This article is a transcription of an episode of the RateFast podcast, which you can listen to by searching “RateFast” in iTunes or the iOS podcast store.
If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you!
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Another company helping to modernize this very complicated system is DaisyBill. With the workload that clinics are expected to perform when going through work comp claims, a lot of the billing process is left incomplete for the insurance carrier, which complicates issues. Another thing, is that billing review is sometimes ignored by clinics, which leaves money on the table that the clinic could potentially collect on.
We spoke with Sarah Moray, founder of DaisyBill, about what her company does to help make these billing difficulties seamless with her cloud based software suite.
E-billing (noun) – billing via the internet.
Alpha (noun) – a phase of software testing which involves a version of said software which may be in a very crude stage missing many of the features yet to be integrated.
Onboarding (noun) – familiarizing a new client with new software or services.
Narrator: Welcome to the California Work Comp Report, a podcast hosted by Arun Croll and Claire Williams, featuring Doctor John Alchemy.
Claire: Good morning, and welcome to the California Work Comp Report. Today is August 11th, 2015, and I have the pleasure of being joined by Doctor John Alchemy, founder of RateFast, and Sarah Moray, founder of DaisyBill. Hello.
Claire: So Sarah, would you mind telling our listeners a little bit about yourself, how you started DaisyBill and when?
Sarah: Absolutely. So my name is Sarah Moray, and I am one of the co-founders of DaisyBill. We started DaisyBill back in 2011 when we found out that the e-billing regulations were coming into effect in the state of California, and then we went live with some of our alpha clients in 2012, when the regulations were effective. And then for the past two years, we’ve really been onboarding most of our clients. So DaisyBill is a web-based application that allows providers to submit bills electronically to claims administrators. And we also track these schedules, we do lots of things to help providers in the work comp industry.
Claire: Great, thanks. And could you let us know where our listeners interested in learning more could find you guys online?
Sarah: Absolutely. You can always visit our website, which is daisybill.com, additionally you’re always welcome to reach out to me directly at firstname.lastname@example.org. And of course, you’re welcome to call me as well. My direct line, which I’m happy to give out, is (347) 676-1548.
Claire: Wonderful, thanks so much. So, RateFast is a work comp cloud software as well, and we wanted to start off by asking what you think are the two biggest mistakes clinics make when doing work comp reports.
Sarah: We see a lot of mistakes in work comp reports and probably one of the biggest mistakes I see, the first one I want to cover, is really not substantiating the billed treatment in the report. Now, the job of the report is a way to accurately describe what happened at the visit, and then what that means for the patient’s recovery. And I just see so many bills that contain a code on them, like an injection for an example or maybe even an x-ray, and yet those things aren’t even mentioned in the report. So those reports really need to be substantive, otherwise it’s difficult for bills to get paid properly. And then also related to being substantive, it being detailed enough. So detail exactly what’s happening in that exam. Detail how much face-to-face time is being spent with the patient, what tests or what body parts are being examined. And then things like if the code is reimbursed by the number of hours, so something like psych testing, for example, be sure to state how many hours were spent on that psych testing. And then the second mistake that I see a lot is either not billing the correct report for the services that were provided, or billing for a report that’s not even reimburseable per the fee schedule. And every practitioner out there should know what a PR-2 is, what a permanent stationary report is, a Doctor’s First Report is, and then what circumstances those particular reports are payable. And everyone should remember that not all physicians are reimbursed for PR-2’s, in most situations, computation reports are not reimburseable. So be sure to read through the regulations or talk to an expert like myself so that everyone really understands them.
Claire: Mhm. John, would you agree that those are common errors you see as well?
John: Yeah, I think they are. And one of the issues, to get back to the level of detail on exams and the level of detail on the history, if the provider, you know, they’re under a time crunch. And they’re trying to help people the best they can, get to that next patient, stay on time. But if they don’t have some type of system that will help guide them through that specific set of questions and hit all those details in the physical exam, documentation, I totally agree. It really minimizes your chances of getting accurate reimbursement, even though you may have done the work.
Claire: Mhm. About how many companies are doing cloud-based billing for work comp?
Sarah: Certainly not that many. I think a lot of people know out there that the medical industry is not particularly technically savvy, and I think a lot of people don’t really expect that. But cloud-based applications really make life a lot easier. I think the more important thing is that the application must be California-specific and it must be compliant to all the California rules and regulations. So the answer is not many, but I think it’s a really important step that providers could take to start moving towards better technology and cloud-based technology, and that’s one thing that DaisyBill does. Everything is web-based, and everything is compliant for all the work comp rules and regulations.
Claire: What would you say is the single most important feature that you created on DaisyBill to keep the work out of work comp billing?
Sarah: I think the biggest thing that we’ve done is made sure that everything is compliant. And I don’t really want to be a broken record here and keep repeating this compliance factor, but it’s just so important that I am gonna repeat it. When people use technology, I just think it’s really important that they’re doing it correctly. So you can have the best technology in the world, but if it doesn’t do what it’s supposed to do, if it doesn’t follow the rules and regulations, then it’s really not gonna help you. And we take that really, really seriously, so that any time there’s an update, whether it be a new billing rule or a fee schedule update, which happens with a lot of frequency, DaisyBill is automatically updated. And a lot of the rules that went into effect as part of ST863 a couple of years ago, make it so that the claims administrator can deny a bill submission if it doesn’t follow those billing and payment rules. So we really want to ensure that providers are following the rules precisely, and that’s really what’s gonna help them get paid. We have a lot of features that make increasing revenue and decreasing the costs that are associated with work comp billing, eliminated. So probably my favorite is our second bill review generator. Providers are leaving so much money on the table, simply because they aren’t able to generate a second bill review compliantly and quickly. And our functionality allows that creation with just the click of a button. So that’s probably my favorite feature, but just everything, the whole compliance life cycle is just really, really critical.
Claire: Mhm. And John, as a user of DaisyBill yourself, would you agree with that important feature?
John: You know, absolutely. And yeah, my practice does use DaisyBill. We’ve been using it for probably half of a year. And from an administrative standpoint, these second bill reviews will simply kill the billing person in the back, trying to do these appeals. I mean, they will go crazy. It’s one of the most frustrating parts of work comp, is not only submitting that bill, but then following up and going through some of this paperwork gymnastics that are necessary to try to simply get paid. It’s very frustrating, I can totally attest to that.
Claire: And could one of you guys explain to our less work comp-savvy listeners what, and when, a second bill review is required?
Sarah: Sure, I’ll be happy to explain that. So, once a provider or a biller has been paid, or has been responded to I should say, with an EOR (explanation of review), at that point, the time starts ticking and the biller has 90 days from the date of receipt of the EOR, the explanation of review, to submit a compliant second bill review. Now one of the changes that went into effect last year is that that second bill review must be compliant, and if it’s not compliant, the claims administrator is under no obligation to respond. If they don’t respond, and that 90 days expires, then the bill is void. There is no further recourse, the writer can’t follow up, and that loss revenue is gone forever. So it must be submitted within 90 days of receipt of the EOR.
Claire: Okay, great, thanks. So what do you see as the next major innovation in work comp billing? Do you ever envision it being able to be done by the patient’s bedside? What would that take?
Sarah: Well, I think that’s an interesting question. I think that work comp is very different from traditional billing out there. Different than Medicare, different than group health. And with Medicare, you can see a patient, you’ll know exactly what you did, and you can send that bill off immediately. Work comp’s a little bit different because it does require so much reporting, and unless someone has a way to automate that reporting, and get that formatted correctly and generated quickly, then I don’t think it will ever be able to be done immediately. So there is technology that you guys are helping with that can assist with that. But I do think that it sometimes takes a bit longer than traditional billing. Of course, the quicker a bill gets out, the quicker that report gets generated and submitted with the bill, the quicker providers are gonna get paid. So anything that providers can do to expediate that process is definitely gonna be beneficial to their financial health and their financial lifecycle.
John: Yeah, I’d like to jump in and say this as well – I don’t think a lot of clinics and providers really understand this concept, but: The doctor sees a patient, the note gets done, and that note might sit in the back billing for a couple of days or a couple of weeks, for whatever reason, and now that clinic has basically done the work, provided the services, the overhead from their side’s been paid, and their revenue is just sitting there with nothing happening. So I can’t say strongly enough that once that report is done, get it billed. Because it’s kind of like, as you just said, Sarah, groceries sitting on the shelf, going bad. And if you do not get this out the door, you’re only losing more and more money every day at practice. And practices are struggling to stay solvent and profitable.
Claire: Definitely, yeah. Thanks, that seems like a very comprehensive answer. So the next innovation sort of getting the reports done faster, getting the billing that is sort of automated with this cloud software. Is that right, Sarah?
Sarah: Absolutely. Anything that you can do to increase that time, or decrease that time, I should say, will definitely help you. So I think that automating both the billing and the report generation, is incredibly important in a time that people really embrace that technology. Stop doing the things that you’ve been doing for the past 10 or 15 or more years. It’s time to really embrace the innovation so that you can have a healthier practice.
Claire: So are many providers still billing by hand?
Sarah: Yes, unbelievably, yes. So the methods of billing that people tell me about on a daily basis really astound me. So people are still using typewriters sometimes, and I’m not exaggerating, I literally had someone tell me that a few weeks ago. So much can really be automated. But yes, people are using things, doing things by hand, and filling out forms by hand, doing things manually, but there really are easier ways out there. I think a lot of times, people get into a routine, they’ve done this for the last dozen years, and they just are afraid of change. But I do really believe, and I think that John agrees, that change is good. And at DaisyBill, we have made the process of transitioning to our new software incredibly easy. You can have people up and running in 48 hours. So I think those old messes of it taking 6 months to implement a new system or having to jump through hoops, that’s all eliminated. We’ve really made this very, very easy in order to embrace this technology and put away a lot of those old messes of submitting things by hand.
John: I have a quick question on that.
John: So people are still billing by hand in work comp, and wouldn’t you say that work comp has been slower to embrace the electronic billing than other areas of health care? And if so, why? What is the problem here? What’s taking everyone so long?
Sarah: I think one of the things is that it is profligated by the rules and regulations in California. And I think that they have to wait for all these rules to be enacted. Blue Cross can mandate that their providers submit things electronically, they can just make a rule and say “If you’re part of our network, you must submit things electronically.” There are a lot of steps that have to go through the legislature in order to mandate that carriers accept these claims electronically, so I think that’s one of the reasons. I also just think that this is a large system. It is, there are a lot of moving pieces, there are a lot of different entities. There are a lot of lobbyists that are putting up roadblocks. So yes, I do think that it’s slower to adopt a new technology, but I will say that California is definitely ahead of most other states out there. They’re in the forefront of bringing this new technology into the state, which I think is good. California’s a huge market, it’s 35% of the national work comp market, so even though it does seem slow, it’s certainly much faster than a lot of other states out there, which are finally just getting around to enacting mandatory e-billing.
Claire: So, can you tell us a little about the, about your personal feelings from the HIP-5 form?
Sarah: Sure. So, the HIP-5? It used to be called, and now it’s called the CMS 1500 form, is the form that is required for professional services billing. About a year and a half ago, the DWC did adopt the use of the new version of the form, so everyone should make sure, I think it’s in the bottom right-hand corner, it shows the version, if you’re using the, I’m sorry, it’s actually the O2-12 version. If you’re using the old version, then you should get rid of all those forms, ‘cause it’s not compliant. I often have people send me bill examples, and I take a look at the form, and it’s just the wrong one, it’s the old one. So make sure that you’re using the most up-to-date forms. The billing and payment side, which you can find on the DWC’s website, or feel free to email me for a link, the DWC payment side has a matrix that basically tells you how it has to be filled out. And providers must follow those regulations precisely, or they can risk that their bill is denied. So it’s very different than how you would fill out the form for Medicare or for Gold Cross, so make sure that you’re not filling it out the same way if you are doing group health billing out there. If people are unsure, I’m happy to take a look at it, you can email me or fax me one and I can take a look at it pretty quickly and let you know what corrections need to be made. But one thing that I will say is that probably over 90% of the CMS-1500’s that I receive are not filled out properly, so make sure to either do your own internal audit, or send me one and I can certainly take a look for you.
Claire: Great, what a wonderful service. And how about, why are you interested in workers’ comp, and how did you get into this area of the medical billing in California?
Sarah: I get that question a lot. People always seem a little perplexed of how I’ve come into this industry and I’m focused exclusively on California workers’ compensation. [Sarah and John laugh] So I started my work comp career working in a medical office for a large orthopaedic practice in Southern California, it was a very successful practice, but when I came in and kind of started reviewing the billing, I just had an inkling that a lot of revenue was being left on the table, just for the work comp component of the practice. They definitely the group health billing down, their self-pay collections were great, their Medicare billing was great, but I could just tell that the workers’ comp was a huge portion of their practice, yet just a fraction of their revenue. And so I had almost no knowledge on work comp billing, so I really just set out there to find resources. I went to websites, I went to associations, and there just seems to be almost no information out there. So along with my business partner Catherine Montgomery, we started Clarity and br.com, which was a free website. It was just designed to share what we learned for doing the billing for that practice, specifically for the work comp billing. And we were really all here just to make sure that the injured worker was properly taken care of, and what I found was that they weren’t always getting the care that they needed because a lot of providers just aren’t willing to work for free. And so I think that it was just really important for me to figure out how to bill properly, figure out all of this, all these rules and regulations, and share that with everyone. And then we started DaisyBill, as I mentioned before, when the e-billing regulations went into effect, I found that there was no system that was designed from the ground up to compliantly manage that e-billing process for workers’ comp in California, and that’s really how we started DaisyBill.
Claire: Mhm. And now that you’ve started it, you mentioned earlier a fear of change, do you see, would you say that’s the biggest challenge for getting the wide adoption of this platform going in California, or is there some other challenge as well?
Sarah: No, I think that that is probably the biggest challenge. It’s convincing people that they need to make a change. A lot of people are stubborn, and a lot of people think that they’re doing everything correctly because it’s the way that they’ve been doing it. And I will say that until about six years ago, there weren’t a lot of changes in the work comp industry in terms of the billing component. Pretty much the way it has been for a really long time, and people got pretty good at it. Certainly there were some challenges and it was not always easy to get paid correctly per the fee cycle, but in terms of the life cycle and the submission of the bill, it pretty much was the same until just four or five years ago. Five or six years ago, I guess I should say. So yes, I think that it is difficult convincing people that there’s a better way to do it, and that they can be helped. Some people have just given up. They’ve thrown their hands up, they’ve said they can’t keep up with the fee schedule, and the truth of the matter is, you can’t keep up with the fee schedule unless you have technology on your side. You can’t keep up with all the regulations and all the timeframes and all the dates unless you have technology on your side. So people need to embrace it. Times change, and there is help out there. That’s the key, is that there are tools that will help them become better billers and better collectors.
Claire: Mhm. John, would you agree with that, and would you also speak to the process of switching over to DaisyBill? Was it an easy change?
John: Well, yeah. I think that there’s a couple of things, a common trap, I think, that providers and their offices play into is this penny wise and pound foolish concept where we don’t want to have to pay any more, we’re already doing this process, I have a biller in the back, and now you’re asking me to pay for another service to get this bill done, and I’m already losing money on this aspect of my practice. I also think that it’s important to throw in here that a lot of clinics only do work comp as a portion of their practice, and it tends to be a minority of their work. So they are reluctant to go ahead and put a lot of resources into fixing the billing problem, if they’re even aware of what the billing problems are. So this whole concept, and I think Sarah said it very well, work comp is a detail monster. And you are not going to get paid unless you know all the ins and outs. And so I think that that tends to be the biggest issue. Clinics really miss out on the value proposition because they’re so busy continuing making the same mistakes day after day. They have no time to fix it, and it’s really unfortunate. But as these services become available, and slowly clinics realize the profit opportunity to see these patients so they can stay open and provide ongoing services for their community, it’s going to take a while, but it’s definitely moving that way.
Claire: Great. And Sarah, out of curiosity, how did you pick the name DaisyBill?
Sarah: That’s probably my most frequently-asked question when I’m talking to new clients, because they think it’s so different, and that’s exactly why we did it, it’s different. If you actually look at our logo closely on our website or any of our materials, the petals of the daisy are actually Band-Aids. And that’s what we want to do, we want to fix a broken system. So we want to help everyone, we want to be different, we want to be fresh. And we are different and fresh, and we feel like with a name and a logo like DaisyBill, that we represent that. And also, nobody forgets the name DaisyBill. So that’s the reason we did it, we really want to be different and distinguish ourselves and I hope that our name and our logo do that.
Claire: Definitely. Let’s see. I’m just going to ask one last question here, and that’s, you know, if there’s some question that you should have asked that we haven’t discussed yet?
Sarah: Oh, good question. I do like when people ask that question. I think one thing that’s come up recently is, and I kind of alluded to this before, is people are starting to ask – is work comp really a good book of business? Is it time that I just say “I’m not going to do this particular segment of my treatment any more?” And like I said, I’ve talked to a lot of providers who feel like it’s time to give up on it, maybe expand their private insurance book of business, but the truth, from my perspective, is that providers who aren’t willing to follow the rules and regulations – they may be better off not doing it. I don’t think that that’s the route they should take. With technology, as I stressed before in some of the previous questions, and with a little bit of discipline, work comp can be a really profitable book of business. And I think that the key here is that providers and billers really need to understand the process, and they need to be willing to do what it takes to properly collect what’s due to them. Part of that is just knowing the simple things, like what is due for the fee schedule. I’m really shocked that providers don’t know this. And I don’t necessarily mean they need to have it memorized, I just mean that they should have a resource in their office, where if they’re doing a surgery, they should know precisely what they’re going to get for those services. And when they get paid, they should know if they’re getting paid correctly. They should know things like “Is there an NPN \discount for treating this patient?” They really need to take control of their practice and know those little things so that they can properly assess what product makes sense for them. People need to be invested in the process, and if they are, then they’re going to be very, very successful. So I think that’s the key in really understanding the work comp process and understanding if it’s a good fit for that particular practice.
Claire: Great. Well, John, any last comments from you before we close out here?
John: Yeah, just before we sign off, again, I’ll put in a shameless plug for DaisyBill. Being a client, Sarah, you know, you and your staff are always so accessible, you have practical answers, you get back to the clients. And also, I would really enjoy inviting all the listeners to all the webinars you put on, because they’re an invaluable resource, they have pertinent information, and I just really wanted to thank you for improving the work comp billing system.
Sarah: Well, I want to thank you, for A. the compliment, and B. for being a great client. I will say that most of our clients come from referrals from other clients, and I think that that’s the best form of marketing, is people recommending DaisyBill. And we really take it seriously, I mean it. Anybody that’s listening, even if you’re not going to change over to DaisyBill for your billing, reach out to us. Use us as a resource. We’re a community that really wants to help the community. The truth is that as people get better at this and as people do it correctly, it really benefits everybody. So we want to be that resource. That’s why we put on these free webinars, we try to do them twice a month. And so go to our website, sign up for them, take advantage of the free resources that we offer. So I really appreciate the compliments and for inviting me here today.
Claire: Thanks so much for joining us, yeah. And again, listeners can visit DaisyBill online at www.daisybill.com, is that right, Sarah?
Sarah: That is correct, yeah.
Claire: Or email you at email@example.com?
Claire: Okay. Thanks so much for joining us for today’s episode of the California Work Comp Report. And Sarah, maybe we’ll have you back again another time.
Sarah: I would love to, thank you so much.
Claire: Thank you.
John: Bye now.