Workers' Compensation Academy: Strategies to Manage Costs of Medical Care in a PA Workers’ Compensation Claim
I, JEFFREY DAVIS, RETROACTIVELY DECLARE THE MONTH OF JANUARY IN THE YEAR 2024 TO BE KNOWN AS “MEDICARE ADVANTAGE MONTH.” Obviously, I don’t have the power to do that, but the health policy community did see a lot of...more
Based on two Commonwealth Court decisions filed on March 17, 2023, medical marijuana is now medical treatment covered by the PA Workers’ Compensation Act (WC Act), and failure to pay is a violation of the Act, with up to 50%...more
On December 14, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that contemplates several changes to, and clarifications of, guidance for the Medicare Advantage (MA) program in coverage year 2024....more
Ever since utilization review (UR) became a mandatory requirement for all medical treatment requests, there have been numerous attempts to challenge not only individual UR determinations and the timeframes in which they have...more
Healthcare organizations across the country should train their attention on a federal court case pending in Georgia that deals squarely with whether RNs performing utilization review (UR) work are exempt from overtime pay...more
On January 25, 2022, the U.S. Court of Appeals for the Second Circuit affirmed a lower court ruling that the Secretary of HHS violated the due process rights of Medicare beneficiaries by failing to provide an administrative...more
California health insurers and health care service plans that provide hospital, medical, or surgical coverage and that are issued, amended, or renewed on or after January 1, 2021 will be required to cover all medically...more
Do you want to learn more about controlling excessive medical costs on your Pennsylvania workers’ compensation claims? Tune in as our lawyers, Sherri Dougherty and Dawn Nicholson, discuss the use of utilization reviews, use...more
Examine the Evolving Challenges That Lie Ahead for Healthcare Stakeholders and State Regulators—and What You Can Do Now to Prepare and Protect Your Organization—at a New Manatt Webinar. Effective health insurance...more
KEYSTONE RX, LLC v. AMERIHEALTH - A recent opinion from the Commonwealth Court of Pennsylvania has changed the rules for Utilization Review and thrown open the doors to a new class of litigants....more
Starting October 2, 2018, health care practitioners authorized to prescribe, order, administer, or furnish a controlled substance must query, or consult, the Controlled Substance Utilization Review and Evaluation System...more
A second district of the California Court of Appeal has now upheld utilization review (UR) and independent medical review (IMR) as constitutional means to manage medical treatment in California's workers' compensation system....more
In 2004 and 2012 the California Legislature enacted reforms to streamline the medical treatment approval process for workers' compensation claims. The most significant of the 2012 reforms was California Senate Bill 863, which...more
While it seems the members of our state legislature have been busy doing nothing but arguing about the budget for the past year – one young state rep has proposed a bill that may have a positive effect on employers seeking...more
In 2015, the Texas Department of Insurance (“TDI”) took action against a number of companies for their failure to be properly licensed as a utilization review agent in Texas, as well as for their failure to comply with other...more
Long term medical care related to workplace injuries can be a costly and frustrating proposition for employers and/or their Workers’ Compensation insurance carriers. In many cases, the injured workers’ medical care continues...more
On November 20, 2014, the WCAB issued Bodam v. San Bernardino County/Department of Social Services, and declared it to be A Significant Panel Decision, which means it is citable before the board, but is not persuasive...more
On November 27, 2013, the Circuit Court of Cook County, Illinois issued an Order in a lawsuit filed by the American Council of Life Insurers, Inc. ("ACLI") v Andrew Boron, Director of the Illinois Department of Insurance and...more
On January 18, 2013, the Illinois Director of Insurance issued Company Bulletin #2013 - 01, Offshoring, to insurers, registered utilization review organizations and licensed third party administrators conducting business...more