providers, lien collection companies and lien claimants won’t last long if they don’t adapt to the statutory, regulatory and legal environment in California’s workers’ compensation system.
The passage of SB 863 and regulations promulgated by the Division of Workers’ Compensation, as well as recent decisions by the Workers’ Compensation Appeals Board (including Torres v. AJC Sandblasting and Zurich North America) sanctioning lien claimants should make clear that the old ways of operating are no longer acceptable.
Yet despite this, some lien claimants have not received the message. They continue to do business as usual when trying to collect on medical bills.
Perhaps it’s because in the past, lien reforms only changed or modified one particular aspect of the process and lien claimants were able to adapt and survive with little effort. Never before have the changes been as comprehensive as what we now see.
Prior to 2013, the only significant law was the statutory filing of liens. Mistakes and errors were corrected at the Appeals Board and it was not uncommon for a majority of lien claims to proceed to court and settle without the proper evidence. The economics of settling the case was the norm.
But the Legislature, DWC and WCAB have not only said those who collect medical bills will be held accountable for their mistakes, they’ve also established clear penalties for non-compliance.
Complaining about the new laws is inconsequential. What’s important is ensuring accountability in each and every collection file.
Changes that medical providers, lien claimants and lien collections companies should make include:
- Educate everyone from the file clerk to collectors to hearing representatives about the new lien environment and the new laws and rules. Every time stamp on every document is important and mistakes can result in failure to get paid and the loss of rights.
- Each collection file must be developed from the beginning. It’s no longer acceptable to wait until the court date to get evidence to prove causation, medical necessity or rights to reimbursement.
- Files can no longer be calendared every 30 days. The purpose of the new laws is to move files along quickly.
- Improve communication between the service provider and the collector. Without communication, it might not be possible to collect on the files.
- Make sure files are in order before going to the Appeals Board. There is no “fix it later” or “fix it at the WCAB” provision in the new laws.
- Stay on top of files. Just because a lien claimant prevails on a certain issue does not mean the process stops. Time requirements must be adhered to, a file might have to go to independent bill review or independent medical review and failure to timely do so could result in a claim being uncollectable.
- Consolidation is a must in the independent bill review process.
- There is no way around paying the lien filing fee or activation fee. Accept it and comply.
Hopefully the message from lawmakers, regulators and judges is starting to become clear for medical providers, lien claimants and collection companies. Compliance should result in better representation of their clients and, possibly, higher recovery rates.
Reid L. Steinfeld is a general counsel, and Richard Boggan is a lien claimant analyst for Grant & Weber in Los Angeles.
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