California’s workers’ compensation system is unique in many ways, and our lien process is one of them. In California, providers can file a lien at any time during the life of the claim, even after the case has closed. This reality, in combination with a provider strategy of filing liens at the same time as treatment is rendered (and before a payment can even be made), effectively clogs the system , increases costs and keeps files open longer than necessary.
According to a recent study completed by the California Commission on Health and Safety and Workers’ Compensation (CHSWC), liens are one of the largest cost drivers in California workers’ compensation system. California employers and insurers are spending roughly $200 million per year on loss adjustment expense to handle medical lien claims.
Liens are also bogging down the courts. According to the CHSWC report, liens consume about 35% of the court’s calendar. Over 450,000 liens are expected to be filed in 2011. Since files cannot be settled via Compromise and Release until all liens are adjusted, this situation prolongs the settlement process and keeps files open. The result? Dollars stay on the books, claims remain open, and timely, efficient, cost-effective resolution is compromised.
Why Are Liens Filed?
- One-third of medical liens involve disputes over the application of the Official Medical Fee Schedule (according to CHSWC).
- A claim has been denied but the provider continues to provide treatment on a lien basis, attempting to collect a portion of the charges.
- The provider is not authorized to provide treatment (not in the Medical Provider Network) and bills are disputed as a result.
- Treatment is provided despite utilization review deeming it non-certified.
- The body part receiving treatment is contested.
What Is Being Done About It?
- In 2010 the WCAB held “lien fiestas” in order to attempt to resolve large numbers of liens at once.
- CHSWC made several lien-related recommendations, including:
- Reinstatement of the $100 filing fee on medical liens to discourage frivolous claims.
- Adoption of a more explicit fee schedule.
- Enactment of a statute of limitations of 18 months from the date of service.
How Can Athens Help?
In-House Bill Review:
Athens employs experts in the Official Medical Fee Schedule and has access to all current updates. Because Bill Reviewers are on-site at Athens, the claims staff can collaborate with them in order to effectively resolve liens. Bill Review professionals may also serve as trial witnesses if required.
Medical Provider Network:
Athens MPN, administered by MedEx, affords our clients a strong defense on the issue of providers not authorized to treat. This allows us to object to treatment rendered outside of the provider network and successfully dispute any liens that may result.
Athens has a proven utilization review process in place through our partner, Professional Dynamics, to assess whether treatment is appropriate. A utilization review decision is a robust defense against a lien for treatment not appropriate under the relevant guidelines.
Seasoned, well-trained and incentivized claims professionals:
Athens Senior Claims Examiners receive on-going continuation education, including lien resolution instruction. We also have several programs in place which reward the staff for resolving and closing claims quickly and efficiently.
California Commission on Health and Safety in Workers’ Compensation Lien Report 2011:
Click here to download