ASK A QUESTION

For a DMEPOS underpayment, do you have any SBR language suggestions?

ANSWER: To appeal workers' comp incorrectly paid DMEPOS bills due to the claims administrator failure to pay the allowed 120% of the Medicare CMS rate, we suggest language similar to this:

“Pursuant to Labor Code 5307.1 and CCR Section 9789.60, the workers’ compensation DMEPOS maximum is 120% of the Medicare CMS rate for California.”

For reference, the DWC site states in its FAQ section:

This is an example from an SBR using DaisyBill's SBR Generator:

Remember: For an SBR, the Amount in Dispute should be the difference between the fee schedule amount effective on the date of service and the amount paid. The SBR-1 form does not require the fee schedule amount; instead, it requires the amount in the dispute which should be the expected amount minus the allowed amount.

California Labor Codes

§ 5307.1

California Code of Regulations (CCR)

§ 9789.60 Durable Medical Equipment, Prosthetics, Orthotics, Supplies

Division of Workers’ Compensation Websites

DWC FAQ

DWC Official Medical Fee Schedule

DaisyBill Solution

DaisyBill’s easy billing software guarantees that workers’ comp bills are always submitted compliantly. For more information about California’s workers’ comp electronic billing, book a demo and see how easily DaisyBill solves workers' comp billing problems.

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About Us

DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.

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