Workers’ Comp Unwrapped

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Ep. 305 – Higher Disability Payments: Optimizing Billing for TTD Increases

The California TTD rate is rising 3.8% in 2025—good news for injured workers, but a billing challenge for providers. In this episode, Max and Ayesha explain how the new rates affect medical billing, med-legal evaluations, and claim timelines. Learn best practices to stay accurate, avoid disputes, and keep collections moving.

#WorkersCompUnwrapped #TTD2025 #CaliforniaWorkersComp #MedicalBilling #TTDIncrease #HealthcareProviders #MedLegalTips #BillingAccuracy #WorkersCompPodcast #ProviderInsights #Podcast #NewEpisode #HealthcarePodcast #WorkersComp #MedicalBilling #MedicalCoding #CPTCodes #FeeSchedules #CaliforniaDWC #PhysicianBilling #DrugPricing #ReimbursementStrategy #BillingUpdates2025 #BuzzsproutPodcast #HealthcareFinance #RevenueCycleManagement #InsuranceBilling #DenialPrevention #MedicalPracticeManagement #NowStreaming #ListenNow

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Ep. 304 – New Physician and Pharmaceutical Fee Schedules: What’s Changing in 2025

California’s DWC has released updated physician and pharmaceutical fee schedules for 2025. In this episode, Max and Ayesha unpack the new CPT codes, drug pricing benchmarks, and conversion factors, and explain how accurate coding prevents denials and maximizes reimbursements. Learn what’s changing, common mistakes to avoid, and how to prepare your billing team for a smooth transition.

#Podcast #NewEpisode #HealthcarePodcast #WorkersComp #MedicalBilling #MedicalCoding #CPTCodes #FeeSchedules #CaliforniaDWC #PhysicianBilling #DrugPricing #ReimbursementStrategy #BillingUpdates2025 #BuzzsproutPodcast #HealthcareFinance #RevenueCycleManagement #InsuranceBilling #DenialPrevention #MedicalPracticeManagement #NowStreaming #ListenNow

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#podcast #newepisode #episode #healthcare #hospitals #medical #workerscomp #attorney #doctors #california #usa #billing #workerscompbilling #trump #medicalprovider #LienFiling #SBR #Revenuecycle #DOR #Eamscasesearh #DIR #Credentialing #Collections #Insurancepayments #LienFunding #WCclaims

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Ep. 303 – Impact of the 2025 Pure Premium Rate Increase on Provider Billing
The WCIRB has approved an 11.2% increase to the 2025 pure premium rate—but what does that mean for California medical providers? In this episode, Max and Ayesha break down the ripple effect this has on reimbursement, preauthorization, denials, and provider billing strategy. Learn how to strengthen documentation, reduce revenue loss, and prepare your workflow for a more aggressive payer environment.

🎙️ Includes:

• What the 11.2% rate increase really means
  
  
• The link between premium hikes and payer behavior
  
  
• Practical billing and IBR tips to stay protected in 2025
  
  

Real talk about tech, timelines, and treatment approvals

#WorkersComp #ProviderBilling #MedicalBilling #WCIRB #ReimbursementStrategy #PurePremiumRate #PayerPolicy #CaliforniaHealthcare #HealthcarePodcast #BillingTips #RevenueCycle #ClaimsDenials #MedicalProviders #UtilizationReview #PreAuthorization 

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Ep. 302 – Liberty Mutual’s Excessive Refund Requests: How to Fight Back
Liberty Mutual has been sending refund requests for authorized, properly billed medical services, but do you really have to pay them back? In this episode, Max and Ayesha break down the legality of these demands, explain how to challenge them through California’s Independent Bill Review (IBR) process, and share real cases where providers successfully fought back.

Learn what the law says, how to respond to refund letters, and how to protect your practice from improper recoupments.

🎙️ Highlights:

• Why these refund demands are often invalid
• Step-by-step process to dispute and win through IBR
• Key California labor codes and CCRs to quote

Proactive steps to avoid future refund issues

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#podcast #newepisode #episode #healthcare #hospitals #medical #workerscomp #attorney #doctors #california #usa #billing #workerscompbilling #trump #medicalprovider #LienFiling #SBR #Revenuecycle #DOR #Eamscasesearh #DIR #Credentialing #Collections #Insurancepayments #LienFunding #WCclaims

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Ep. 301 – Navigating PPO Contracts and Silent PPOs: Maximizing Revenue
 In this season opener, Max and Ayesha break down the world of PPO contracts and expose the hidden impact of silent PPOs on your workers’ comp reimbursements. Learn how to identify unauthorized discounts, challenge underpayments, and protect your revenue using the tools and regulations available to California medical providers. Whether you're a doctor, biller, attorney, or employer—this is your playbook for fighting back.
🎙️ Topics Covered:

• What PPO and silent PPO contracts really mean
• How to detect improper repricing
• Step-by-step guide to filing SBR and IBR
• Real cases and how they were wonPractical tools and legal tips for staying ahead

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#podcast #newepisode #episode #healthcare #hospitals #medical #workerscomp #attorney #doctors #california #usa #billing #workerscompbilling #trump #medicalprovider #LienFiling #SBR #Revenuecycle #DOR #Eamscasesearh #DIR #Credentialing #Collections #Insurancepayments #LienFunding #WCclaims

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Subtitle: If You Don’t Update the Claim, You’re Updating Your Write-Off List
In this episode of Workers Comp Unwrapped, Max is joined by Ayesha to break down why timely and accurate claim amendments are essential in California workers’ compensation. From new diagnoses and expanded body parts to treatment plan changes, they cover when and how to file amendments to avoid denials, delays, and lost revenue. Get actionable steps, real-world examples, and insider tips on staying compliant with CCR § 9785 and Labor Code § 4061.
🔍 Learn:

• When claim amendments are legally required
• Best practices for PR-2s, RFAs, and billing updates
• Common mistakes that lead to denied payments
• How MLM supports providers through the amendment process

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#podcast #newepisode #episode #healthcare #hospitals #medical #workerscomp #attorney #doctors #california #usa #billing #workerscompbilling #trump #medicalprovider #LienFiling #SBR #Revenuecycle #DOR #Eamscasesearh #DIR #Credentialing #Collections #Insurancepayments #LienFunding #WCclaims

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In this episode of Workers Comp Unwrapped, Max and Ayesha dive into the frustrating world of post-acute care claim denials, where even the most necessary treatments can be deemed "not medically necessary." They explore common reasons for denials, including lack of prior authorization, coding errors, and medical necessity disputes. Ayesha shares strategies to prevent denials, offering insights into how to submit better claims and fight back when denials occur. From home health care to skilled nursing and physical therapy, providers must navigate these challenges to ensure timely reimbursements and avoid financial losses. Tune in to learn how to streamline your claims process and improve your success rate with post-acute care billing.

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#podcast #newepisode #episode #healthcare #hospitals #medical #workerscomp #attorney #doctors #california #usa #billing #workerscompbilling #trump #medicalprovider #LienFiling #SBR #Revenuecycle #DOR #Eamscasesearh #DIR #Credentialing #Collections #Insurancepayments #LienFunding #WCclaims

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In this must-listen episode, Max and Ayesha dive into the critical documents every provider, employer, and insurer must have to stay compliant—and paid—in California’s workers’ comp system. From first reports to lien filings, discover the exact forms, legal requirements, and common documentation pitfalls that can cost thousands in denied claims and penalties.

Whether you're new to workers' comp or overdue for a documentation overhaul, this episode breaks it down with clarity, compliance tips, and real-world examples.

#WorkersComp #CaliforniaCompliance #HealthcareCompliance #WorkersCompensation #MedicalBilling #DWC #OccupationalHealth #ClaimsManagement #WorkersCompAudit #DocumentationMatters #HealthcareProviders #HRCompliance #WorkplaceSafety

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#podcast #newepisode #episode #healthcare #hospitals #medical #workerscomp #attorney #doctors #california #usa #billing #workerscompbilling #trump #medicalprovider #LienFiling #SBR #Revenuecycle #DOR #Eamscasesearh #DIR #Credentialing #Collections #Insurancepayments #LienFunding #WCclaims

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In this episode of Workers Comp Unwrapped, Max and Ayesha break down the most important—and often missed—deadlines in California workers’ comp. From bill submissions to lien filings and UR appeals, every stage of the claims process has a strict timeline. And missing even one can mean losing your right to payment.
Ayesha shares practical tips to avoid common mistakes, track critical dates, and implement systems that prevent revenue loss. Whether you’re billing, appealing, or filing liens, this episode helps you stay compliant—and get paid.

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#podcast #newepisode #episode #healthcare #hospitals #medical #workerscomp #attorney #doctors #california #usa #billing #workerscompbilling #trump #medicalprovider #LienFiling #SBR #Revenuecycle #DOR #Eamscasesearh #DIR #Credentialing #Collections #Insurancepayments #LienFunding #WCclaims

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In this episode of Workers Comp Unwrapped, Max and guest expert Ayesha dive into the real impact of Maximum Medical Improvement (MMI) on providers. While MMI signals medical stability for injured workers, it opens a new chapter of billing challenges, lien deadlines, and heightened scrutiny for healthcare providers.
Learn what MMI truly means under California law, how it affects treatment approvals, and why failing to act quickly post-MMI can jeopardize your payments. Ayesha shares actionable insights on lien strategy, UR compliance, and how to avoid the most common mistakes providers make after MMI is declared.
If you're a provider navigating the complexities of workers' comp claims, this episode is your roadmap to staying protected—and paid—after MMI.

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#podcast #newepisode #episode #healthcare #hospitals #medical #workerscomp #attorney #doctors #california #usa #billing #workerscompbilling #trump #medicalprovider #LienFiling #SBR #Revenuecycle #DOR #Eamscasesearh #DIR #Credentialing #Collections #Insurancepayments #LienFunding #WCclaims

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